The Right End-of-Life Care

The question of cost drives many aspects of life; it even can play a role in choosing a hospital for end-of-life care.

Want to fight the grim reaper with every weapon at your disposal, and no expense spared? In Miami, Westchester General Hospital is the place for you. New Yorkers should head to NYU Langone Medical Center, and in Savannah, Ga., patients will want Candler Hospital.

But if you prefer to spend fewer hours in a doctor's waiting room, fewer days in the hospital intensive care unit and less money on insurance co-payments, other hospitals would work better for you.

The average patient served by suburban Miami's Memorial Regional Hospital spends about $4,300 on physician co-payments in the last two years of life, compared to more than $6,600 for patients treated at Westchester General. The cost is less at Memorial Regional because end-of-life patients are treated less intensely. They have fewer days in intensive care and more in hospice care, fewer specialist appointments and more days at home, than at Westchester General.

End-of-life treatment is dramatically different in New York than in Savannah and just about every other community in America.

How can that be? Even Dr. Elliott Fisher, a Dartmouth Medical School professor who has been researching the geographic variation in health care for more than 20 years, is often surprised by how much patient care varies from one hospital to the next. Fisher, principal investigator for the Dartmouth Atlas project, is director of the Center for Health Policy Research at the Dartmouth Institute for Health Care Policy and Clinical Practice.