Home > End of life care, Health care > Best health-care system in the world…not (2)

Best health-care system in the world…not (2)

Medicare spending on medical care at the end-of-life is much higher in Los Angeles than in San Diego, yet quality measures tend to favor San Diego, according to a study published in the Journal of Palliative Medicine.

Using Medicare and state health planning and outcome data, Robert M. Kaplan of the UCLA School of Public Health explored differences in health care use by Medicare beneficiaries living in the two California counties.

During the last two years of life, total costs among Medicare decedents were 42% higher in LA than San Diego, Kaplan found, even though “the disease burden in the two areas appears to be approximately equal.”

LA spending was 53% higher for non-emergent hospital admissions and inpatient care and 78% higher for ICU/CCU admissions per decedent. LA residents see more specialists in the last two years of life, too. Does supply drive demand? LA has about 35% more hospital beds per 10,000 persons than San Diego.

Meanwhile, San Diego residents were much more likely to die while receiving hospice care: only 22.4% of the people who died in LA were enrolled in a hospice program, compared with 44.6% in San Diego.

Bill Sez: this study was published before the recalculation of Medicare spending by region became public. We’ll see if the new analysis changes Kaplan’s conclusion that “the most plausible explanation for the LA-San Diego cost differences is greater discretionary use of the hospital as a site of care, owing to a greater per-capita supply of hospital beds.”


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