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End-of-Life Care

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End-of-life care expenditures and use among Medicare colorectal cancer patients differ more by age than gender

A new study examined age and gender differences in end-of-life care use and expenditures among Medicare-insured patients with colorectal cancer. The differences were larger by age than by gender, although they varied across health services. Acute service (for example, inpatient, outpatient, and physician) expenditures were significantly lower for older groups, while expenditures for social supportive services (for example, skilled nursing facility, home health, and hospice) were generally higher.

Average Medicare expenditures were significantly lower in older cohorts (almost $8,900 less for those aged 85 and older as compared with those aged 68-74). Although women were more likely to use inpatient services than men, the overall spending on inpatient services in the last year of life did not differ much by gender (less than 10 percent of the mean inpatient stay).

Among decedents aged 68 to 74 who used inpatient care, inpatient expenditures were higher for women than men. These differences did not persist for older cohorts. Average end-of-life care expenditures for women were $1,600 higher than for men, which were due to higher average expenditures on home health and hospice services.

Nearly universal Medicare coverage, which overcomes some of the usual barriers to health care, may partly explain the absence of substantial gender differences in care use and expenditures in the last year of life among elderly persons with colorectal cancer. Still, remaining gender differences could be attributed to differences in need or treatment patterns. Differences in spending on social supportive services may reflect differences in the availability of informal caregivers at the end of life.

The study was supported in part by the Agency for Healthcare Research and Quality (HS10561).

See "Age and gender differences in Medicare expenditures at the end of life for colorectal cancer decedents," by Lisa R. Shugarman, Ph.D., Chloe E. Bird, Ph.D., Cynthia R. Schuster, M.P.P., and Joanne Lynn, M.D., M.S., in the March 2007 Journal of Women's Health 16(2), pp. 214-227.

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