US Curbs On Care For Elderly, Terminally Ill

A policy of cutting expensive life-prolonging care for the terminally ill not only saves little money but is ethically questionable, says a report in the Journal of the American Geriatrics Society. A study of 115 gravely ill patients at five major hospitals found that even after receiving whatever treatment their doctors chose to give them at the time of admission, 99 of the 115 died within five days of entering the hospital. Only one survived beyond two months.

Additionally, a study of Medicare records contradicts the assumption that older Americans use a disproportionate share of high-cost treatment. Robert Binstock of Case Western Reserve University told an American Public Health Association meeting that even if rationing were ethically and morally palatable, the dollars saved are insignificant. Dr Binstock and Richard Fortinsky found that older Americans cost Medicare only $53 more per hospitalization, and that as older people age, the mean cost of their hospitalizations decreased, perhaps because high-cost operations decrease with age.

Eliminating operations would save Medicare only 6.2% of its total bypass costs, 1.2% of total hip replacement costs and a tenth of 1% of all kidney transplants; this would save only 1% of the total US health care bill, they said.