Study Finds Cost Differences Between Races For Those Receiving End-of-Life Care

Main Category: Palliative Care / Hospice Care
Also Included In: Public Health
Article Date: 11 Mar 2009 - 4:00 PDT

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Black and Hispanic patients more often have higher end-of-life care costs than white patients, according to an NIH study published Monday in the Archives of Internal Medicine, the AP/Washington Post reports. For the study, Ezekiel Emanuel, chair of the Department of Bioethics at NIH, and other researchers analyzed medical and treatment records from the last six months of life of 160,000 Medicare beneficiaries.

The study found that Medicare costs for white patients averaged $20,166 in the six-month period. By comparison, the average cost for black patients was about 30% higher, or $26,704, and nearly 60% higher, or $31,702, for Hispanic patients. According to the study authors, minority patients were not charged more than white patients, but they received more invasive, intensive and costly treatments at the end of life.

The study raises a question of whether health care is "misallocated over a lifetime" for minority patients, who tend to receive aggressive treatments when it appears to be too late for improving or extending life, the authors said.

While the study did not give a reason for the cost disparities, the authors suggested that minorities might be more likely to have distrust and suspicions about receiving less successful treatment than white patients. Emanuel said, "Some of it may be preference. Some of it may be fear-based." Other physicians cited cultural or spiritual beliefs, such as waiting for a miraculous recovery or not hastening death by stopping treatment, the AP/Post reports.

Otis Brawley, a black Atlanta-based physician and chief medical officer for the American Cancer Society, said the study's findings "make sense," adding, "They play into all of my prejudices and they play into all of my personal experiences." Brawley said that minority patients with low incomes often seek less preventive medical treatment, so they are less likely than white patients to have longstanding relationships with physicians, who in turn might be less willing to "pull the plug" without knowing their patients' wishes. He also cited the dynamics of families as a reason that affects end-of-life decisions. Brawley said, "The breakdown of the family in certain cultures contributes somewhat to this phenomenon," adding, "I've seen it so many times" (Tanner, AP/Washington Post, 3/9).

An abstract of the study is available online.

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