Greg Scandlen casts a skeptical eye on a Dartmouth Health Atlas study that claims to have found large, unexplained regional variations in Medicare use:
So the authors smugly assume that by adjusting for age, sex, race, and illness, they have eliminated any population differences that might contribute to different courses of treatment.
Golly, might there be anything else that distinguishes people in New York City from people in Ogden, Utah or Minot, North Dakota that might cause one population to be treated differently at the end of their lives? Let’s put on our thinking caps and noodle on this really, really hard.
Just maybe some people have different family structures and living conditions that enable them to stay at home during their last days, and just maybe these conditions are more favorable in Ogden and Minot than in New York. Conditions such as:
- Owning their own homes.
- Having intact families around, including adult children.
- Being strongly religious, especially Mormon in Ogden.
- Living in the same community all their lives.
- Residing in one or two story homes, rather than walk-up apartments.
- Having well-established networks of friends and civic associations.
- Enjoying a low rate of crime.
One final thought: If you download the study and look at the pretty maps, you will notice an almost perfect correlation between the areas where people most often die in the hospital and the areas where people are most likely to vote for Democrats. So here is another variable that stands out – the political orientation of the population. Is it possible that Democratic patients have an entitlement mentality that demands they be taken care of, while Republican patients are more self-reliant? Inquiring minds want to know.
A worthwhile question.