Hospitals in Los Angeles County spend more on often-futile care for elderly patients at the end of life than medical centers elsewhere in California, according to a groundbreaking study to be released today.
Chronically ill Medicare patients stayed in the hospital longer, saw more doctors and received more intensive-care treatment in Los Angeles than in other metropolitan regions, including Sacramento, San Francisco and San Diego, according to research by Dartmouth Medical School. There was no evidence that the care prolonged patients' lives.
Indeed, the aggressive care in hospitals might actually have hastened their deaths, the authors said, based on previous studies showing that hospitalizations can lead to infections and other deadly complications.
"It is at least equally plausible that people are being harmed by overuse than that they're benefiting ... and we know that they're spending a lot more money," said Dr. Elliott S. Fisher, a Dartmouth professor and one of the study's authors.
The reason for the disparity: The Los Angeles region has more doctors and hospital beds for its population than other parts of the state, according to the study published in the journal Health Affairs.
The supply generates its own demand.
"Once you put something in -- MRI machines, surgical suites, ICU beds -- they'll fill it," said Laurence Baker, an associate professor at Stanford University and a co-author of the study. "Doctors by nature like to deliver care."
The research, the first of its kind to allow broad comparisons among individual hospitals, could cause insurers and policymakers to rethink how medical centers are compensated. It could also add fuel to the debate over the costs of end-of-life care, which is contributing to soaring national healthcare costs.
"This is the first ray of light on a very important facet of healthcare delivery performance," said Dr. Arnold Milstein, medical director of the Pacific Business Group on Health, a coalition of employers interested in improving quality and lowering health costs.
The study, which covers 1999 to 2003, addresses the treatment of patients on Medicare, the government health insurance program for the elderly and disabled. The patients studied suffered from one of a dozen chronic illnesses whose prognoses are grim, including metastatic cancer, AIDS and end-stage diabetes.
The researchers looked at medical costs in patients' last two years of life and the intensity of treatment provided in their last six months.
