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Does Capitated Reimbursement Encourage the Right Care for the Wrong Reason?

J. Randall Curtis, MD, MPH; Gordon D. Rubenfeld, MD, MS

JAMA. 1997;278(12):1025-1026.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

The quality of medical care at the end of life is receiving increased attention in both the popular press¹ and professional journals.^2,3 This interest has developed in part because of the perception that people die with ineffective, painful, expensive, and unwanted medical interventions that deprive them of their dignity, personal interactions, and family savings. This perception is not wholly unfounded. Approximately 60% of Americans die in hospitals.⁴ Among the deaths of hospitalized patients in the SUPPORT study,⁵ half died after receiving mechanical ventilation for more than 1 week. Many families of dying patients report that their loved ones experience moderate to severe pain during most or all of the loved ones' last few days. Many of the families of dying patients experience severe caregiving and financial burdens.⁶ Efforts to improve the quality of end-of-life care through advance directives, education, and more accurate prognostic information have . . . [Full Text PDF of this Article]

Author Affiliations
From the Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle.

Footnotes
Reprints: J. Randall Curtis, MD, MPH, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Box 359762, 325 Ninth Ave, Seattle, WA 98104 (e-mail: jrc@u.washington.edu).

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