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Advance Directives Can Reduce End-of-Life Medical Costs, Authors Say

Documents are free and legally binding, but seldom used (May 8)

A new article published online in the American Journal of Public Health makes a case that end-of-life care issues need to become an integral part of the public health agenda. Dan Morhaim, MD, and Keshia Pollack, PhD, of the Johns Hopkins Bloomberg School of Public Health, point out that the low rate of completion of advance directives in the minority population can be identified as another health care disparity.

Advance directive documents are free, legally binding, and readily available, and yet too few Americans have completed one, the authors say. Although end-of-life discussions can be difficult, Morhaim and Pollack recommend that advance-directive conversations become routine between doctors, nurses, and other key health providers and their patients, and that they be viewed as another aspect of preventive care.

End-of-life care consumes an estimated 30% of Medicare expenditures, and the effect on Medicaid and commercial insurance costs is substantial as well, according to the authors. Increasing the rate of completion of advance directives could conceivably lower these expenses and would do so by respecting patients’ values and wishes, they say.

Typically, advance directives address several areas regarding end-of-life care when a person becomes unable to make medical decisions for himself or herself, including defining the type and amount of care he or she might receive under various medical circumstances, designating a health care agent to make medical decisions when the individual is no longer able to do so, and other end-of-life care issues, including organ donation as well as funeral and burial plans.

“Increasing the rate of completion of advance directives in the United States, empowering individuals and families to determine their care decisions at a critical time, and reducing unwanted end-of-life care expenses needs to become part of the public health agenda,” Pollack said. “Our research shows the public wants to have control of their life, even at the end, and are looking to their physicians or other health professionals to lead the way and initiate these discussions.”

Source: Bloomberg School of Public Health

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