Over-treatment: Defensive vs. Offensive Medicine

Nancy Morden has a new article in Health Affairs that examines the association between hospital characteristics and eleven end-of-life care measures, such as hospice use and hospitalization.  Her study reveals a relatively high intensity of care in the last weeks of life.  At the same time, there was more than a twofold variation within hospital groups with common features, such as cancer center designation and for-profit status.  These hospital characteristics explained little of the observed variation in intensity of end-of-life cancer care and that none reliably predicted a specific pattern of care. These findings raise questions about what factors may be contributing to this variation.   




Is the law in part to blame?  Surrogate-driven over-treatment is often due to defensive medicine.  Here, physician-driven over-treatment is due to offensive medicine.  Morden demonstrates that financial incentives play a role.