Doctors and hospitals contribute to spiraling health care expenditures by using virtually every technological advancement and prolonging life at all costs, a medical expert said this week.

"Prolongation of dying" has resulted in "90 percent of health care expenses" occurring in the last year of the average patient's life, said Thomas Riemenschneider, director of the Biomedical Ethics Center at Case Western Reserve University's School of Medicine."Are we extending the quality of life or only the life at tremendous costs?" asked Riemenschneider, who also is chief of pediatric cardiology at Case Western Reserve, Cleveland, Ohio.

He told University of Utah medical school instructors and students the health care community is under pressure from business, government, insurance companies and society to reduce medical costs.

"Where the emphasis" on health care "had been on quality and then access, it is now on costs," Riemen-schneider said.

Businesses, facing annual increases in medical benefit programs for their employees and retired workers, now are challenging doctors and hospitals to reduce those expenses.

"Business is telling us, `You guys aren't doing the job. We're going to do it for you.' The driver for the businessman is the cost of medical care, not the quality," he said.

In a traditional economic system, an increase in supply translates into a decrease in price, he said, "but that hasn't worked in health care."

More and more doctors entering the industry and new technology have resulted in more doctors treating one patient and more medical tests on that patient, pushing the cost up with each new service.

"We've got to get rid of the excess in our system," Riemenschneider said. "You don't start by ordering 45 tests. We have to ensure the appropriate use of new technology."

About half of the yearly increase in medical costs is the result of inflation, over which doctors and hospitals have virtually no control, he said. But costs related to such things as "intensity of services" can be reduced.

"If we don't do it, somebody will do it for us," he said.

One approach, he said, is for doctors to encourage healthy habits and healthy lifestyles among their patients. The time for prevention is now, he said.

"There never has been a time when our society's been more ready for it," Riemenschneider said. But the majority of doctors "are not ready for it. We don't take the time for it."

One reason most doctors and health-care providers spend little time on preventive medicine and encouraging healthy lifestyles, he said, "is because we don't get reimbursed for prevention."

But he said such programs will help doctors achieve the ethical goal of "providing high-quality care for all in society. It's an opportunity to move to a higher level of health care."

The payoff to employers, Riemenschneider said, is healthier and more productive workers who take less sick leave, recover more quickly from hospitalization, and eventually reduce the costs of health benefit programs.