IN NEW YORK CITY, TWO VERSIONS OF END-OF-LIFE CARE
May 30, 2008
There are two starkly different paths toward death in New York City's hospitals, one for patients at elite private institutions, another for those at public hospitals, according to new data compiled as part of a Consumer Reports rating system, says the New York Times.
Most elderly patients in their last two years of life have more intensive treatment, more tests, more days of hospitalization -- and more out-of-pocket costs -- at private teaching hospitals than their counterparts at the city's municipal hospitals, which have historically served the neediest New Yorkers, says the New York Times. Intensity is measured by how many days the average patient spent in the hospital, how many times a doctor visited that patient and how much the patient or private insurer spent for doctors beyond what Medicare covered. For example:
- Patients in the city's private hospitals averaged 54 visits from doctors, while those in public hospitals averaged 24 visits during the final six months.
- In private hospitals, 56 percent of patients saw 10 or more physicians, compared with 32 percent in public hospitals.
- Private patients paid an average of $4,000 out-of-pocket over two years, nearly double the $2,200 per patient at the city-run institutions.
But in terms of the ultimate outcome, there was little difference:
- The Dartmouth Atlas showed that 58 percent of the public-hospital patients died in the hospital as opposed to at home or in hospice care, compared with 57 percent for private hospitals.
- Thirty percent of patients in public hospitals had been admitted to intensive care units before their death, compared with 27 percent in private hospitals.
- Many fewer patients from public hospitals -- 7 percent -- were enrolled in a hospice than patients from private hospitals, where the rate was 12 percent, according to the Dartmouth data.
Source: Anemona Hartocollis and Ford Fessenden, "In New York, Two Versions of End-of-Life Care," The New York Times, May 30, 2008.
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