NCPA - National Center for Policy Analysis


April 9, 2008

A new report from the Dartmouth Institute for Health Policy and Clinical Practice examines spending on chronically ill patients during the last two years of life.  The researchers discovered staggering variations in the number of services that patients with severe chronic disease receive at the end of life, depending on the hospital, region or state and not on how sick they are.

For example:

  • An elderly person spent an average 10.6 days in the hospital during the last two years of life in Bend, Ore., but 34.9 days in Manhattan.
  • The variation is even more striking in the last six months of life, when chronically ill patients visited the doctor an average of 14.5 times in Ogden, Utah, compared to 59.2 times in Los Angeles, Calif.

These differences create wild variations in how much Medicare spends on patients during the last two years of life, say the researchers:

  • The U.S. average was $46,412.
  • The highest spending was in New Jersey at $59,379 per patient, or a quarter more than the average.
  • The lowest was in North Dakota at $32,523 per patient, or a quarter less than the average.
  • UCLA Medical Center spent more than $93,000 per patient over the last two years of life. 
  • The Mayo Clinic, by contrast, spent $53,432 -- a little more than half the amount of UCLA on similar patients over the same period of time,

If the U.S. health care system mirrored the practice patterns of gold-standard health care systems such as the Mayo Clinic in Minnesota, Medicare could have saved $50.1 billion, or 17.3 percent of all spending on these patients alone.  Those savings would come just when Medicare needs that money most, as baby boomers prepare to retire in droves, putting unprecedented pressure on the health care system, according to the researchers.

Source: "Chronically Ill Patients Get More Care, Less Quality," Dartmouth Institute Atlas of Health, April 7, 2008; based upon: John E. Wennberg et al., "Tracking the Care of Patients with Severe Chronic Illness," Dartmouth Institute Atlas of Health.


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