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Despite new critical care technologies, the proportion of Medicare spending on end-of-life care is not increasing

Although health services delivered near the end of life will continue to consume large portions of medical dollars, the proportion of Medicare spending for end-of-life care is not increasing. Thus, efforts to contain Medicare expenditures should not focus on those near the end of life, conclude the researchers involved in the first nationwide study of both Medicare and non-Medicare expenditures for the last year of life. Their work was supported in part by the Agency for Healthcare Research and Quality (HS09566 and HS11825).

Researchers led by Stephen Crystal, Ph.D., of Rutgers University, analyzed the 1992-1996 Medicare Current Beneficiary Survey, which contains yearly health care use and cost data for about 10,000 elderly men and women. The mean annual medical expenditures (1996 dollars) for the elderly from 1992 to 1996 were $37,581 during the last year of life versus $7,365 for other years. The estimated 1992-1996 mean Medicare expenses during the last year of life were $22,967. However, the portion of Medicare expenses spent on the last year of life in 1992-1996 was 26 percent, similar to that spent on the last year of life between 1976 and 1988.

In addition, last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 25 percent of Medicaid, and 18 percent of all non-Medicare expenditures. Additional non-Medicare expenditures near the end of life are directed toward facility-based management of chronic conditions preceding death rather than to acute terminal conditions per se. As the elderly population ages, average total end-of-life medical expenses (adjusted for inflation) will probably change little, but the portion paid by non-Medicare sources supporting chronic and custodial care will likely rise, conclude the researchers.

More details are in "Medical expenditures during the last year of life: Findings from the 1992-1996 Medicare current beneficiary survey," by Donald R. Hoover, Ph.D., M.P.H., Dr. Crystal, Rizie Kumar, M.S., and others, in the December 2002 Health Services Research 37(6), pp. 1625-1642.

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