Palliative care can cut costs and improve quality of life

The World Health Organization recently announced that chronic diseases — including heart problems, stroke, cancer, persistent respiratory conditions and diabetes — have now become the world’s leading cause of mortality, representing 63 percent of all deaths. Fully a quarter of these people are less than 60 years old, and 90 percent of early deaths are in the low- to middle-income population.

This represents a marked departure from previous data in which infectious diseases were most devastating. Unlike infectious diseases, however, chronic illnesses start early, progress slowly and last a long time. This translates not only into a substantial loss of productivity, but also the need for a staggering amount of health care resources. Most gripping is the fact that the lion’s share of human suffering can be prevented by a healthy lifestyle. Yet, for too many, the damage has been done.

WHO magnifies the importance of palliative care, an emerging field of medicine that emphasizes quality of life and freedom from suffering for those with chronic diseases.

In last week’s column I cited a recent study from the New England Journal of Medicine that found that a group of lung cancer patients receiving palliative care had a significant improvement in quality of life and mood. It also found that these patients had “less aggressive care at the end of life but longer survival” when compared with those receiving conventional treatment alone. Less aggressive care means lower costs. Because palliative care provides both quality and cost benefits, this field should become a cornerstone of American health care.

Hospice is another essential service which, as distinct from palliative care, focuses on management of pain, anxiety and other suffering at the end of life. Similar to palliative care, attention is given to not just physical, but also emotional, social and spiritual needs of the dying patient.

There is actually a covered hospice benefit under Medicare Part A. Hospice care is also covered by most private insurers. However, hospice is a system with reimbursement on a per diem basis to cover all care. As such, people must choose between acute care treatments and hospice. University Health Alliance is a notable exception in Hawaii that allows hospice and concurrent conventional treatment.

Palliative care services are treated differently by most insurers. Palliative care is often offered in collaboration with conventional treatment.

To qualify for hospice, a dying patient must be certified to have six months or less to live. The tragedy is that 35 percent of patients die within a week of admission. As such, this valuable service is underutilized.

St. Francis Healthcare System of Hawaii is a skillful and compassionate leader in palliative and hospice care. I had the opportunity to interview Dr. Anna Loengard, chief medical officer of St. Francis Healthcare System, a palliative care specialist, and Dr. Wen-yu Lee, the hospice medical director, who are at the forefront of this important work.

Palliative care and hospice have been shown to reduce costs and enhance the quality of life for the chronically ill and those who are about to die.

We are most fortunate to have these services available in Hawaii. As the two hospitals sold by St. Francis emerge from bankruptcy for the second time in short order, our community would be well served to see a further expansion of palliative care and hospice.