08 August 2013

Health Care Rationing, Why Should the Elderly Support It?

This is a catch 22 situation if I ever heard of one. Dr. James Sabin, writing blogs for “Over 65” makes some excellent points. I think he admits if what he is proposing is done wrong, it will not be a good thing. In reading and rereading his blog here, I am inclined to agree with many of his ideas. Yet in the back of my brain, I keep going back to a discussion I had with a now deceased doctor who said there is too much rationing for the sake of rationing. He said he hated to give up on a patient unless the patient asked him to. As a doctor of oncology, he would not give up easily. He was not afraid of trying different treatments and did discover a lot of drug combinations that were successful for cancer. He never sought credit for his work and all he cared for was the well-being of his patients.

A point that Dr. Sabin makes, but does not emphasize hard enough (although this is done in the introduction for the over 65 project), is all the money wasted on cures for the diseases of the elderly when some of this could better be used to care for the elderly. Not only care for the elderly, but also to develop preventive medicine which could alleviate the pain and suffering many of the elderly experience.

Dr. Sabin does make four excellent points which need consideration. While I have some reservations, I would urge everyone to read his blog. His first point as to why we should support health care rationing is improved health. While moving money to infrastructure investments such as housing, social services, and transportation could help many people, I am afraid that putting more people into care facilities too early is not an answer. Yet, I see this all around me and many people do not last long when confined in care facilities.

First, social services is not made part of this care, more often excluded if possible, and transportation is often limited for lack of funds and normally this is reserved for trips to the doctor or the hospital. I do not know what assisted living facilities are like in other parts of the country, but here they seem more like confining facilities that restrict the residents like cattle and only allow them freedom within the facility.

Then we can discuss retirement homes which are purchased and the residents can come and go just like it was their residence, medical facilities exist on the site of up to 25 plus retirement homes and is available to the residents during certain hours and available to others of elderly public for certain hours. Medical personnel are on call to the retirement home residents 24/7 and they may be transferred to hospitals when needed.

The second point in the blog is improved access. This means doing this for the poor elderly populations. This would include access to primary care and geriatric care. If a patient is hospitalized, then these two cares would ensure proper care and/or oversee care when discharged to ensure there is minimal readmission to the hospital. This will prevent the hospitals from gaming the system to apply more and more tests not needed on the elderly.

The third point is improved medical care. This is a powerful point as it could prevent health care rationing. By preventing hospital after hospital readmission, much of the wasteful interventions would not happen and therefore costs could be contained rather than continue to rise. When it comes to the elderly, often less treatment is better and less harm is inflicted on the elderly because of the over treatment which hospitals and many physicians are wont to do.

The fourth and last point Dr. Sabin presents is the need for improved intergenerational equity. This is probably the weakest of the points. I say this because until the over treatment waste is removed from the equation, care is taken to not always use the latest and most costly treatments, the coming expansion of the over 65 population will continue to put a severe drain on the resources for elderly care; and rationing will become a necessity whether we like it or not.

To make Dr. Sabin's points workable, those of us over 65 now need to help point the way and work to see that rationing does not become a reality. I am often accused of being too harsh in my expression of hospital greed, but this is a large part of what will drive rationing for those needing more care at times. What I am unable to justify is the millions of dollars taken out of hospitals by hospital administrators and some administrator staffs for their salaries and bonuses. This is a large part of the drivers behind all the tests conducted by hospitals that are not necessary and considered wasteful and harmful for elderly patients.

To keep salaries and bonuses increasing, staff reductions are common among the nurses and overtime is forbidden among the overworked staff. Unnecessary tests are ordered and hospitalists are directed to see that tests are done. Several investigations around the country are being done in hospital emergency departments where doctors have been ordered to find ways to admit patients to the hospital so that more tests could be done, which in turn could stretch the hospital stay of the patients.

This blog is applicable to what hospitals are doing to cause readmissions. This is a large area for concern if we are to prevent health care rationing.

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