Health Care Spending and End-of-Life Care
This New York Times article from December 23 highlights one of the pitfalls of the arguments made by Peter Orszag and others that hundreds of billions of spending in health care (and in Medicare) are “waste” that can easily be eliminated. The piece highlights a major flaw in the Dartmouth Atlas surveys about spending on end-of-life care that allege some hospitals have much higher costs than others: “If you consider only the patients who die, there is really no way to know whether it makes sense to spend more on one case than another.” The article quotes a data analysis from UCLA and several other California hospitals that found that, after considering the effects of elderly patients with heart failure who did and did not die, found much less variation in spending than the Dartmouth Atlas’ analysis examining only patients who died.
Note also that the prospect of additional focus on “wasteful” end-of-life spending – through various payment changes made as a result of bureaucratic studies and proposals – concerns officials at UCLA, “who say that unless the distinction can be clearly drawn between excellence and excess in medical care, efforts to cut wasteful spending could be little more than blunt rationing. ‘There’s a real risk of doing harm here – real harm,’” said UCLA’s Chief Medical Officer.