Carlos Garcia, chief compliance officer for Metropolitan Hospital, said the new owners have not had a chance to study the complicated data. ''We are reviewing this report now, so I can't comment,'' he said.

• In west Miami-Dade, two-thirds of the patients at Westchester General will bounce between 10 or more specialists in their last six months of life. At Homestead, only a third will do that. Westchester General did not respond to two requests for comment.

The hospitals with high costs insist they shouldn't be criticized.

''Mount Sinai is going to do everything it can to follow the wishes of our physicians, patients and their families as cost effectively as possible,'' spokeswoman Pamela Gadinsky said in an e-mail.

``According to the report, Mount Sinai's aggressive score (99.3) costs Medicare approximately $82,816. However, Jackson Memorial's less aggressive score (88.3) costs Medicare only 1 percent less at $81,695.''

The research by Dartmouth Atlas, which is affiliated with Dartmouth College and its medical school, has consistently found that high-cost areas are invariably those with high numbers of hospital beds and specialists relative to patient population.

That's certainly true in South Florida, which has high rates of empty beds and many specialists.

The new data cover 2001 through 2005, and are adjusted for sex, race, age and severity of illness for Medicare, the federal health insurance for the elderly.

CHRONIC CONDITIONS

The report focuses on patients with at least one of nine chronic conditions so that the researchers can measure comparable populations. Much of the information concerns Dartmouth's Hospital Care Intensity index, which measures the number of days patients spend in hospitals and the number of doctors they see as in-patients.

One section of the report considers how a son might advise parents thinking of moving to Florida.

By going to Dartmouthatlas.org and using the HCI index, ``he notes that the east coast regions in southern Florida -- Miami and Fort Lauderdale -- rank high on the HCI index, while Fort Myers ranks slightly below the 50th percentile among all U.S. hospitals.''

The report contrasts that with one hospital in Miami-Dade. ``For patients . . . who want everything possible done to rescue them no matter how ill or near to death they may be, Westchester General Hospital stands out.''

A third of all deaths there are in intensive care, ''placing it in the 99th percentile in the country for aggressive end-of-life care,'' the report says. The high number of physician visits connected with such care -- 85 -- means the average physician co-payments for a Westchester patient are $6,000 -- about 50 percent more than the co-pays a similar patient could expect at Holy Cross.

Dartmouth's Fisher notes there can be serious quality of life concerns for those who end their days in intensive care, hooked up to machines and monitors.

''This is a very important issue for patients and their families to consider,'' he said.

THREE COMPARED

The report compares three Miami-Dade hospitals with high HCI scores -- Westchester, Mount Sinai and Hialeah -- with three that have much lower scores -- South Miami, Baptist and Jackson Memorial. Of these, Baptist has the lowest percentage of intensive care unit care during a final illness (25 percent) and the highest percentage admitted to hospice (46 percent), where treatment concentrates on comfort and alleviating pain.