http://jama.jamanetwork.com/ en-us Mon, 10 Sep 2012 00:00:00 GMT Tue, 01 Jan 2013 00:43:50 GMT Silverchair editor@jama.jamanetwork.com webmaster@jama.jamanetwork.com http://jama.jamanetwork.com/article.aspx?articleID=1104456 Wed, 05 Oct 2011 00:00:00 GMT White DB, Arnold RM. <span class="paragraphSection">There are 2 widely known problems with end-of-life care in the United States. First, care often does not reflect patients' values and preferences. Second, end-of-life care constitutes a disproportionate amount of health care expenditures. There is a need to improve the value of health care spending because of changing economic and political climates and because Medicare and Medicaid costs account for nearly a quarter of the federal budget. Despite recognition that advance directives have conceptual limitations, their appeal persists because of the theoretical possibility that advance directives can simultaneously improve the patient centeredness of care and decrease health care expenditures near the end of life.</span> 306 13 1485 1486 10.1001/jama.2011.1430 http://jama.jamanetwork.com/article.aspx?articleID=1104456