Universal healthcare / "forced" palliative care
January 26, 2014 3:19 PM Subscribe
I was talking about universal healthcare with someone who said that in a certain country the government provides only palliative care after a certain age (he thought it was 76). I was pretty certain this was definitely not the case but a google search of "which country provides only palliative care after 76" did not provide a definitive answer. Me-fites, is this a thing, anywhere in the world? I assumed it was something in the death panels vein (i.e. false).
In New Zealand, most operations covered for free by the state have waiting lists. Your position on the waiting list is determined by many things. Age does factor into it. I had an aunt who was 80-something with gradual heart failure. An operation would have helped. She was at the stage where she could barely walk without it causing problems. But she was so far down the waiting list that basically it was never going to happen, and she never moved up it because more urgent cases jumped the queue. After 10 years on the waiting list, she died.
Nowadays there is a rule that people can't spend more than (I think) two years on the waiting list, but because there is actually more people than that waiting, you get bumped off it in certain circumstances and have to start the process from scratch (thus meaning your two year clock resets). Also they won't put you on the waiting list until they think they will be able to get to you within two years. I'm not sure how age factors into it now. My aunt's situation was in the 1980s.
posted by lollusc at 3:53 PM on January 26, 2014
Nowadays there is a rule that people can't spend more than (I think) two years on the waiting list, but because there is actually more people than that waiting, you get bumped off it in certain circumstances and have to start the process from scratch (thus meaning your two year clock resets). Also they won't put you on the waiting list until they think they will be able to get to you within two years. I'm not sure how age factors into it now. My aunt's situation was in the 1980s.
posted by lollusc at 3:53 PM on January 26, 2014
Oh, and my grandfather on my other side had prostate cancer a few years ago, and the state would not cover treatment for it because it's likelihood of killing him before he died of old age (he was already 87) was very low.
I think this makes sense. There is a limited amount of funding to go around and you want to spend it where it will do the most good.
posted by lollusc at 3:55 PM on January 26, 2014 [2 favorites]
I think this makes sense. There is a limited amount of funding to go around and you want to spend it where it will do the most good.
posted by lollusc at 3:55 PM on January 26, 2014 [2 favorites]
Okay, one more comment and then I'll stop. The reason why this is different from the "death panels" idea is that for all these people treatment was still available. It was just not state-funded. You could pay a private hospital for your treatment and the cost, while high, is still nowhere near the impossible amounts it costs in the USA. My mother recently had a knee operation privately because she got sick of waiting lists, and it cost her about $7000 total, including hospital stay and all surgeon costs. Heart operations and cancer treatments are, of course, much worse, but people do pay for them privately, and choosing to do that once or twice in a lifetime probably still works out cheaper or similarly to the total cost of private health insurance that you would pay over your lifetime if there was no universal healthcare.
posted by lollusc at 3:59 PM on January 26, 2014 [8 favorites]
posted by lollusc at 3:59 PM on January 26, 2014 [8 favorites]
What he said was false. There is no country where it becomes illegal to purchase medical care over a specific age.
Some insurance programs (socialized or otherwise) provide more end-of-life care than others, but claims of forced palliative care are false. And it's worth remembering that many socialized care programs also have a privatized layer sitting on top, for those who want more than the socially agreed-upon de minimis care.
posted by grudgebgon at 4:06 PM on January 26, 2014 [4 favorites]
Some insurance programs (socialized or otherwise) provide more end-of-life care than others, but claims of forced palliative care are false. And it's worth remembering that many socialized care programs also have a privatized layer sitting on top, for those who want more than the socially agreed-upon de minimis care.
posted by grudgebgon at 4:06 PM on January 26, 2014 [4 favorites]
This does happen in the US as well. Doctors determine all the time that age and other health conditions make a patient unsuitable for surgury, transplants , chemotherapy etc. Now if you have a huge amount of money eventually somebody will do it but good doctors will strongly encourage patients not to go through with it.
posted by AlexiaSky at 4:07 PM on January 26, 2014 [2 favorites]
posted by AlexiaSky at 4:07 PM on January 26, 2014 [2 favorites]
What he said was false. There is no country where it becomes illegal to purchase medical care over a specific age.
According to the OP that's not what he said; he said that the government didn't provide the care, not that it was illegal to purchase it. Those are completely different statements.
posted by Justinian at 4:08 PM on January 26, 2014 [4 favorites]
According to the OP that's not what he said; he said that the government didn't provide the care, not that it was illegal to purchase it. Those are completely different statements.
posted by Justinian at 4:08 PM on January 26, 2014 [4 favorites]
An Australian here with a mother fast approaching the 76 year old mark and they are talking about doing a heart valve transplant or 2 on her in the few years as her current ones are slowly degrading. There has never been any mention of her being too old so it's defiantly not a sweeping across the board you are too old no treatment for you thing if exists in Australia. Sorry I couldn't give you a definite answer but it might help you eliminate one more country from your list.
posted by wwax at 4:08 PM on January 26, 2014 [1 favorite]
posted by wwax at 4:08 PM on January 26, 2014 [1 favorite]
I would write to Sarah Kliff of Wonkblog/Washington Post and/or Kaiser Health News and ask.
I tend to tihink that national systems are far more complex in the way modulation of healthcare delivery occurs than to rely on such a single arbitrary factor as age.
Here's an article (by Kliff) which gives some view of the levers involved in Holland. This whole topic is probably best considered in the absence of USA though; there are only minimal real cost controlling elements baked into the PPACA. Most other western countries have greater control over pricing of health-related goods and services and insurance rates, so the effective control is unlikely to be a specific age, per se; rather, it's more probable that a GP and other healthcare players will have incentives to put patients on certain paths of care according to best outcome/cost, as saeculorum mentions above.
posted by peacay at 4:17 PM on January 26, 2014 [1 favorite]
I tend to tihink that national systems are far more complex in the way modulation of healthcare delivery occurs than to rely on such a single arbitrary factor as age.
Here's an article (by Kliff) which gives some view of the levers involved in Holland. This whole topic is probably best considered in the absence of USA though; there are only minimal real cost controlling elements baked into the PPACA. Most other western countries have greater control over pricing of health-related goods and services and insurance rates, so the effective control is unlikely to be a specific age, per se; rather, it's more probable that a GP and other healthcare players will have incentives to put patients on certain paths of care according to best outcome/cost, as saeculorum mentions above.
posted by peacay at 4:17 PM on January 26, 2014 [1 favorite]
@Justinian: correct. I mistook his google search for the original claim.
posted by grudgebgon at 4:23 PM on January 26, 2014
posted by grudgebgon at 4:23 PM on January 26, 2014
QALY isn't hard and fast in the UK. My grandfather had prostate work done at nearly 90 on the NHS.
(the fact that the operation massively decreased his quality of life — he contracted MRSA in the operating theatre and survived it, tough old bird that he was — is neither here nor there.)
posted by scruss at 4:52 PM on January 26, 2014 [1 favorite]
(the fact that the operation massively decreased his quality of life — he contracted MRSA in the operating theatre and survived it, tough old bird that he was — is neither here nor there.)
posted by scruss at 4:52 PM on January 26, 2014 [1 favorite]
With regard to Canada, my 89 yr old grandmother had a double hip replacement that significantly improved her quality of life for her last couple of years. A previous hip replacement had crumbled into the bone and required a major fix. It was dangerous and she could have died, but she was quite clear that she preferred to risk death rather than live in pain. Nobody told her she couldn't have it and that she'd just have to manage with pain meds because it was too risky or too expensive. I don't think she waited long for the operation, either, but we're going back well over 10 years now.
My other grandmother is now 90 and she is in excellent health, but has just had a minor heart problem detected. She has had a cardiologist assigned, there is talk of regular monitoring and eventually a pacemaker. I don't associate these with 'palliative'. I believe a friend of hers had a triple bypass fairly recently and he's well into his 90s.
Obviously this is anecdotal, but my experience in Canada has been that people well over the age of 76 have the same access to health care as the rest of us. Their providers might recommend palliative care, if treatment is going to be too stressful or dangerous (based on their age or health), but my understanding is that it is not denied on the basis of age alone.
posted by thatminx at 1:56 AM on January 27, 2014 [1 favorite]
My other grandmother is now 90 and she is in excellent health, but has just had a minor heart problem detected. She has had a cardiologist assigned, there is talk of regular monitoring and eventually a pacemaker. I don't associate these with 'palliative'. I believe a friend of hers had a triple bypass fairly recently and he's well into his 90s.
Obviously this is anecdotal, but my experience in Canada has been that people well over the age of 76 have the same access to health care as the rest of us. Their providers might recommend palliative care, if treatment is going to be too stressful or dangerous (based on their age or health), but my understanding is that it is not denied on the basis of age alone.
posted by thatminx at 1:56 AM on January 27, 2014 [1 favorite]
Just to support the QALY justification, the calculation is used to support the initial approval of a drug/treatment to the NHS on cost-benefit grounds, its not used on a case by case basis (i.e. its not used as a 'we'd give you this heart transplant but you won't gain enough QALYs back to make it justified because you're 77' type thing.)
I'm a health economist and have studied the various worldwide health systems. I've never heard of this or anything like it. I'm pretty sure its completely false.
posted by litereally at 5:18 AM on January 27, 2014 [8 favorites]
I'm a health economist and have studied the various worldwide health systems. I've never heard of this or anything like it. I'm pretty sure its completely false.
posted by litereally at 5:18 AM on January 27, 2014 [8 favorites]
Obamacare has palliative care written into it. You get a special medicare benefit for it. My mom passed away and we used this benefit.
posted by Ironmouth at 9:29 PM on October 16, 2014
posted by Ironmouth at 9:29 PM on October 16, 2014
This thread is closed to new comments.
Although I am by no means an expert, at least the UK will deny certain medical treatments due the (cost per) "Quality Adjusted Life Year" metric that generally drives funding of medical treatment in the UK. Older people tend to have more expensive health care needs, and those needs tend not to significantly alter their lifespan, so those treatments do not do well on a cost per QALY metric. This definitely doesn't result in forced palliative care, but it does have the effect that the treatments available to people tends to decrease as a function of age.
posted by saeculorum at 3:52 PM on January 26, 2014 [1 favorite]