BACKGROUND
Increased attention is being paid to the amount and types of medical services rendered in the period before death. There is a popular impression that a greater share of resources is being devoted to dying patients than in the past. We examined trends in the proportion of Medicare expenditures for persons 65 years old or older in their last year of life to determine whether there were any changes from 1976 to 1988.
METHODS
Using Medicare program data for 1976, 1980, 1985, and 1988, we classified Medicare payments according to whether they were made for people in their last year of life (decedents) or for survivors. We also assigned expenses for care in the last year of life according to intervals of 30 days before the person's death and examined trends according to age.
RESULTS
Reflecting the large overall increase in Medicare spending, Medicare costs for decedents rose from $3,488 per person-year in 1976 to $13,316 in 1988. However, Medicare payments for decedents as a percentage of the total Medicare budget changed little, fluctuating between 27.2 and 30.6 percent during the study period. Payments for care during the last 60 days of life expressed as a percentage of payments for the last year also held steady at about 52 percent. Furthermore, the pattern of lower payments for older as compared with younger decedents also prevailed throughout the study period.
CONCLUSIONS
The same forces that have acted to increase overall Medicare expenditures have affected care for both decedents and survivors. There is no evidence that persons in the last year of life account for a larger share of Medicare expenditures than in earlier years.
[1]
D Kidder,et al.
The effects of hospice coverage on Medicare expenditures.
,
1992,
Health services research.
[2]
Withholding and withdrawal of life support from the critically ill.
,
1990,
The New England journal of medicine.
[3]
E. Emanuel,et al.
Advance directives for medical care--a case for greater use.
,
1991,
The New England journal of medicine.
[4]
K. Levit,et al.
National health expenditures, 1990
,
1991,
Health care financing review.
[5]
A. McBean,et al.
Trends and patterns in place of death for Medicare enrollees
,
1990,
Health care financing review.
[6]
A. Scitovsky.
Medical care in the last twelve months of life: the relation between age, functional status, and medical care expenditures.
,
1988,
The Milbank quarterly.
[7]
T. Hodgson,et al.
The care of the terminally ill: morality and economics.
,
1983,
The New England journal of medicine.
[8]
John W. Tukey,et al.
Exploratory Data Analysis.
,
1979
.
[9]
A. LaCroix,et al.
Morbidity and disability in older persons in the years prior to death.
,
1991,
American journal of public health.
[10]
N. Roos,et al.
Health care utilization in the years prior to death.
,
1987,
The Milbank quarterly.
[11]
R. Prihoda,et al.
The use and costs of Medicare services in the last 2 years of life
,
1984,
Health care financing review.
[12]
M. Lawton,et al.
The quality of the last year of life of older persons.
,
1990,
The Milbank quarterly.