In modern times, doctors in medical school and residency are steeped in a 'teach to the protocol' environment, mandated by the government and the threat of lawsuits if bold efforts don't work. With the gradual takeover of health care by governments, creativity and and initiative are going to decline even further but some hospitals still engage in high hospital care intensity (HCI) and they have lower rates of patients dying from a major complication, called failure to rescue. 

Aggressive treatment is what everyone wants, but the economic reality is that such efforts will only be available for the rich. Because aggressive health care will mean longer hospitalizations and no longer under control of a health insurer, but rather a centralized government policy that mandates the same effort for everyone.

The intensity of medical care already varies around the country but it was not based solely on individual wealth in the past. Yet when costs for everyone are borne by everyone, intensity is going to be scrutinized because an aggressive treatment style has been implicated in rising health care costs, especially during the end-of-life period.  It's why America has both the best and most expensive care in the world and voters have decided they no longer want to be the best. 

Inpatient surgery also is a cost burden and so Kyle H. Sheetz, M.D., M.S., of the Center for Healthcare Outcomes and Policy, Ann Arbor, Mich., and colleagues analyzed national Medicare data to examine increased HCI and outcomes after major surgery. 

They identified 706,520 patients at 2,544 hospitals who underwent 1 of 7 major cardiovascular, orthopedic or general surgical operations. The Dartmouth Atlas provides metrics of health care intensity for Medicare beneficiaries in their last two years of life. 

Patients who had surgery at high HCI vs. low HCI hospitals had increased major complication rates. However, patients who had surgery at high HCI hospitals were 5 percent less likely to die of a major complication (failure to rescue) than at a low HCI facility. However, patients treated at high-HCI hospitals had longer hospitalizations, more inpatient deaths and lower hospice use during the final two years of life.

"Hospital care intensity has an independent influence on established quality metrics for surgical care, although its ability to improve quality through direct augmentation appears limited."