Stopping life-sustaining treatments for end-of-life patients one month before their death could reduce medical costs by nearly half, compared to continuing them until the end, according to a study released Tuesday by a state-run health insurance agency.
According to the report from the Health Insurance Research Institute, a think thank under the state-run National Health Insurance Service, patients who decided to forgo life-prolonging treatment on average spent 4.6 million won ($3,310) in their final month, while those who continued treatment racked up bills of 9.1 million won.
The first group spent on average 500,000 won in the final month for medical procedures directly related to immediate survival, such as for a medical ventilator or CPR. The second group spent 1.89 million won for the same purpose during the month.
The study was based on 44,425 terminal patients who stopped life-sustaining treatment shortly before death and 4,4425 who did not in 2023.
It was also found that patients who decided not to receive life-sustaining treatment just days before their death ended up spending more money.
The average medical bill for the final month was 18 million won for the group that reached the decision between eight and 30 days before death. Researchers noted that this is possibly because these particular patients tend to receive highly priced medical care extensively in that period while deciding whether to discontinue the treatment.
"This is proof that timely discussion on stopping treatment is crucial," researchers said in the study.
Discussions over 'dying with dignity'
"It was found that establishing a long-term plan ahead (for the life-sustaining treatment), rather than to reach a decision just before death, reduced the medical costs before death. ... There needs to be a policy to ensure that the patient has sufficient time to mull over and reach a decision, and a social discussion and system change for it," the study said.
The research also found that the system of allowing terminal patients to refuse life-sustaining treatments has led to what could be seen as positive outcome on the patients' well-being, such as more of them choosing to be in hospice care rather than to spend the last days of their lives in the intensive care units.
The research was conducted amid an ongoing social discussion on possibly expanding the scope of patients subject to stopping life-sustaining treatments. The current system says it is permitted only for patients in the "end-of-life process," which means a state of imminent death with no possibility of revitalization or recovery.
There are talks to apply the law for all patients in the final stages of a disease, which includes the terminal stage as well as the period leading up to one's likely death.
As of Aug. 9, there are about 3 million people countrywide who have signed forms to refuse life-sustaining treatment in case of untreatable disease, according to the National Agency for Management of Life-sustaining Treatment. Some 6.8 percent of the adult population here and 21 percent of all people aged 65 and older have signed the statement.
minsikyoon@heraldcorp.com
