Health care rationing ...( nt age or who were only a few years pas...)

Old and terminally ill patients were responsible for the lowest costs overall. Declining expenditures indicate health rationing, where expenses and outcome are weighed against one another, rather than striving for an optimal medical outcome. One explanation for health care rationing could be that patients do not want intensive care. "It is conceivable that the most elderly in-patients want less medically aggressive, i.e. less costly, treatment," explains Dr. Brockmann. According to some surveys, the majority would rather die at home than in hospital. The reality is somewhat different, as nearly 50 per cent of all people die in hospitals. Brockmann supposes that age-specific cost patterns are caused by clinical decision making. For example: age is an indicator of probability of death, and a death that occurs during treatment might be considered a medical failure. Furthermore, there is less knowledge about the treatment of older patients and the most elderly. Like babies, the elderly have been largely excluded from clinical trials in order to minimize analytical problems caused by co-morbidity or an increased risk that participants die during the course of the study.

The question remains as to whether lives at advanced ages could be saved if age rationing were discontinued and maximum medical treatment were to be applied to everyone, irrespective of their age. Brockmann plans to carry out a follow-up study using data from different health insurers in Germany and other countries.

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Contact: Dr. Hilke Brockmann
Brockmann@demogr.mpg.de
49-381-208-1161
Max-Planck-Gesellschaft
11-Nov-2002