How much does it cost to die? Depends where you live

The controversy of practice variability continues:

If you are dying in Miami, the last six months of your life might well look like this: You will see doctors, mostly specialists, 46 times; spend more than six days in an intensive care unit; and stand a 27 percent chance of dying in a hospital ICU. The tab for your doctor and hospital care will run just over $23,000.

Spend those last six months in Portland, Ore., and you will go to the doctor 18 times, half to see your primary care doctor; spend one day in intensive care; and stand a 13 percent chance of dying in an ICU. You will probably die at home, with the support of a hospice program. Total tab: slightly more than $14,000.

Combined with the inability to say no, these are major reasons why health care costs are soaring. The problem with practice variability is that there is no evidence to guide physicians with futile care.

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