BMJ  2004;328:1201 (15 May), doi:10.1136/bmj.328.7449.1201-b

Letter

Use of healthcare resources in the last six months of life

Findings should be approached with caution outside United States

The first 150 words of the full text of this article appear below.

EDITOR—The article by Wennberg et al on variation in the use of healthcare resources at the end of life raises several questions.1

It implies that the frequency of use of services is associated with workforce supply, but other studies contradict this. Supplier induced demand does not explain doctor variability in Norway,2 and economists have noted the methodological difficulty of making interpretations about supplier induced demand.3 Variability is still a major phenomenon in countries with centrally planned health systems which have less scope for inducement, such as the NHS in the United Kingdom. There is a fine interpretative line between healthcare activity that is induced by supply and healthcare activity that varies because some patients face inequitable barriers to access. Even if inducement is an issue in the United States, this interpretation may not be generalisable to other countries, given the market orientation of aspects of healthcare there.

The . . . [Full text of this article]

Tom Love, research fellow

t.love@tcgp.dundee.ac.uk

Tom Fahey, professor

Health Informatics Centre, University of Dundee, Dundee DD2 4BF


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Relevant Article

Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States
John E Wennberg, Elliott S Fisher, Thérèse A Stukel, Jonathan S Skinner, Sandra M Sharp, and Kristen K Bronner
BMJ 2004 328: 607. [Abstract] [Full Text] [PDF]

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