The New York Times (May 30, 2008 http://www.nytimes.com/2008/05/30/nyregion/30hospitals.html?_r=1&ref=health&oref=slogin) reported that data from a 15-year research project (The Hospital Care Intensity Report) conducted by Dartmouth College show that there is a drastic difference in end-of-life care that is offered by private hospitals compared to public hospitals in New York City. In terms of aggressiveness of care, NYC’s private hospitals ranked in the 94th percentile, whereas the city’s public hospitals ranked in the 69th percentile. As would be expected, there was also a concomitant increase in the out-of-pocket expenses for private hospital patients versus city-run hospital patients ($4,000 vs. $2,200 in two years).
The study shows that the last two years of a person’s life (especially those who suffer from chronic illnesses) are often the time when the most intensive medical treatment is needed; however, more is not always better. Dr. David Goodman, one of the
co-authors of the Dartmouth Atlas of Healthcare, the site where this report is published, claims that “the general principle is that greater intensity of care is not better, and at the high end can actually be harmful. New York’s healthcare system is full of ironies… and the dichotomy of treatment might illustrate how a city with an abundance of sophisticated doctors and wide disparities in patients’ income and education could result in unfair distribution of resources.”
Why is there such a dichotomy in treatment models? There are several possible explanations. Kenneth Rask, president of Greater New York Hospital Association explains that “the aggressiveness of private hospitals is attributed to both the sophistication of the patients and the intention of the physicians to give them the best possible care.”
Another less principled but probably more realistic view is that the physicians in public hospitals have no real financial incentives to order more tests or do more procedures. In addition, according to Dr. Eric Manheimer, medical director at Bellevue Hospital and clinical professor at NYU School of Medicine, private hospitals are often more disorganized with “specialists referring to other specialists, with nobody coordinating, which results in confused messages, more referrals, more hospitalizations, deterioration in health care, and a more anxious patient.”
The study shows that the last two years of a person’s life (especially those who suffer from chronic illnesses) are often the time when the most intensive medical treatment is needed; however, more is not always better. Dr. David Goodman, one of the
co-authors of the Dartmouth Atlas of Healthcare, the site where this report is published, claims that “the general principle is that greater intensity of care is not better, and at the high end can actually be harmful. New York’s healthcare system is full of ironies… and the dichotomy of treatment might illustrate how a city with an abundance of sophisticated doctors and wide disparities in patients’ income and education could result in unfair distribution of resources.”Why is there such a dichotomy in treatment models? There are several possible explanations. Kenneth Rask, president of Greater New York Hospital Association explains that “the aggressiveness of private hospitals is attributed to both the sophistication of the patients and the intention of the physicians to give them the best possible care.”
Another less principled but probably more realistic view is that the physicians in public hospitals have no real financial incentives to order more tests or do more procedures. In addition, according to Dr. Eric Manheimer, medical director at Bellevue Hospital and clinical professor at NYU School of Medicine, private hospitals are often more disorganized with “specialists referring to other specialists, with nobody coordinating, which results in confused messages, more referrals, more hospitalizations, deterioration in health care, and a more anxious patient.”
New York state treats end-of life patient more aggressively than any other state, except New Jersey. In looking at the report, it is evident that the dichotomy of care is even more pronounced when compared with other states, especially western states such as Utah, Oregon, Idaho, Washington, and Montana.
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