People who die in the hospital undergo more intense tests and procedures than those who die anywhere else.

An analysis by Arcadia Healthcare Solutions also shows that spending on people who die in a hospital is about seven times that on people who die at home.

The work confirms with hard data what most doctors and policymakers already know: Hospital deaths are more expensive and intrusive than deaths at home, in hospice care, or even in nursing homes.

“This intensity of services in the hospital shows a lot of suffering that is not probably in the end going to offer people more quality of life and may not offer them more quantity of life either,” says Dr. Richard Parker, chief medical officer at Arcadia.

Arcadia analyzed all the Medicaid claims data for a private Medicaid insurance company in one Western state and detailed how many billable medical procedures each patient received and where. Patients in hospitals were billed for far more medical interventions in the last days of their lives than people who died in other settings. The company declined to name the state or company.

The study showed that 42 percent of patients died at home at a cost of about $4,760 for their last month of life, while 40 percent died in a hospital at a cost of $32,379. Dying in a nursing home was the second most expensive locale, inpatient hospice was third and an emergency room was fourth.

“In the end, everyone died. They all died,” Parker tells Shots. “If we look at this retroactively, retrospectively — and we could go back and ask people — I bet most of them would say I’d rather be home with my family.”

Parker says the cost of hospital deaths paid for by Medicare or private insurance are likely even higher because they pay doctors and hospitals more for their services.

Many studies have shown that people, when asked, say they’d prefer to die at home rather than in a hospital. However, those wishes aren’t always realized if a person hasn’t given clear instructions to a doctor or family member.

Parker says hospitals are designed to cure people who are ill rather than to allow people to die peacefully.

“The culture of American medicine today and for the last several decades is to keep treating patients regardless of the quality of life,” he says. “A lot of physicians have been reluctant to admit that the patient’s life is coming to an end.”

The picture is more complicated than the data show, says Dr. Lachlan Forrow, a professor of medicine and medical ethics at Harvard University.

Many patients move from home to hospice to hospitals and back during the last 30 days of life. And some may end up in the hospital because their pain or symptoms weren’t adequately controlled at home.

Still, he says, hospitals are just not good at caring for dying people.

“We do lots of very expensive things in hospitals to people in the last part of life who would rather be home, and we do those in part because in the hospital they get paid for,” he says.

It’s the only way to justify keeping in a hospital the people who need around the clock nursing care but can’t get it at home.

“If we really tried to make sure people at home could have what they needed at home, we could take better care of them, with less medical system-caused suffering, at lower cost, sometimes much lower cost,” he says.

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As the summer unfolds, people are understandably interested in whether travel insurance will cover them if they cancel a trip because of concerns about the Zika virus. Other readers asked whether student health plans are a better option than the coverage from a health law marketplace and how an employer can’t offer mental health coverage. Here are the answers.

My wife and I have a trip planned to South America, but we’re increasingly worried about the Zika virus. We bought travel insurance when we booked the trip. If we cancel, will we be able to get our money back?

A typical travel insurance policy won’t reimburse you for trip expenses if you cancel because you’re afraid of traveling to a country where there have been reports of an outbreak of a disease such as the Zika virus.

But if you purchased a “cancel-for-any-reason” policy, your claim is more likely to be approved, said Megan Freedman, executive director of the U.S. Travel Insurance Association, a trade group. Like standard trip cancellation policies, these policies provide financial protection for unreimbursed expenses if you have to cancel your trip before it starts or interrupt it once you’re there. These policies also allow you to cancel for any reason, including pregnancy, a particular concern with the Zika virus. They typically cost a bit more than a standard policy. If you cancel, you’ll generally be reimbursed for about 75 percent of your prepaid expenses.

The Zika virus causes only mild flu-like symptoms in most people, but if women contract it during pregnancy, it can cause a devastating birth defect called microcephaly in their baby. Researchers estimate that babies born to between 1 and 13 percent of pregnant women who are infected during their first trimester will have that problem.

The virus is generally passed along through the bite of an infected mosquito.

Even if your travel insurance policy won’t approve your claim, it’s worth contacting your airline or hotel to ask about refunds, Freedman said.

“Ask what if any concessions your hotel or airline is extending,” she said.

I’m leaving my job to go to graduate school this summer. The college offers a student health plan, but would I be better off buying an individual plan on the marketplace? Since I worked half of the year, I suspect I won’t get much in subsidies.

The best choice for you will depend on a couple of factors, including how good the student plan is at your school and your coverage priorities: Do you want a plan with generous coverage or would you prefer something that may have a higher deductible, for example, but probably has a lower price tag?

Student health plans vary widely from school to school, said Stephen Beckley, a higher education health care consultant in Fort Collins, Colo. At many schools, coverage is equivalent to a platinum level plan on the state marketplace, meaning it pays 90 percent of the cost of medical services. A survey of student health plans at 38 public and private schools conducted by Hodgkins Beckley Consulting found average premiums were $184 at public universities and $217 at private colleges.

A platinum-level plan on the health law marketplaces would likely run more than that, especially if you don’t qualify for a federal tax credit to help pay the premium. On the state marketplaces, more than three-quarters of people who buy plans get premium tax credits, which are available to people with annual incomes up to 400 percent of the federal poverty level (about $47,000 for an individual). This year, after factoring in an average premium tax credit of $290, consumers paid on average $106 per month for coverage in the 38 states where the federal government operates the marketplace. Most people buy silver plans on the state exchanges, which pay for 70 percent of medical services, leaving them to pick up more of the cost of care than a platinum plan does.

My employer does not offer mental health benefits. What can I do?

You’re in a tough spot. The federal mental health parity law doesn’t require companies to offer mental health benefits. Rather, it says that if they do, the benefits have to be at least as generous as their medical/surgical benefits.

You have several options, but none of them is a slam dunk. Some therapists charge on a sliding scale for a small proportion of their caseload, said Lynn Bufka, a psychologist who is the associate executive director for practice research and policy at the American Psychological Association.

Depending on where you live, you may be able to find a local mental health clinic or federally qualified health center that offers mental health services for less than you’d pay a private therapist, Bufka said. You could also check out universities near you that have training programs for mental health professionals. You might be able to work with a student who’s under close supervision by a trained professional.

Once you find someone, ask if there are things you can do to help accelerate the work using self-help books or guided exercises between sessions.

“It’s important for people to understand that psychotherapy does not need to be a forever thing,” Bufka said. “It could be a 10 to 12 week intervention.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Email questions for future columns: KHNHelp@KFF.org. Michelle Andrews is on Twitter: @mandrews110.

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