Dying Well

Our report Dying Well argued that Australians don’t die the way they would like to. Most people would prefer to die at home with the support of family and friends and good quality support services. Most die in hospital or nursing homes. Often death is an isolating, depersonalised experience, in clinical settings visited by distraught and alienated family and friends. In many cases treatment continues when it is pointless. Not surprisingly, there is now strong support for people having the right to determine the circumstances of their own death, including active assistance when they choose it.

We place an unrealistic faith in health care to keep us alive – if only for a little longer. We don’t discuss, plan or prepare for death any more. Our report argued we should promote public discussion of dying; prompt conversations about our preferences for treatment and support when death is immanent, support advance care plans to make sure our preferences are implemented, and significantly increase support for people to die at home when that is their preference. These changes would be cost neutral.

Policy change and implementation to improve the quality of death in Australia is a challenge. Our report generated significant media and stakeholder attention. We presented at a number of forums, appeared before Federal and State parliamentary committees, participated in policy forums and workshops and briefed Federal and State Ministers and Shadow Ministers. Incremental changes have emerged, particularly in support for the implementation of advance care plans and greater support for home based palliative care. There is enormous interest but many issues, including the right to die when we choose to, remain unresolved.

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Trends in health policy

Health Affairs lists five key trends in health for 2015 for the United States: (1) getting data to transfer easily across providers, (2) tougher negotiations on high cost speciality drugs, (3) innovation to reduce costs and improve services for people with complex chronic conditions, (4) greater transparency on costs and performance through publication of data, and (5) a move away from fee for individual services and toward bundling services for complete episodes of care.

National trends are harder to spot in Australia, but the following are contenders: (1) shifting hospital costs to the States to force negotiation on revenue sharing options, (2) innovation in funding and organisation to reduce avoidable hospital admissions through the introduction of Primary Health Networks and reforms to Medicare funding, (3) efficiency and quality improvements in private hospitals through private health insurance funding reforms, and (4) changes to price negotiation processes to reduce the cost of the pharmaceutical benefits scheme.