Why do we spend twice as much on futility than prevention?

North America spends at least 20% of its global healthcare budget on patients that are in their last month of life, yet less than 5% is spent on disease prevention. Much of this late-stage treatment represents clearly futile interventions and micromanagement that is usually not within the best interests of the patient, nor significantly life-prolonging or enhancing of comfort/dignity/QOL. The only benefactors of such futility are those who perform such interventions. Clearly, there are flagrant vested interests that drive such activity. Moreover, it is easier to deliver “false hope” to patients rather than having a fulsome conversation in which the natural history of disease(s) and associated prognosis is outlined. Ironically, most patients with incurable illnesses and limited life expectancy, if involved in the decision making process, would actually elect to forego late-stage/futile AAMM in favour of CPM. Therefore, the simple process of promoting PCC/PE through asking the patient “what they want” could reduce spending on futility, and the savings achieved could be reinvested into disease prevention programs.


About drvincentmaida

Consultant in Palliative Medicine & Wound Management, Assistant Professor, University of Toronto & McMaster University, Researcher & Author.
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