Where You Die Depends on Where You Live
More than half of Medicare recipients getting treatment at Westchester Medical Center in Valhalla, N.Y. (57.3 percent) ended up dying in the hospital, according to the [Dartmouth Atlas] report. Only 18.7 percent of cancer patients who got care at Evanston Northwestern Healthcare in Evanston, Ill., ended up dying in the hospital.
Dartmouth’s previous end-of-life studies have had detractors. Some hospitals argue that they provide more aggressive treatments to prolong life.
Hate to be cynical, but this is what happens when impersonal bureaucracies control the money and (effectively) make the decisions.
Life tends to be prolonged when it increases the income of the prolongers. You can call this “Bruce’s Law.”
The real question is: How do we get the money away from the doctors, hospitals and insurance companies and into the hands of patients and their families.
I suspect there are cultural preferences about whether people die in hospitals or prefer to die at home. Hospitals are a place for treatment; leaving the hospital to die at home suggests giving up or there is no hope. I can understand the reluctance to admit defeat by a patient’s family influencing where the patient dies.
I suppose if you are willing to move, you can determine how you will die — in a manner of speaking.
Aside from the silliness of implying that in-hospital death rates are somehow indicative of health care adequacy, a cursory Google search suggests that these hospitals may differ in important ways.
The Evanston hospital is part of the NorthShore University HealthSystem. It is one of 4 hospitals in the group. The 2009 annual report said a new cancer center was going to be added to it in 2010. According to the annual report, most of NorthShore’s cancer cases are newly diagnosed at an early stage. The system is a teaching affiliate of the University of Chicago Pritzker School of Medicine.
Westchester Medical Center is a regional hospital that provides advanced services to New York’s Hudson Valley, northern New Jersey, and southern Connecticut. According to Wikipedia, it is “the primary academic medical center and University Hospital of New York Medical College.”
If NorthShore refers its complex cancer patients away from Evanston while Westchester has all of the complex patients referred to it, there wouldn’t be any particular mystery about the differences in in-hospital death rates.
I wish that the Dartmouth Atlas folks would take the time to address issues like this. Until they do, their findings aren’t a lot of help in guiding policy.
I agree with Devon. I think there might be some big end-of-life philosophy differences to deal with on this one. I would bet that studying religious attitudes toward death in the different areas would yield some interesting insight into the differences.
The article makes another interesting point: You don’t know that you’re going to die until you’re actually dead. It’s hard to give up hope and send someone home when you’re uncertain as to whether or not it’s time.