At the end of life, less is usually more. Less pain, of course, but also fewer visits to the hospital and fewer treatments in the last few months of life are preferred by most patients and families. Nonetheless, many dying patients find themselves hospitalized, receiving unnecessary, and expensive, interventions in their last weeks.
Now, a team led by Stanford and Department of Veterans Affairs health economist Risha Gidwani-Marszowski, DrPH, decided to investigate how health care systems affect care given at the end of life. She found two groups that could be easily compared: veterans with cancer who receive care through the VA and veterans with cancer who receive care through Medicare.
Their work appears in Health Affairs.
VA physicians are salaried, while physicians and organizations that provide care through Medicare bill for each service they provide, a system known as fee for service. Those differing incentives make it unsurprising that Medicare patients received more unnecessary services than VA patients, Gidwani-Marszowski told me. Specifically, as explained in the press release:
The study showed that Medicare patients were more likely to receive unduly intensive care at the end of life including chemotherapy, hospitalization, admission to the intensive care unit, longer stays in the hospital and death in the hospital than those who received care through the VA.
This research is particularly relevant given the ongoing conversations that propose restructuring the VA toward a Medicare-like model where it pays for, rather than provides, services.
The findings are not just important for veterans and VA policy, but for anybody who needs medical care at the end of life, which is a majority of us. We as a society need to ensure we are setting up the organization of health care and its financial incentives to ensure that the services patients receive are the ones that are in their best interests at the end of life.
Previously: New tools to improve end-of-life communication available, Conflict and compromise: How clinicians can improve end-of-life conversations and Desire for quality end-of-life care crosses ethnic groups
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