So if people have to take responsibility, they need more information. And theyre not having it. Were having politicians and economists financial-speak, and it doesnt do the man in the street any good whatsoever. Bill: I totally agree, but the one-to-one relationship in terms of healthcare costs for a single individual is not evident in the US either. As you were talking, Phil, I was envisioning that you go into the hospital and literally, when you walk in to get an MRI theres a big price tag, X number of dollars for this procedure, posted over the door. The trend in US healthcare is to create the exact opposite. Because of another part of healthcare reform, were trying to make hospitals as hospitable as possible. Part of the reimbursement equation for hospitals moving forward has everything to do with patient satisfaction. So when you walk in the door, you need to go, Wow, I feel good about this place, its clean, its beautiful, everyones so nice, Im confident that Im going to get good healthcare. I give you high rankings and that helps you with your reimbursement. I feel that if you treated them like a commodity and posted costs on everything, theyd say That was such an insensitive experience; Im going to mark these guys low. And then economically the hospital just hurt itself. University College Hospital Macmillan Cancer Centre, London. Image Anthony Weller / Archimage Katie, what have you noticed about Canada and how it relates to other countries since youve been there? Katie: As with other countries, I think that theres also a need to establish a stronger link between peoples use of healthcare and their understanding of the cost of it in Canada. And then when it comes to the buildings, there could be more study into the cost of the infrastructure and how it relates to the costs of delivering healthcare over the longer term ; whole-of-life value for money.
Palliative specialists support UK care pathway
A similarly high number of doctors indicated that they would want the pathway themselves if they were terminally ill, show the results. “The Liverpool care pathway is the most widely used integrated care pathway for end of life care, but it has recently been criticised after accounts in the media of patients having food and fluids withdrawn and hospitals being offered financial incentives for using the pathway,” writes Krishna Chinthapalli (British Medical Journal [BMJ], London, UK) in the BMJ. The journal emailed 3021 hospital doctors to gauge their views of the care pathway, which engages a multidisciplinary team to assess whether a patient is indeed dying, and to consider and agree on palliative care options, including whether nonessential treatments and medications should be discontinued. Of the 647 respondents, 185 were palliative medicine consultants, 168 were doctors in training or career grade posts in palliative medicine, and 210 were doctors of other specialties. A total of 87% reported having used the LCP in clinical practice. However, 57% of respondents felt that recent negative press in the UK media has led to the care pathway being used less. Almost three-quarters (74%) of palliative medicine specialists felt this way. Indeed, 60% of doctors who believed there was less use of the pathway as a result of a negative perception in the UK media said that relatives of dying patients had asked them not to use it, and that 80% of staff were apprehensive about it. One palliative medicine specialist said: “Negative press regarding the LCP has caused additional distress for relatives at an already distressing time when their loved one is dying. This has caused a dilemma in judging if discussing the LCP will cause more distress than the benefit of being on the LCP.” Notably, 90% of doctors said that they would want the pathway themselves during a terminal illness, although the questionnaire did not make it clear whether that meant dying from a terminal illness.