Careful assessment of patient needs can reduce costs in end-of-life care

Decision-makers can manage high expenditures as deaths increase and improve patient experience if they understand what drives end-of-life costs and if services find a better balance between treating disease and managing symptoms, according to a new policy brief in which Trinity researchers made significant contributions.

The brief, ‘Health and social care near the end of life: Can policies reduce costs and improve outcomes?’, published by the European Observatory on Health Systems and Policies, suggests that a skilled assessment of patients’ needs as well as support for them and their families can improve experiences and may reduce costs of care.

“While such assessments are expensive to carry out, the associated savings can be substantial,” says Charles Normand, Professor Emeritus at Trinity College Dublin and one of the lead authors of the brief.

“The challenge is to find better ways to identify those at risk of receiving expensive care that is unlikely to help them to live longer or have a better quality of life.”

Assisting patients and their families with difficult decisions is challenging. Choosing palliative care over standard treatment does not mean giving up on seeking a cure but rather on living as well as possible, and even living longer. Evidence shows this is often in line with what patients prefer.

Health and social care costs at end-of-life in Europe

Costs of care for people near the end of life vary widely. A small number of very frail patients with multiple chronic conditions and dementia uses the bulk of costs. In Ireland, for example, about two-thirds of the spend on health and social care at the end of life was on 10% of decedents, while the lowest-cost 50% accounted for only 7% of spending.

Hospital care is the largest component of end-of-life care expenditures, but not all of it is necessary or appropriate. Many admissions can be prevented, while some hospital care is inappropriate for people with complex needs and multiple chronic diseases.

 

“As the ‘baby boomer’ generation ages, the number of deaths per year will increase in most of Europe,”explains co-author Jon Cylus, Coordinator of the Observatory’s London Hub.

“Managing care at the end of life better is critical, if health and social care systems are to achieve financial sustainability and enable people to die with dignity.”

The policy brief is part of the economics of healthy and active ageing series by the Observatory, which challenges the often-negative perception of the economic consequences of population ageing.

The series shows that a growing older population is not necessarily very costly to care for, and that older people provide significant economic and societal benefits.