In The Journal of the American Medical Association, Justin Bekelman and colleagues, including Scott Halpern, Connie Ulrich and Ezekiel Emanuel compare site of death, health care utilization and hospital expenditures in 7 countries: Belgium, Canada, England, Germany, the Netherlands, Norway and the United States. Using administrative and registry data, the researchers measured deaths in acute care hospital, along with inpatient and outpatient measures, and hospital expenditures paid by insurers. They find that a smaller proportion of decedents, older than 65, died in acute care hospitals in the United States and the Netherlands compared to decedents in Belgium, Canada, England, Germany and Norway. Hospital expenditures near the end of life were higher in the United States, Norway and Canada, intermediate in Germany and Belgium, and lower in the Netherlands and England. However, intensive care unit admissions in the last 180 days of life were more than twice as common in the United States as in other countries.