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Nicholas LH. Using Address Data to Track Household Financial Burden of Disease. Med Care 2023; 61:S92-S94. [PMID: 37963026 PMCID: PMC10635339 DOI: 10.1097/mlr.0000000000001909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The financial burden of illness cannot be correctly characterized without accounting for the impacts across healthy and sick members of a household. Currently, we have very few large, nationally representative data resources to facilitate such work. This paper describes ways to move the field forward through a novel application of address data.
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Li J, Braun RT, Kakarala S, Prigerson HG. How Should Cost-Informed Goals of Care Decisions Be Facilitated at Life's End? AMA J Ethics 2022; 24:E1040-E1048. [PMID: 36342486 PMCID: PMC9811733 DOI: 10.1001/amajethics.2022.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Interventions near patients' deaths in the United States are often expensive, burdensome, and inconsistent with patients' goals and preferences. For patients and their loved ones to make informed care decisions, physicians must share adequate information about prognoses, prospective benefits and harms of specific interventions, and costs. This commentary on a case discusses strategies for sharing such information and suggests that properly designed advance care planning incentives can help improve communication and decision sharing.
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Affiliation(s)
- Jing Li
- Assistant professor in the Comparative Health Outcomes, Policy, and Economics Institute and in the Department of Pharmacy in the School of Pharmacy at the University of Washington in Seattle
| | - Robert Tyler Braun
- Assistant professor in the Division of Health Policy and Economics in the Department of Population Health Sciences at Weill Cornell Medical College in New York City
| | - Sophia Kakarala
- Research assistant at the Center for Research on End-of-Life Care at Weill Cornell Medicine in New York City
| | - Holly G Prigerson
- Irving Sherwood Wright Professor of Geriatrics at Weill Cornell Medicine in New York City
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Zhu Y, Enguidanos S. Advance directives completion and hospital out-of-pocket expenditures. J Hosp Med 2022; 17:437-444. [PMID: 35527477 PMCID: PMC9325451 DOI: 10.1002/jhm.12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Health care costs remain high at the end of life. It is not known if there is a relationship between advance directive (AD) completion and hospital out-of-pocket costs. This analysis investigated whether AD completion was associated with lower hospital out-of-pocket costs at end of life. METHODS We used Health and Retirement Study participants who died between 2000 and 2014 (N = 9228) to examine the association between AD completion status and hospital out-of-pocket spending in the last 2 years of life through the use of a two-part model controlling for socioeconomic status, death-related characteristics and health insurance coverage. RESULTS About 44% of decedents had completed ADs. Having an AD was significantly associated with $673 lower hospital out-of-pocket costs, with a higher magnitude of savings among younger decedents. Decedents who completed ADs 3 months or less before death had higher out-of-pocket costs ($1854 on average) than those who completed ADs more than 3 months before death ($1176 on average). CONCLUSIONS AD completion was significantly associated with lower hospital out-of-pocket costs, with greater out-of-pocket savings among younger decedents. Early AD completers experienced lower costs than decedents who completed ADs closer to death.
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Affiliation(s)
- Yujun Zhu
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Susan Enguidanos
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Richards OK, Iott BE, Toscos TR, Pater JA, Wagner SR, Veinot TC. "It's a mess sometimes": patient perspectives on provider responses to healthcare costs, and how informatics interventions can help support cost-sensitive care decisions. J Am Med Inform Assoc 2022; 29:1029-1039. [PMID: 35182148 PMCID: PMC9093030 DOI: 10.1093/jamia/ocac010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/13/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We investigated patient experiences with medication- and test-related cost conversations with healthcare providers to identify their preferences for future informatics tools to facilitate cost-sensitive care decisions. MATERIALS AND METHODS We conducted 18 semistructured interviews with diverse patients (ages 24-81) in a Midwestern health system in the United States. We identified themes through 2 rounds of qualitative coding. RESULTS Patients believed their providers could help reduce medication-related costs but did not see how providers could influence test-related costs. Patients viewed cost conversations about medications as beneficial when providers could adjust medical recommendations or provide resources. However, cost conversations did not always occur when patients felt they were needed. Consequently, patients faced a "cascade of work" to address affordability challenges. To prevent this, collaborative informatics tools could facilitate cost conversations and shared decision-making by providing information about a patient's financial constraints, enabling comparisons of medication/testing options, and addressing transportation logistics to facilitate patient follow-through. DISCUSSION Like providers, patients want informatics tools that address patient out-of-pocket costs. They want to discuss healthcare costs to reduce the frequency of unaffordable costs and obtain proactive assistance. Informatics interventions could minimize the cascade of patient work through shared decision-making and preventative actions. Such tools might integrate information about efficacy, costs, and side effects to support decisions, present patient decision aids, facilitate coordination among healthcare units, and eventually improve patient outcomes. CONCLUSION To prevent a burdensome cascade of work for patients, informatics tools could be designed to support cost conversations and decisions between patients and providers.
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Affiliation(s)
- Olivia K Richards
- University of Michigan, School of Information, Ann Arbor, Michigan, USA
| | - Bradley E Iott
- University of Michigan, School of Information, Ann Arbor, Michigan, USA
| | - Tammy R Toscos
- Parkview Mirro Center for Research & Innovation, Fort Wayne, Indiana, USA
| | - Jessica A Pater
- Parkview Mirro Center for Research & Innovation, Fort Wayne, Indiana, USA
| | - Shauna R Wagner
- Parkview Mirro Center for Research & Innovation, Fort Wayne, Indiana, USA
| | - Tiffany C Veinot
- University of Michigan, School of Information, Ann Arbor, Michigan, USA
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Hopeck P. Care workers’ experiences discussing financial issues with families facing end-of-life decisions. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2021. [DOI: 10.4081/qrmh.2020.9102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Numerous studies have confirmed the presence of financial difficulties for families when a loved one is at the end of life. However, few studies examine the discussions family members have with care workers about financial issues during end of life. The research presented here examines the experiences that care workers have with family members expressing financial concerns and how care workers respond. I conducted in-depth interviews with fifty-eight care workers, defined in this study as clergy, patient advocates, and nurses who had experiences talking with families about financial issues. Transcripts of the interviews served as the data set. I transcribed, coded and analyzed the data. Families talk about financial issues openly, although sometimes guiltily. Some families express difficulties implicitly, and in these cases, care workers often had to piece together information based on other statements and behaviors of the family. Care workers suggest solutions at the interpersonal, organizational, inter-organizational, social, and national levels. Findings also support prior research that it is important for families to have end-of-life discussions before death is imminent so that families may plan accordingly, and offer insights about care workers and their role in making financial discussions easier for families.
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Close E, White BP, Willmott L, Gallois C, Parker M, Graves N, Winch S. Doctors' perceptions of how resource limitations relate to futility in end-of-life decision making: a qualitative analysis. JOURNAL OF MEDICAL ETHICS 2019; 45:373-379. [PMID: 31092631 DOI: 10.1136/medethics-2018-105199] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/07/2019] [Accepted: 03/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility. SETTING Three tertiary hospitals in metropolitan Brisbane, Australia. DESIGN Qualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic analysis. RESULTS Doctors' perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing. CONCLUSIONS Doctors' ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors' role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making.
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Affiliation(s)
- Eliana Close
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Cindy Gallois
- Faculty of Social and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Malcolm Parker
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sarah Winch
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Miljeteig I, Defaye FB, Wakim P, Desalegn DN, Berhane Y, Norheim OF, Danis M. Financial risk protection at the bedside: How Ethiopian physicians try to minimize out-of-pocket health expenditures. PLoS One 2019; 14:e0212129. [PMID: 30753215 PMCID: PMC6372229 DOI: 10.1371/journal.pone.0212129] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/27/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Out-of-pocket health expenditures can pose major financial risks, create access-barriers and drive patients and families into poverty. Little is known about physicians' role in financial protection of patients and families at the bedside in low-income settings and how they perceive their roles and duties when treating patients in a health care system requiring high out-of-pocket costs. OBJECTIVE Assess physicians' concerns regarding financial welfare of patients and their families and analyze physicians' experiences in reducing catastrophic health expenditures for patients in Ethiopia. METHOD A national survey was conducted among physicians at 49 public hospitals in six regions in Ethiopia. Descriptive statistics were used. RESULTS Totally 587 physicians responded (response rate 91%) and 565 filled the inclusion criteria. Health care costs driving people into financial crisis and poverty were witnessed by 82% of respondants, and 88% reported that costs for the patient are important when deciding to use or not use an intervention. Several strategies to save costs for patients were used: 37-79% of physicians were doing this daily or weekly through limiting prescription of drugs, limiting radiologic studies, ultrasound and lab tests, providing second best treatments, and avoiding admission or initiating early discharge. Overall, 75% of the physicians reported that ongoing and future costs to patients influenced their decisions to a greater extent than concerns for preserving hospital resources. CONCLUSION In Ethiopia, a low-income country aiming to move towards universal health coverage, physicians view themselves as both stewards of public resources, patient advocates and financial protectors of patients and their families. Their high concern for family welfare should be acknowledged and the economic and ethical implications of this practice must be further explored.
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Affiliation(s)
- Ingrid Miljeteig
- Research Group in Global Health Priorities, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Research and Development, Helse Bergen Health Trust, Bergen, Norway
| | - Frehiwot Berhane Defaye
- Research Group in Global Health Priorities, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Medical Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Paul Wakim
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Dawit Neema Desalegn
- Research Group in Global Health Priorities, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Medical Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Ole Frithjof Norheim
- Research Group in Global Health Priorities, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, United States of America
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Hageman SA, Tarzian AJ, Cagle J. Challenges of Dealing with Financial Concerns during Life-Threatening Illness: Perspectives of Health Care Practitioners. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2018; 14:28-43. [PMID: 29505397 DOI: 10.1080/15524256.2018.1432008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The costs of serious medical illness and end of life care are often a heavy burden for patients and families (Collins, Stepanczuk, Williams, & Rich, 2016 ; Kim, 2007 ; May et al., 2014 ; Zarit, 2004 ). Twenty-six practitioners, including social workers, managers/administrators, supervisors, and case managers from five health care settings, participated in qualitative semistructured interviews about financial challenges patients encountered. Seven practitioners took part in a focus group. Practitioners were recruited from hospice (n = 5), long-term care (n = 5), intensive care (n = 5), dialysis (n = 6), and oncology (n = 5). Interview and focus group questions focused on financial challenges patients encountered when facing life-threatening illness. Interview data were transcribed and thematically coded and trustworthiness of data was established with peer debriefing, member checking, and agreement on themes among the authors. Practitioners described interacting micro, meso, and macroinfluences on the financial well-being and challenges patients encountered. Microlevel influences involved patient characteristics, such as their demographic profile and/or health status that set them up for financial aptitude or challenges. Macrolevel influences involved the larger health care/safety net system, which provided valuable resources for some patients but not others. Practitioners also discussed the mesolevel of influence, the local setting where they worked to match available resources with patients' individual needs given the constraints emerging from the micro and macrolevels. Practitioners described how they navigated the interplay of these three areas to meet patients' needs and cope with financial challenges. Implications for practice point to directly addressing the kind of financial concerns that patients and families facing financial burden from serious medical illness have, and identifying ways to bridge knowledge and resource access gaps at the individual, organizational, and societal levels.
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Affiliation(s)
- Sally A Hageman
- a University of Maryland, Baltimore, School of Social Work , Baltimore , Maryland , USA
| | - Anita J Tarzian
- b University of Maryland, Baltimore, School of Nursing , Baltimore , Maryland , USA
| | - John Cagle
- a University of Maryland, Baltimore, School of Social Work , Baltimore , Maryland , USA
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Immunothérapie : une innovation de rupture non soutenable économiquement ? Bull Cancer 2016; 103 Suppl 1:S186-S192. [DOI: 10.1016/s0007-4551(16)30377-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Meluch AL, Oglesby WH. Physician–patient communication regarding patients’ healthcare costs in the US: A systematic review of the literature. ACTA ACUST UNITED AC 2015. [DOI: 10.1179/1753807615y.0000000010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Aplin B, Nazzal M, Qu W, Zelenock G, Kazan V, Abbas J. Patient variables impacting hospital costs from 2008 to 2010. Am J Surg 2014; 210:134-40. [PMID: 25457235 DOI: 10.1016/j.amjsurg.2014.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/29/2014] [Accepted: 08/04/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studying the variables associated with the increased costs of health care provides valuable insight. METHODS A review and analysis of the pertinent variables and information collected for 118.3 million hospital admissions recorded as Nationwide Inpatient Samples database was done for the years 2008 to 2010. We used hospital charges as an approximation of costs in the analysis of the patient variables and other factors contributing to hospital costs. RESULTS The top 5 factors with the most impact on charges were diagnostic category, length of stay, number of procedures, major operating room procedures, and ownership of the hospital. CONCLUSION The top 5 factors with the most impact on charges were length of stay, number of procedures, major diagnostic category, major operating room procedures, and ownership of the hospital.
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Affiliation(s)
- Brett Aplin
- Department of Surgery, The University of Toledo, Toledo, OH
| | - Munier Nazzal
- Department of Surgery, The University of Toledo, Toledo, OH.
| | - Weikai Qu
- Department of Surgery, The University of Toledo, Toledo, OH
| | | | - Viviane Kazan
- Department of Surgery, The University of Toledo, Toledo, OH
| | - Jihad Abbas
- Department of Surgery, The University of Toledo, Toledo, OH
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Tucker-Seeley RD, Abel GA, Uno H, Prigerson H. Financial hardship and the intensity of medical care received near death. Psychooncology 2014; 24:572-8. [PMID: 25052138 DOI: 10.1002/pon.3624] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/26/2014] [Accepted: 06/30/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although end-of-life (EOL) care can present a substantial financial burden for the household, the influence of this burden on the intensity of care received at the EOL remains unknown. The goal of this study was to determine the association between financial hardship and intensive care in the last week of life. METHODS The Coping with Cancer (CwC) Study is a longitudinal, multisite cohort study of terminally ill cancer patients and their informal caregivers, September 2002-February 2008. Patients (N = 281) were followed from baseline to death, a median of 4.4 months after baseline assessment. Intensive care was defined as the use of resuscitation and/or ventilation in the patient's last week of life. Financial hardship was measured at study baseline as a positive response to whether the household had to use all or most of their savings because of the family member's illness. RESULTS Twenty-nine percent reported financial hardship, and 9% received intensive EOL care. Patients reporting financial hardship had a 3.22 (95% CI: 1.38, 7.53) higher likelihood of receiving intensive EOL care compared with patients not reporting financial hardship. After adjusting for sociodemographic characteristics and patient preferences, patients reporting financial hardship had a 3.05 (95% CI: 1.22, 7.62) higher likelihood of receiving intensive EOL care. CONCLUSION The depletion of a family's financial resources is a significant predictor of intensive EOL care, over and above the influence of sociodemographic characteristics and patient preferences.
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Teaching and practicing cost-awareness in the intensive care unit: A TARGET to aim for. J Crit Care 2014; 29:107-11. [DOI: 10.1016/j.jcrc.2013.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/16/2013] [Accepted: 08/18/2013] [Indexed: 11/20/2022]
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Exploring public attitudes towards approaches to discussing costs in the clinical encounter. J Gen Intern Med 2014; 29:223-9. [PMID: 23881272 PMCID: PMC3889963 DOI: 10.1007/s11606-013-2543-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/28/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patients' willingness to discuss costs of treatment alternatives with their physicians is uncertain. OBJECTIVE To explore public attitudes toward doctor-patient discussions of insurer and out-of-pocket costs and to examine whether several possible communication strategies might enhance patient receptivity to discussing costs with their physicians. DESIGN Focus group discussions and pre-discussion and post-discussion questionnaires. PARTICIPANTS Two hundred and eleven insured individuals with mean age of 48 years, 51 % female, 34 % African American, 27 % Latino, and 50 % with incomes below 300 % of the federal poverty threshold, participated in 22 focus groups in Santa Monica, CA and in the Washington, DC metro area. MAIN MEASUREMENTS Attitudes toward discussing out-of-pocket and insurer costs with physicians, and towards physicians' role in controlling costs; receptivity toward recommended communication strategies regarding costs. KEY RESULTS Participants expressed more willingness to talk to doctors about personal costs than insurer costs. Older participants and sicker participants were more willing to talk to the doctor about all costs than younger and healthier participants (OR = 1.8, p = 0.004; OR = 1.6, p = 0.027 respectively). Participants who face cost-related barriers to accessing health care were in greater agreement than others that doctors should play a role in reducing out-of-pocket costs (OR = 2.4, p = 0.011). Participants did not endorse recommended communication strategies for discussing costs in the clinical encounter. In contrast, participants stated that trust in one's physician would enhance their willingness to discuss costs. Perceived impediments to discussing costs included rushed, impersonal visits, and clinicians who are insufficiently informed about costs. CONCLUSIONS This study suggests that trusting relationships may be more conducive than any particular discussion strategy to facilitating doctor-patient discussions of health care costs. Better public understanding of how medical decisions affect insurer costs and how such costs ultimately affect patients personally will be necessary if discussions about insurer costs are to occur in the clinical encounter.
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McLeod-Sordjan R. Death preparedness: a concept analysis. J Adv Nurs 2013; 70:1008-19. [DOI: 10.1111/jan.12252] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Renee McLeod-Sordjan
- Pace University; College of Health Professions; New York New York USA
- Attending Division of Medical Ethics, North Shore-Long Island Jewish, University Hospital System; Great Neck, New York USA
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Changing expectations concerning life-extending treatment: The relevance of opportunity cost. Soc Sci Med 2013; 85:66-73. [DOI: 10.1016/j.socscimed.2013.02.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 02/20/2013] [Accepted: 02/25/2013] [Indexed: 11/22/2022]
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