End-of-Life Care Costs Under Scrutiny

"How can the best medical care in the world cost twice as much as the best medical care in the world?"

That’s the question Peter Orszag, head of the Congressional Budget Office, posed after seeing a new study showing huge variations in the cost of care provided to Medicare patients with chronic illnesses at the nation’s top academic medical centers. The study has implications not just for the quality of end-of-life care, but also for the financial future of Medicare.

Dartmouth researchers found that total Medicare spending in the last two years of life (pdf) ranges from an average of $93,842 for patients at UCLA Medical Center to $53,432 at the Mayo Clinic. The author of the study said doctors and hospitals that provided more care, or more intensive care, did not necessarily achieve better results for patients.

The study, which raised the possibility that the government could save large amounts of money, comes at a time when experts are predicting that Medicare could go broke under the weight of the aging baby boom generation by 2019. With more than 70 percent of Americans now dying in hospitals or institutions, a 2004 study of family perceptions of end-of-life care showed less than half rated the care their loved ones received in hospitals as “excellent.”