Death can be a frightening prospect. Will I die hooked up to machines or unfettered and at peace?
It can also be expensive, a reality we should ponder since the number of Ontarians over 65 is expected to more than double within the next 25 years.
For both these reasons, it’s urgent that provincial governments invest right now in more palliative care.
Our latest research shows that if more people died in palliative care instead of in acute care or the intensive care unit, Ontario could save as much as $2.1 billion between now and 2036. Patients would also receive better end-of-life care.
How so? The Canadian Institute for Health Information notes that per capita healthcare costs are by far most expensive for people aged 80 and over. Within 15 years the oldest Baby Boomers will be reaching their 80s.
Where those Boomers die will make a big difference in costs. Even within hospitals, costs differ depending on the type of care. In 2010/11, the cost of a patient dying in the intensive care unit was $8,149 more than the cost of those dying in palliative care. Acute care cost $10,000 more than palliative care.
Yet, between 2003 and 2011, over four times as many patients died in intensive care than in palliative care. Over ten times as many patients died in acute care.
How much could we save if we expanded palliative care?
If we estimate that about 36 percent of patients in Ontario could be transferred to palliative care, Ontario would save $355 million from 2003 to 2011 by ensuring palliative care spaces are available for people near immanent death.
Things get even more dramatic when we look into the future. Using Ontario Ministry of Finance projections, we calculated that annual savings from more deaths in palliative care would be $107 million in 2036 alone. Cumulative savings between 2012 and 2036 would be as high as $2.1 billion.
Palliative care is a better way to die, and it’s much cheaper than hospital care. This is because palliative care focuses on alleviating a person’s pain rather than fighting to keep them alive at all costs.
Palliative care teams discuss a care plan with a patient and their family, allowing them to choose whether or not they desire heroic interventions, endless tests and/or being kept alive artificially. For the patient who wants to avoid these things, the result is better end-of-life care. For the health care system, the result is lower expenses.
It should be noted that palliative care doctors have highly specialized expertise in pain management. The palliative care team focuses not on keeping patients alive as long as possible, but on making patients as comfortable as possible – emotionally, physically and spiritually.
Allowing peaceful surroundings with family also enriches care beyond what is possible for those who lay dying in acute or ICU wards.
There are, then, at least two reasons to expand palliative care in Ontario and in all provinces. First and foremost, it’s better care at the end of life. Secondly, palliative care is less expense than the alternatives which are our current default.
Provincial governments are always looking for ways to save money. Considering the exorbitant health care costs of those aged 80-plus, and looking at the aging of our population, the looming strain on our health care system is obvious.
For both the care of dying Canadians and care of the public purse, the sooner we invest in this, the better.