Comparative Metrics and Policy Learning: End-of-Life Care in France and the US

Abstract

Comparative policy analysis sometimes relies on the use of metrics to foster policy learning. We compare health care for patients at the end of life (EOL) in the US and France. The analysis aims to enable policy makers in both nations to reexamine their own health systems in light of how their counterparts are responding to common concerns about the intensity, quality and cost of EOL care. We find that a higher percentage of French decedents 65 years and over, are hospitalized, yet they spend fewer days in intensive care units (ICUs) than their counterparts for whom data are available (Medicare beneficiaries) in the US. In addition, decedents in the US consult with a higher number of different physicians than their French counterparts. We also compare patterns of hospital use for decedents in EOL care among academic medical centers (AMCs) in the US and France. We find greater variation among French AMCs than among their counterparts in the US.

Keywords:

• comparative analysis
• end of life care
• France
• United States

Additional information

Notes on contributors

Michael K. Gusmano

Michael K. Gusmano, PhD is an Associate Professor of Health Policy in the Rutgers University School of Public Health and a core member of the Institute for Health, Health Care and Aging Research. In addition to his appointments at Rutgers, Dr. Gusmano is a research scholar at the Hastings Center and a Senior Fellow at the Rockefeller Institute of Government. His research focuses on aging, health, and social policy.

Victor G. Rodwin

Victor G. Rodwin, PhD, MPH, is a Professor at the Robert F. Wagner School of Public Service, New York University and Co-Director (with Michael Gusmano) of the World Cities Project. Professor Rodwin’s research and teaching focus on population health and policy, comparative analysis of health care systems and international perspectives on health system performance and reform.

Daniel Weisz

Daniel Weisz, MD, MPA, is a research associate at the Robert N. Butler Columbia Aging Center, Columbia University. Dr. Weisz’s research efforts, as a staff member of the World Cities Project (WCP), have been directed at the health policy implications of comparisons of health system performance and the analysis of health and health care disparities both inter- and intra-city in New York, Paris, London and other cities included in the WCP. He is a New York State licensed physician, a Board certified General and Cardiothoracic Surgeon, retired from clinical practice.

Jonathan Cottenet

Jonathan Cottenet is a statistician in the Department of Biostatistics and Medical Informatics, University Hospital Center in Dijon, France.

Catherine Quantin

Catherine Quantin, MD, PhD, is a Professor and head of the Department of Biostatistics and Medical Informatics, University Hospital Center in Dijon, France. She is also a researcher at the Institut National de la Santé et de la Recherche Médicale in France (Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI) team, Paris).