Letter To The Editor, Editorial Address Study On End-of-Life Hospital Spending For Medicare Beneficiaries

Main Category: Palliative Care / Hospice Care
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 11 Apr 2008 - 10:00 PDT

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Two newspapers on Thursday published a letter to the editor and an editorial about a recent study conducted by researchers at the Dartmouth Institute for Health Policy and Clinical Practice that found wide variations among the top U.S. academic medical centers in spending on care for Medicare beneficiaries with chronic conditions during the last two years of their lives. Summaries of the letter and editorial appear below.

• Jim Jaffe, Baltimore Sun: The study has prompted some observers to question the efficiency of the health care system, but the problem "isn't that expensive hospitals charge more for a given test or procedure, but rather that they do a lot more of them" and "fewer marginal ones," Jaffe, public affairs vice president for the Center for the Advancement of Health, writes in a Sun opinion piece. According to Jaffe, "Raising this issue at a time of economic stress highlighted new data showing that job growth in America today is basically confined to the health and education sectors," which "raises a red flag about the painful cost of imposing efficiencies in these areas despite chronic and growing public concerns about rising bills." Lawmakers "are sensitive to the human cost of creating a more efficient medical system, but they seldom speak of it," Jaffe writes, adding, "Instead, they speak in general terms about reform and tend to focus on the need to expand services for the uninsured and to help the insured pay their bills" (Jaffe, Baltimore Sun, 4/10).
  
  
• New York Times: The "reason for the disparities" found in the study is "not that one hospital charges a lot more for a given service than the others" but that "high-cost hospitals provide a lot more services for patients than the lower-cost hospitals: keeping patients in the hospital and in intensive care for longer periods, sending them to a slew of specialists and doing a lot more tests and procedures," a Times editorial states. "No doubt the high-cost institutions think they are 'going the extra mile' for their patients, but some patients don't want such aggressive care, and most don't experience any health benefits from it," the editorial states, adding, "Few will be surprised to discover that doctors in high-expenditure institutions are typically paid on a fee-for-service basis, which means they earn more if they do more." According to the editorial, "Reducing the cost of medical care will require changing longstanding habits -- no easy feat" -- and that "may not happen until the medical profession reaches consensus on which treatments will truly improve the health of patients and which are superfluous" (New York Times, 4/10).
  

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