Dying Costs More For Blacks, Hispanics

(AP)  Striking new research shows dying blacks and Hispanics have much steeper treatment costs than whites, sobering evidence that racial health-care differences continue right up until death.

It's not that minorities are being charged more than whites. It's that they tend to get more costly, intensive treatments including feeding tubes and other invasive medical procedures near death. That's in sharp contrast with what often happens throughout their lives, when minorities are less likely than whites to get aggressive medical care.

The results raise a troubling question about whether medical resources for nonwhite patients are "misallocated over a lifetime," with minorities receiving more treatment at the end, when there is little chance of improving or extending life, the study authors said.

The study appears in Monday's Archives of Internal Medicine. It involved nearly 160,000 Medicare patients and records on their treatment in the last six months of life. It is the most comprehensive on the topic and confirms results suggested in smaller studies on disparities in end-of-life care, said co-author Dr. Ezekiel Emanuel, a researcher in the bioethics department at the National Institutes of Health.

Medicare costs in those final months averaged $20,166 for whites. Among blacks, they were $26,704, about 30 percent higher; and among Hispanics, $31,702 or almost 60 percent higher. Those individual cost differences can add up to billions of dollars on a national scale, Emanuel said.

Reasons why minorities receive more costly end-of-life care are unclear; the study had no data to explain that. But Emanuel and other doctors offered several theories.

"Some of it may be preference. Some of it may be fear-based," Emanuel said.

Distrust of doctors and suspicions about getting less attentive treatment than whites likely is another factor, the study authors said.

Also, because of cultural or spiritual beliefs, some minorities are more likely to hold out hope for a miraculous recovery, or to oppose letting doctors play God and hasten death by abandoning treatment, said Dr. Elbert Huang, a Chinese-American physician with the University of Chicago Medical Center.

Letting doctors withdraw aggressive end-of-life treatment is mostly a western European approach, Huang said.

In a smaller, earlier study of healthy elderly patients in Rochester, N.Y., Dr. William Bayer said he found blacks were more likely than whites to say they would favor aggressive treatment even after brain death.

Blacks in that study tended to believe that "if God wants to take our lives, he will decide when and where that will happen," said Bayer, of the University of Rochester Medical Center.

Dr. Otis Brawley, a black physician in Atlanta and chief medical officer for the American Cancer Society, said the new findings "make sense."

"They play into all of my prejudices and they play into all of my personal experiences," Brawley said.

He said other reasons contribute to the phenomenon.

Because low-income minority patients often get less preventive medical care, they're less likely than whites to have long-term relationships with doctors, Brawley said. So physicians who treat them late in life may be strangers unwilling to "pull the plug" without knowing their wishes.

Also, Brawley said, black patients often have splintered families, and estranged relatives are in charge of making end-of-life decisions.

"They feel guilt about saying, 'let this patient die,"' he said.

"The breakdown of the family in certain cultures contributes somewhat to this phenomenon," he said. "I've seen it so many times."

[honestabe8]

OneBigMistake: You are an idiot. What reason was there to bring up Obama?

[saturn05]

I forgot, look up the movie Soylent Green with Charleton Heston and maybe you will get more ideas on what to do with the bodies after we die.

[saturn05]

"Medicare costs in those final months averaged $20,166 for whites. Among blacks, they were $26,704, about 30 percent higher; and among Hispanics, $31,702 or almost 60 percent higher. Those individual cost differences can add up to billions of dollars on a national scale, Emanuel said. "
How do these figures above from the article convert to 60% higher?

[pdchapin]

Actually the cause is very simple to understand. As they die or are near death, both hospitals, agencies and Big pharm see another one of their stalwart , public paid for cash cows nearing its end--so they jump in with both feet and milk that baby for all its worth.

Posted by harbinger19 at 12:41 PM : Mar 10, 2009

Actually, hospitals are paid on the basis of the DRG assigned to case: basically the diagnosis. You'd make more money if the patient dies quickly before you run up a lot of expenses. A patient who lingers can end up costing the hospital money. When DRGs were first introduced, the Congress got angry that hospital stays suddenly went down. Those of us working in the field at the time did a "Duh, what did you think was going to happen? Wasn't that the point - to get costs down?"

I assume DRGs are still being used. It's been a while since I worked in this area. If anybody knows what's currently being done - and not just their prejudices - I'll stand corrected.

[supportamericans]

To your question about a mention of health care in the Constitution, the Constitution opens, "We, the people of the United States of America, in order to form a more perfect union, establish justice, insure the common defense, promote the general welfare, and secure the blessings of liberty for ourselves and our posterity . . ." I believe that helping the populace remain alive might fall under promoting the general welfare. It is hard for me to imagine that some of the people commenting would want the sick and the elderly to go untreated. How could you bear to turn someone away from medical care? We are the greatest nation in the world, and we can afford to provide for our poor. By the way, on the Statue of Liberty, the poem reads, "Send me your tired, your poor, your huddled masses yearning to breathe free." Lady Liberty seems to be one of the few generous voices left; we have become gorged on our own greed. To keep a child alive, to give an old person medical care, for these things, I am willing to pay some taxes.

[harbinger19]

can anyone show were in the Constitution or Declaration it says that healthcare is something people are entitled to? If it isn't there people aren't entitled to it. If you need to work at McDonald's or go into the military to ensure you and your family then suck it up and do it. Stop asking those of us who make decent livings to take things away from our kids to help carry your burdens.
Posted by anti-global at 9:45 AM : Mar 10, 2009

From the Declaration of Independence---
That part about "life, liberty and the pursuit of happiness" Life means health and most unhealthy people are not happy that's 2 out of three. Know this--every society is only as strong as the weakest among them--so when you don't help--the illness spreads and eventually all are consumed. Take a good look at our country--had we made different choices in how we shaped our society--it would have had a very different outcome.

[harbinger19]

"Reasons why minorities receive more costly end-of-life care are unclear; the study had no data to explain that. But Emanuel and other doctors offered several theories."

Actually the cause is very simple to understand. As they die or are near death, both hospitals, agencies and Big pharm see another one of their stalwart , public paid for cash cows nearing its end--so they jump in with both feet and milk that baby for all its worth. After all, who is going to criticize or want to limit care for a dying person? It is the last bastion of politically correct relics--holier than holy.

The fact is, agencies are budgeted based on what they spend --not on what is saved. This means if an agency does not spend all of its allocation and then some--they are perceived as not needing that money next time.

this means that as agencies like Medicaid or Medicare or Social Services sees another of their patients dying--they will have to make up for a life time of care that will be gone...if they don't they will lose money--which translating from patient to patient could mean the loss of hundreds of millions if not billions. So they go for that last push--and they put the word out to the companies who provide the services and drugs--every body knows that as each poor person dies---spend like crazy..no matter what --because if they don't the health services benefits will be cut and eventually that will translate into less profits for Big pharm and hospitals.

It's really very, very easy to understand.....DUH...

[sockpuppet4]

I suspect one small reason. If you parade to the cemetary with floats and jazz bands at about one mile per hour it is sure to cost more. Not to mention the costs of a reception for eleven hundred family members.

[dragyn30]

sandy19731 you are absolutely right!

I think I will find another news station because it seems that CBS is looking to show things that are outrageous and that only make me angry.

Between this garbage and that Suleman freak I am done - they are not reporting the new they are trying to anger as many peole as possible to create more negative in the world.

[colt8881]

When you die everybody should be made into fertilizer that would solve the whole problem.