Medical Care Too Often is Being Pushed on the Elderly

Another important measure of the push model in health care is expenditures during the last two years of life. Senior citizens need to beware. Some doctors see the elderly as "cash cows" because those over 65 years of age have nearly unlimited health insurance coverage through medicare. These doctors make more money the more tests they order and the more procedures they do. I read just the other day that a significant percentage of our seniors undergo surgery during their last year of life.

 One of the simplest ways to assess the overall medical culture of a region or a hospital is by determining the amount of money expended on health care during the final two years of life. In medical cultures where overtreatment is the rule, the costs per patient are often 2 times higher than in cultures where physicians understand and respect that life eventually comes to an end for us all. For example, looking at the Dartmouth Atlas we can compare two Florida hospital systems: Tallahassee Memorial Healthcare, in Tallahassee, to Mt. Sinai Hospital in Miami Beach. The average per capita Medicare expenditures during the final two years of life was $40,000 for Tallahassee Memorial Healthcare and $83,000 for Mt. Sinai Hospital. Why was Mt. Sinai over twice as expensive? Patients in Mt. Sinai Hospital visited their physicians far more frequently (99th percentile for number of physician visits as compared to patients in other hospitals throughout United States), remained in the hospital far longer (99th percentile) and receive more intensive care (99th percentile) than patients treated in Tallahassee Memorial Healthcare, or for that matter nearly ever other hospital system in the United States. How can we guard against this push mentality?  Further thoughts on prevention tomorrow.