ICU For Terminal Patients 5 Times More Likely In US Than In England

By John Ballard

Death panels across the pond, perhaps? 
I don't think so. The professionals who conducted this study are too circumspect to advance any final explanations. But as a layman who has been doing his homework the reason seems obvious top me: protracted end of life medical care brings in more money than allowing hospice to come around and do their job.

In the US, patients who die in hospital are almost five times more likely to have spent some time during their last hospital stay in the Intensive Care Unit (ICU) as equivalent patients in England, according to a new study by researchers from both countries.

The study is the work of lead author Dr Hannah Wunsch, assistant professor of anesthesiology and critical care medicine at Columbia University in New York, and colleagues, and is published in the 1 November print issue of the American Journal of Respiratory and Critical Care Medicine.

Wunsch and colleagues also found that terminally ill patients over the age of 85 were 8 times more likely to spend time in the ICU during their last hospital stay than their counterparts in England. [LINK]

I would very much like to have someone explain that part I just put in boldface.

Eight times more likely!   For people 85 years old? Diagnosed as "terminal"? Huh?

I think this part has something to do with why:

... they decided to compare England and the US because the two countries have similar life expectancies and demographics, but widely different healthcare systems.

For example, England has one sixth of the number of ICU beds per head of population compared to the US, and responsibility for decisions about medical care appears to lie predominantly with doctors, whereas in the US it lies mostly with patients or their surrogate decision-makers.

Why do you suppose patients and their advocates make such decisions? The decision to leave a terminal patient in ICU as long as possible results in protracted suffering. Prolonging intensive care for someone deemed terminal seems unnecessary at least, and cruel at worst.

But one person's tragedy can be an opportunity for someone else. Unlike morticians whose business has to be done quickly, hospitals, thanks to science, can sometimes prolong a revenue stream for an exceedingly long time. Especially when they can blame the patient or his family.

I doubt that individual physicians are the culprits. The blame probably lies, as is so often the case, with policies that must be followed. So much for professional advice. 

A few more tidbits at the link, but you get the idea.

Another item comparing Canadian and US health care can be found at Maggie Mahar's place, A Letter From Canada.

...The Canadian Institute for Health Information charts migration patterns for practicing physicians. According to the Institute�s data, the gross number of doctors leaving the country hit two peaks in the last 35 years: one in the late 1970s, when Canada lost between 500 to 600 doctors a year, and another in the mid-1990s, when it lost around 600 to 700 a year. But when assessing the brain drain, it�s important to consider not only the number of doctors who are leaving, but also the number returning to Canada. This number has been holding fairly steady since 1980, with around 250 to 350 returning per year. Thus, the net loss of physicians is fairly small.

And in recent years, not only has the brain drain trend slowed, it has actually reversed. In 2004, Canada gained 85 doctors. In 2005, it gained 61 physicians and in 31 in 2006.

How many leave Canada for the U.S.? Since 1992, between 60 and 70 percent of physicians who emigrate have headed south of the border. In the mid-1990s, the number leaving for the U.S. spiked at about 400 to 500 a year. However, in recent years, this number has declined, with only 169 physicians leaving for the States in 2003; 138 in 2004; and 122 in each of 2005 and 2006. These numbers represent less than half a percent of all doctors working in Canada.