Medicare spends more per patient in New York City than in Portland, Oregon, during the last six months of life. These geographic variations in spending are in many ways a reflection of the local medical culture.
Providers and patients in the Northwest, for example, tend to favor less invasive care at the end-of-life, while folks elsewhere follow the mantra of more is always better.
There is now evidence that spending variations exist between white and minority populations as well.
A new study conducted by the National Institutes of Health (NIH), and published in the Archives of Internal Medicine, examined the treatment records from 160,000 Medicare beneficiaries during the last six months of life.
It found that, on average, Medicare spends:
- $20,166 per white patient over the last six months; and
- $26,704 per black patient (or 30% more than a white patient); and
- $31,702 per Hispanic patient (nearly 60% more than a white patient).
Some analysts argue that minority patients and their families may favor more intensive care at the end-of-life due to religious or other spiritual beliefs.
But the study also asks whether medical dollars are misallocated over the course of a minority patient’s life.
Minority patients are less likely to receive necessary preventative care and other medical treatments than are their white peers over the course of their lives.
Documented disparities exist in access to influenza vaccinations, lung surgeries, renal transplantation, treatment for heart disease, referrals for cardiology specialist care and treatment for HIV/AIDS. This is true even for minority individuals with health insurance. It is believed to be due to 1) institutional racism within medical facilities, and 2) a scarcity of healthcare providers in predominantly minority areas.
Some argue that doctors and medical centers attempt to make up these disparities by over-treating minority patients at the end of their lives, even when it may be too late to do any good.
As We See It, the excess time and money spent on care delivered in the last six month of minority patients’ lives would be better used on preventative appointments and other efforts earlier on to detect diseases and chronic conditions.