If you are dying in Miami, the last six months of your life might well look like this: You'll see doctors, mostly specialists, 46 times; spend more than six days in an intensive care unit and stand a 27% chance of dying in a hospital ICU. The tab for your doctor and hospital care will run just over $23,000.
But spend those last six months in Portland, Ore., and you'll go to the doctor 18 times, half of those visits with your primary care doctor, spend one day in intensive care and stand a 13% chance of dying in an ICU. You'll likely die at home, with the support of a hospice program. Total tab: slightly more than $14,000.
Why do some people spend a lot of time in an ICU dying? I had an example of how this happens explained to me by a hospice nurse (and my meeting with her was not the least bit casual or accidental either): If you have relative who has, say, metastatic bone cancer and they have a heart attack you might think to call for paramedics. Mistake. What will the paramedics do? Cardiopulmonary resuscitation. That'll break some rib bones (brittle from the cancer) and then they'll rush your elderly injured dying relative to the hospital to be treated for heart and bone breaks. But recovery is not possible. Once on life support they'll last maybe days or even weeks or months longer. Tens of thousands of dollars will flow from the US Treasury into coffers of the hospital and various consulting physicians of an assortment of specialties. Your relative will end life with lots of inserted tubes and a respirator and surrounded by strangers.
People worry about the cost of health care. Well, is the three and a half times higher cost of final days in New York City buying anything over the costs of Wichita Falls?
Portland and Miami reflect that tremendous variation among regions. The most expensive city out of 309 hospital referral regions is Manhattan, at a cost of $35,838 for the last six months; the least expensive is Wichita Falls, Texas, at $10,913.
Estimates show that about 27% of Medicare's annual $327 billion budget goes to care for patients in their final year of life.
That $88 billion spent in the final year of life is about three times what the US National Institutes of Health spend on research to find real effective cures that will some day prevent those killer diseases from making those final years into final years. Effective cures will be far cheaper than ineffective treatments too. Stem cell therapy will be cheaper than open heart surgery and nursing care for stroke victims. Gene therapy and immunotherapy that cure cancer will be cheaper than radiation, chemo, and surgery for cancer.
|Share |||By Randall Parker at 2006 October 28 02:16 PM Economics Health|