Posted by Sir Four at 2:17pm Feb 28 '09This question has come up in discussing how to control the costs of medical insurance. The most expensive treatments are usually the cutting edge stuff that is used to prolong the lives of terminally-ill patients. Given there is only so much money available (under any insurance scheme) to go toward treating the covered population, some hard decisions have to be made to reign in costs associated with end-of-life care.
My feeling is that several factors should come in to play when deciding whether a life-extending treatment will be funded. I'll list the ones I can come up with:
A) Severity of disease. What is the survival rate at the stage of disease the patient is suffering from? Higher rates of survival help legitimize coverage for the most expensive treatments.
B) Age of the patient. How much meaningful lifespan the patient has left (if cured) should be considered. A man age 40 with cancer has much more life to gain if saved by expensive treatments than a man age 80. He may also have dependents relying on him.
C) Health of the patient outside the disease in question. If a patient has been in poor health prior to acquiring the disease in need of treatment, this should be considered. I'm thinking about the difference between a healthy and active 70 year old who develops cancer versus a 70 year old who is bed-ridden due to multiple other health problems who develops the same cancer. The latter probably has little to gain in life expectancy even in the event his cancer is cured. In fact, he is less likely to survive the treatment at all.
D) Quality of life following treatment. A patient with little chance of regaining meaningful quality of life following the expensive treatment might be a poor candidate for the treatment.
Based on these factors, a sort of formula could be developed to help decide on funding for treatment. If you pass any one of the above, it should be almost a given that you will be treated. That is, you're diagnosed with a very serious disease, but you are young or in good health otherwise. You get covered. You are old and perhaps not in great health, but the severity of your newly-diagnosed disease is is minimal to moderate. You get covered.
It would only be when multiple factors come into play that funding is questioned. Most of the time this will involve elderly patients suffering terminal illness. In these cases, we must focus on palliative care, that is, making things as comfortable as possible in their remaining days.
Nailing down the specifics of who qualifies for coverage and who doesn't will not be easy. I can imagine some sort of scoring system on the diseases themselves that relates to odds of survival. As for age considerations, it could focus on how far off from the average lifespan a patient is. A patient 40 years shy of the average lifespan would be given more consideration for treatment than a patient 2 years shy of it. Note, that's not to say the latter patient would be denied treatment as a rule (he or she may still be a good candidate for it based on other criteria).
And despite all of the above, it should always remain that individuals/families could opt to offer private funds to cover treatments that our insurance scheme won't cover.
My feeling is that several factors should come in to play when deciding whether a life-extending treatment will be funded. I'll list the ones I can come up with:
A) Severity of disease. What is the survival rate at the stage of disease the patient is suffering from? Higher rates of survival help legitimize coverage for the most expensive treatments.
B) Age of the patient. How much meaningful lifespan the patient has left (if cured) should be considered. A man age 40 with cancer has much more life to gain if saved by expensive treatments than a man age 80. He may also have dependents relying on him.
C) Health of the patient outside the disease in question. If a patient has been in poor health prior to acquiring the disease in need of treatment, this should be considered. I'm thinking about the difference between a healthy and active 70 year old who develops cancer versus a 70 year old who is bed-ridden due to multiple other health problems who develops the same cancer. The latter probably has little to gain in life expectancy even in the event his cancer is cured. In fact, he is less likely to survive the treatment at all.
D) Quality of life following treatment. A patient with little chance of regaining meaningful quality of life following the expensive treatment might be a poor candidate for the treatment.
Based on these factors, a sort of formula could be developed to help decide on funding for treatment. If you pass any one of the above, it should be almost a given that you will be treated. That is, you're diagnosed with a very serious disease, but you are young or in good health otherwise. You get covered. You are old and perhaps not in great health, but the severity of your newly-diagnosed disease is is minimal to moderate. You get covered.
It would only be when multiple factors come into play that funding is questioned. Most of the time this will involve elderly patients suffering terminal illness. In these cases, we must focus on palliative care, that is, making things as comfortable as possible in their remaining days.
Nailing down the specifics of who qualifies for coverage and who doesn't will not be easy. I can imagine some sort of scoring system on the diseases themselves that relates to odds of survival. As for age considerations, it could focus on how far off from the average lifespan a patient is. A patient 40 years shy of the average lifespan would be given more consideration for treatment than a patient 2 years shy of it. Note, that's not to say the latter patient would be denied treatment as a rule (he or she may still be a good candidate for it based on other criteria).
And despite all of the above, it should always remain that individuals/families could opt to offer private funds to cover treatments that our insurance scheme won't cover.
When should a patient's treatment lose funding? - Sir Four