More End-of-Life Spending May Be Worth It
At least in Canada. This is from Jason Shafrin on a recent JAMA paper (gated):
After controlling for patient case mix, the authors examine variation in hospital spending in the last year of a patient’s life. The authors note that “Higher-spending hospitals differed in many ways, such as greater use of evidence-based care, skilled nursing and critical care staff, more intensive inpatient specialist services, and high technology, all of which are more expensive.” Higher spending hospitals (on a per patient basis) tend to be hospitals with a larger volume of patients. They are also more likely to “be located in urban areas; be associated with regional cancer centers; have on-site computed tomography and magnetic resonance imaging scanners, cardiac catheterization laboratories, and cardiac surgery capability; and be early adopters of critical care response teams.”
Higher spending hospitals had overall reduced mortality rates for four diseases considered. “In the highest- vs. lowest-spending hospitals, respectively, the age- and sex-adjusted 30-day mortality rate was 12.7% vs. 12.8% for AMI, 10.2% vs. 12.4% for CHF, 7.7% vs. 9.7% for hip fracture, and 3.3% vs. 3.9% for colon cancer.”
More from Jason Shafrin’s post in the Healthcare Economist.
Various studies have found higher-spending hospitals (and higher-spending hospital regions) have lower mortality when weighted for health status. But the marginal, quality-adjusted life years come at a high price. That in and of itself is not a problem. The problem is that the marginal cost of additional months are paid for by third-party payers, such as Medicare. As individuals, there is a limit to how much of our lifetime earnings we can afford to spend on end-of-life care. Few families would willing agree to give up, say, three-quarters of their lifetime earnings to extend their lives by only a year months (spent mostly in a long term care facility). Moreover, as a society we cannot afford collectively that which we cannot afford individually. I have no problem if Bill Gates wants to spend $1 million extending his life by a few months (from 88.6 to 88.9). But taxpayers cannot guarantee every citizen $1 million in end-of-life care — all paid for by our grandchildren (tomorrow’s taxpayers). That is why it is important to allow people more control over their health care dollars. When people are in control, they make trade-offs. When society is responsible, people assume a mentality of entitlement.
Some would contend that better quality of life in earlier years (50s-60s) is of greater value to the individual and society than more end-of-life spending in the very late years.
Shafrin also points out that pretty much all US hospitals would fall into the “high spending” category in comparison to Canada, so the marginal benefit might be even smaller.
Since I don’t have access to the full paper here, are all those comparative mortalities statistically significant? I’m assuming they are because otherwise reporting them as differences would be incorrect, but the AMI mortality difference is so small that I’m a little skeptical.
Like Devon, I am skeptical that increased spending is a good thing.
To Carol,The state owns the school, we the tepyaxars fund the school.To Randy,Whoever did this at the church also stuck them on peoples windshields. This is so wrong.I wonder if it was done at other churches, or just at the Catholic church, where Martino, Reda and Scriva go ? How low can you get?About as low as saying it is okay to use the schools return address for a newsletter, I GUESS. DIRTY POLITICS at it’s best.Well-loved.