Discrepancy between clinical ethics and economy

Abstract

Two cases with excess medical expense under the comprehensive health-care payment system in spite of ethical consideration were reported.

Case 1 was a 70 year-old male who was admitted due to severe acute alcoholic pancreatitis. Respiratory support and continuous hemofiltration were applied. Although remission was obtained, his condition worsened again. Then, ethical analysis with Jonsen's method was performed, and the decision of therapeutic continuity was made. However, he could not recover again and died of multi-organ failure. Consequently, excess medical expense (difference between real reimbursement by DPC/PDPS and theoretical reimbursement assuming fee for service payment system) of 490 thousand yen had occurred without any financial aid.

Case 2 was a 53 year-old male. He was admitted for terminal state of osteosarcoma. Massive dose of narcotics was necessary to heal his pain which derived from multiple bone metastasis. He died at 95 days after admission. Although the excess expense estimated about 5.25 million yen, we could not find any appropriate method to reduce it under comprehensive payment system.

In order to achieve appropriate therapy under ethical consideration, some public financial support for excess expense is necessary in comprehensive health-care payment system.