Utilization of Physician Services at the End of Life: Differences Between the United States and Canada

This study draws on physician claims for the elderly from the U.S. Medicare program and the Canadian provinces of Quebec and British Columbia to compare physician service use by people with fewer than six months to live relative to those who live longer. Physician service quantities are expressed in relative value units (RVUs), and aggregated into clinical type-of-service categories. Relative to survivors, those in the United States approaching death receive about the same amount of evaluation and management services as those in Quebec and British Columbia, though less in absolute value; they also receive about the same amount of procedures as those nearing death in British Columbia, but half as much in proportion as people nearing death in Quebec. Further analyses of appropriateness of care to the dying appear no less necessary in Canada than in the United States.