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Editorials |

ICU Care at the End of Life

Kelly A. Wood, MD, MHS, FCCP; Paul E. Marik, MD, FCCP
Author and Funding Information

Affiliations: Pittsburgh, PA
 ,  Dr. Wood is Assistant Professor of Pulmonary and Critical Care Medicine, University of Pittsburgh. Dr. Marik is Professor of Critical Care Medicine, University of Pittsburgh.

Correspondence to: Paul Marik, MD, FCCP, Professor of Critical Care Medicine, Department of Critical Care, University of Pittsburgh, 640A Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261; e-mail: maripe@ccm.upmc.edu



Chest. 2004;126(5):1403-1406. doi:10.1378/chest.126.5.1403
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Total health-care costs in the United States have reached an astonishing $1.4 trillion, or 14% of the gross domestic product. Per capita spending is double that of other industrialized nations.1 Yet, according to the World Health Organization, the United States ranks 37th of 191 countries in its overall health system performance, and 72nd from the viewpoint of disease-adjusted life expectancy.2 A disproportionate share of the total health-care costs in the United States is attributable to the care of the elderly patient before their death. In 1999, inpatient expenditures for the Medicare fee-for-service population was $90 billion, of which one fourth was accrued by descendants.3 Previous data have indicated that 40% of this expenditure occurs in the last month of the descendant’s life.4 Furthermore, 60% of all intubations and tracheostomies are performed in Medicare descendants, and 39% of Medicare descendants are admitted to an ICU during their terminal illness.3

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