Less is not always more, but it can be good enough. The New York Times published an article yesterday showing “two starkly different paths toward death in New York City’s hospitals, one for patients at elite private institutions, another for those at public hospitals, according to new data compiled as part of a consumer rating system.” The data showed that despite getting more expensive and intensive care, including more physician referrals, elderly patients in their last two years of life in private hospitals had similar outcomes as those in public hospitals.

Although the article arrogantly goes into bashing the financial incentives of doctors in private hospitals for ordering more tests and physician referrals, the bottom line is this: the super aggressive throw-everything-at-the-patient mentality doesn’t usually make much of a difference in prolonging life. The reason most doctors do it is the fear of litigation. This is the burden of practicing defensive medicine and public hospitals can get away with doing less because their patients tend to have lower expectations than their rich “upper class” counterparts.

Maybe we should do our best to take patient care out of the hands of big hospitals and into the more sensible hands of independent outpatient physicians and specialty centers (the ones big hospitals have been fighting so hard). And, please, let’s also not forget about some kind of tort reform.

Filed under: Health Policy