title: The inverse relationship between cost and prognosis.
abstract: While doctors get the blame for increasing medical costs, studies how that societal, political factors, and medicine's limitations are the culprit. Clinicians (I use the term to distinguish between those M.D.s who work at the bedside and others who are in nonpatient direct care) are well aware of the hugh costs associated with serious illness, but it is only recently that many papers are appearing in the medical literature discussing this problem in relation to medical care. In a study published in JAMA (April 10, 1981), Steven A. Schroeder, et al., found that high cost illness is really terminal illness in a random sample of 776 adult high-cost patients. Two years after discharge at least 34% of high cost patients had died and these patients accounted for 39% of the hospital charges incurred by the total group studied. Francis Moore and colleagues pointed out in the New England Journal of Medicine (March 12, 1981) that this very group of patients also had the highest incidence of complications in the surgical field. In one year they identified 36 such cases at the Peter Bent Brigham Hospital in Boston; the total cost of their care was nearly $2,000,000. While there were unnecessary complications, in this group of patients it is very likely inevitable that the complication rate will be high. Since many authors seem to imply that it is the clinicians who are at fault to a large extent in generating these costs, I would like to point out that the physician-clinician actually has control over a relatively small percent of the total cost.
mesh_terms: D003256:Community Participation; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics*; D004470:Economics, Medical; D006266:Health Education; D006801:Humans; D011379:Prognosis; D014481:United States