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Everything We Can
How much care is too much?
Joan Teno, MD
In the ferocious debate over health care reform, everyone—from economists to policymakers to pundits—was scrutinizing health care spending. Why are medical costs so high? Who’s to blame? How do we fix it? One figure leaped to the fore: Care for beneficiaries with chronic illnesses during the last two years of their lives accounts for about one-third of all Medicare spending. The number isn’t all that surprising when you consider that no one knows for sure when the clock begins ticking on someone’s last year of life, and the costs are necessary in order to give that person a chance to make it not their last year of life.
The problem is the wide range of spending across the country, higher in some areas than others, suggesting that care practices are based more on local customs than on evidence-based medicine, patient choice, or disease severity. Researchers such as John Wennberg of the Dartmouth Institute for Health Policy and Clinical Practice say that some chronically ill and dying Americans are receiving too much care—more than they and their families actually want or benefit from.
It’s not the cost or the waste and inefficiency that most troubles health care providers who treat dying patients or study end-of-life issues. It’s the poor experiences of the patients and their families—patients who undergo invasive tests and procedures that rob them of quality of life, loved ones who suffer guilt and regret in addition to their grief. How does this continue to happen?
Alpert Medical School