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Comment & Response |

Characteristics of Patients Dying With Cancer in Developed Countries

Christof Schaefer, MD, MBioethics, MA1
[+] Author Affiliations
1Department of Radiation-Oncology, MVZ Klinikum Straubing GmbH, Straubing, Germany
JAMA. 2016;315(24):2731-2732. doi:10.1001/jama.2016.4036.
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To the Editor A cross-national study1 found differences in 7 developed nations in the place of death, health care utilization, and hospital expenditures for patients dying with cancer, a finding that might be surprising but corresponds with comparable studies.2

The question arises if the observed differences could have been caused by the different data sources. Concerning Germany, the authors used only data from BARMER GEK, which was incorrectly called Germany’s largest health insurance fund (it is the second largest insurance fund3). The other 168 health insurance funds were not considered and private insurance was completely ignored. If all of those data were used, the results might have been different. According to the study, the hospital expenditures of the German system were intermediate. It is likely that the real costs are higher because private insurance is more expensive and other insurance funds cover sicker patients. The authors could defend their approach as pragmatic because it would be difficult to contact all of the German health insurance funds. However, the German Federal Statistical Office possesses all of the data, including all health insurance funds, and would describe the German health care system more accurately. Consulting this database reveals that 47% of all patients died in the hospital in 2008,4 which contradicts the 38% in the study.

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January 19, 2016
Justin E. Bekelman, MD; Scott D. Halpern, MD, PhD; Carl Rudolf Blankart, PhD; Julie P. Bynum, MD, MPH; Joachim Cohen, MSc, PhD; Robert Fowler, MDCM, MS(Epi); Stein Kaasa, MD, PhD; Lukas Kwietniewski, MSc; Hans Olav Melberg, PhD; Bregje Onwuteaka-Philipsen, PhD; Mariska Oosterveld-Vlug, PhD; Andrew Pring, MSc; Jonas Schreyögg, PhD; Connie M. Ulrich, PhD, RN; Julia Verne, MBBS, PhD; Hannah Wunsch, MD, MSc; Ezekiel J. Emanuel, MD, PhD; for the International Consortium for End-of-Life Research (ICELR)
1Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia2Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
2Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia3Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia4Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
5Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany6Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island
7Dartmouth Institute for Health Policy and Clinical Research, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
8End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
9Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada10Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
11Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway12Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway
5Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
13Department of Health Management and Health Economics, University of Oslo, Oslo, Norway14Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
15Department of Public and Occupational Health, EMGO Institute for Health and Care Research and Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
16National End of Life Care Intelligence Network, Public Health England, London
2Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
10Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
JAMA. 2016;315(3):272-283. doi:10.1001/jama.2015.18603.
June 28, 2016
Carl Rudolf Blankart, PhD; Ezekiel J. Emanuel, MD, PhD; Justin E. Bekelman, MD; for the International Consortium for End-of-Life Research
1Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
2Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
3Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
JAMA. 2016;315(24):2732. doi:10.1001/jama.2016.4042.
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