The Committee on Approaching Death says the United States should come up with better tools for measuring the cost and quality of care people get while they are dying.
Medicare, Medicaid and other government programs should post end-of-life care cost and care quality statistics, and the government should encourage private insurers and the big health care providers to do the same, the committee says.
The committee is calling for the nation to use financial incentives to decrease the amount of emergency room care and acute medical care dying people use; improve coordination of care for the dying; and increase use of advance planning, to reduce the amount of unnecessary or unwanted care dying patients get.
The Institute of Medicine is an independent, nonprofit, government-chartered group of experts that gives the country advice about health-related issues.
Many members of the Committee on Approaching Death work at hospitals, medical schools or universities. Members with significant insurance industry experience include Patricia Bomba, medical director for geriatrics at Excellus BlueCross BlueShield, and Leonard Schaeffer, a former chairman of WellPoint.
In a section on the cost of end-of-life care, committee members note that increases seem to have more to do with the factors driving up all types of U.S. health care costs, not with a disproportionate level of growth in spending on people who are dying. People in the last year of life account for about 25 percent of Medicare expenditures, and that figure is about the same as it was in the 1970s, committee members say.
One good way to control the cost of end-of-life medical care may be to improve community-based long-term care (LTC) services and caregiver support services, to reduce the pressure on families to send dying people to the hospital, committee members say.
In a section on long-term care insurance (LTCI), the committee members note that only 10 percent of older Americans have private LTCI, and that only about one-third of older Americans have enough assets to pay for one year of nursing home care.
“The need for new and public private long-term care insurance options that would stabilize the financial future of Americans — a neglected corollary to addressing long-term care services and their financing — is beyond the scope of this report,” the committee members say.
Elsewhere, the committee members say the government faces pressure to shift nursing home funding to home care services and adult daycare programs. The government says the groups supporting that shift should think about what happened when the country tried to shift funding for mental hospitals to community-based mental health programs.
“The mental hospitals were closed or greatly reduced in size, and responsibility for former residents’ continuing service needs was shifted to community service providers that were neither adequately prepared nor funded to assume this responsibility,” the committee members say.