Physicians' political preferences and the delivery of end of life care in the United States

BMJ. 2018 Apr 11;361:k1161. doi: 10.1136/bmj.k1161.

Physicians' political preferences and the delivery of end of life care in the United States: retrospective observational study.

Jena AB1,2,3, Olenski AR4, Khullar D5,6, Bonica A7, Rosenthal H8.

Author information

1

Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA jena@hcp.med.harvard.edu.

2

Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

3

National Bureau of Economic Research, Cambridge, MA, USA.

4

Department of Economics, Columbia University, New York, NY, USA.

5

Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.

6

Department of Medicine, Weill Cornell Medical College, New York, NY, USA.

7

Department of Political Science, Stanford University, Stanford, CA, USA.

8

Department of Politics, New York University, New York, NY, USA.

Abstract

OBJECTIVES:

To compare the delivery of end of life care given to US Medicare beneficiaries in hospital by internal medicine physicians with Republican versus Democrat political affiliations.

DESIGN:

Retrospective observational study.

SETTING:

US Medicare.

PARTICIPANTS:

Random sample of Medicare beneficiaries, who were admitted to hospital in 2008-12 with a general medical condition, and died in hospital or shortly thereafter.

MAIN OUTCOME MEASURES:

Total inpatient spending, intensive care unit use, and intensive end of life treatments (eg, mechanical ventilation and gastrostomy tube insertion) among patients dying in hospital, and hospice referral among patients discharged but at high predicted risk of 30 day mortality after discharge. Physicians were categorized as Democrat, Republican, or non-donors, using federal political contribution data.

RESULTS:

Among 1 480 808 patients, 93 976 (6.3%) were treated by 1523 Democratic physicians, 58 876 (4.0%) by 768 Republican physicians, and 1 327 956 (89.6%) by 23 627 non-donor physicians. Patient demographics and clinical characteristics were similar between groups. Democrat physicians were younger, more likely to be female, and more likely to have graduated from a top 20 US medical school than Republican physicians. Mean end of life spending, after adjustment for patient covariates and hospital specific fixed effects, was US$17 938 (£12 872; €14 612) among Democrat physicians (95% confidence interval $17 176 to $18 700) and $18 409 among Republican physicians ($17 362 to $19 456; adjusted Republican v Democrat difference, $472 (-$803 to $1747), P=0.47). Intensive end of life treatments for patients who died in hospital did not vary by physician political affiliation. The proportion of patients discharged from hospital to hospice did not vary with physician political affiliation. Among patients in the top 5% of predicted risk of death 30 days after hospital discharge, adjusted proportions of patients discharged to hospice were 15.8%, 15.0%, and 15.2% among Democrat, Republican, and non-donor physicians, respectively (adjusted difference in proportion between Republicans v Democrats, -0.8% (-2.7% to 0.9%), P=0.43).

CONCLUSIONS:

This study provided no evidence that physician political affiliation is associated with the intensity of end of life care received by patients in hospital. Other treatments for politically polarised healthcare issues should be investigated.