Calculating the cost of dying

The tense debate over ‘end of life issues’ gripping our nation since Terri Schiavo’s last days continues to generate lots of articles and some changing laws. It’s important to have the discussion. But some of it is cold and calculating.

USA Today had this piece today that adds up the industry costs of care for the daying.

If you are dying in Miami, the last six months of your life might well look like this: You’ll see doctors, mostly specialists, 46 times; spend more than six days in an intensive care unit and stand a 27% chance of dying in a hospital ICU. The tab for your doctor and hospital care will run just over $23,000.
But spend those last six months in Portland, Ore., and you’ll go to the doctor 18 times, half of those visits with your primary care doctor, spend one day in intensive care and stand a 13% chance of dying in an ICU. You’ll likely die at home, with the support of a hospice program. Total tab: slightly more than $14,000.

The article looks at a few factors that make it “more expensive to die in some areas of the country than others.”

But experts on the end-of-life care say one main reason for the vast difference between the two cities may be that in Oregon, doctors, or staff at hospitals and hospices, encourage patients with life-threatening illnesses to talk about the end of life, what kind of medical care they want and where they want to die. The state has a history of such debate: Oregon residents have long supported palliative care, a term usually used to describe medical care for the terminally ill that focuses more on comfort treatments than cures. And, in 1994, voters there became the first in the nation to approve doctor-assisted suicide, a referendum signed into law in 1998.

USA Today ought to check with the latest changes out in Oregon (see post just below), because they’re no longer calling it ‘suicide,’ doctor-assisted or otherwise.  And that’s an obvious reason why the costs are lower in Oregon. When you make it easier for the elderly or seriously ill residents of your state to die at will, change the wording of the law and call it compassion and choice, you’re going to have fewer of them around to care for, which of course “costs” less.

But only when dollars are the costs calculated.