finding,forexample,thathalfoftheelderlyovereighty
years old now die in the hospital and even higher
percentagesofthoselessthaneightyyearsolddo.These
arenumbersthatactuallyexceedthoseinmostdeveloped
countriestoday.VersionsofSara’s storyarebecoming
global. As incomes rise, private sector health care is
increasing rapidly, usually paid for in cash. Doctors
everywhere become alltoo ready to offer falsehopes,
leadingfamiliestoemptybankaccounts,selltheirseed
crops,andtakemoneyfromtheirchildren’seducationfor
futiletreatments.Yetatthesametime,hospiceprograms
are appearing everywhere from Kampala to Kinshasa,
Lagos to Lesotho, not to mention Mumbai to Manila.
Scholars have posited three stages of medical
developmentthatcountriesgothrough,parallelingtheir
economicdevelopment.Inthefirststage,whenacountry
is in extremepoverty, most deathsoccur in thehome
because people don’t have access to professional
diagnosis and treatment. In the second stage, when a
country’seconomydevelopsanditspeopletransitionto
higherincomelevels,thegreaterresourcesmakemedical
capabilitiesmorewidelyavailable.Peopleturntohealth
caresystemswhentheyareill.Attheendoflife,they
oftendieinthehospitalinsteadofthehome.Inthethird
stage,asacountry’sincomeclimbstothehighestlevels,
peoplehavethemeanstobecome concerned aboutthe
quality of their lives, even in sickness, and deathsat
home actually rise again.
ThispatternseemstobewhatishappeningintheUnited
States.Whereas deathsinthehome wentfrom a clear
majorityin 1945 tojust 17 percent inthelateeighties,