Background: Medical costs are substantially higher during the last year (LY) of life. Lubitz (1993) found that while ~5% of Medicare beneficiaries >=65 died annually in the 1970s-1980s, LY expenditures constituted 27%-31% of Medicare costs. About 40% of LY Medicare expenditures occurred in the last month (LM) of life, largely for inpatient care. Non-Medicare and 1990s LY costs are less well studied.
Methods: The Medicare Beneficiary Survey (MCBS) obtains annual medical expenditures by payer/service for ~12,000 Medicare enrollees selected from a clustered-weighted frame. Linear/logistic polynomial models fit to MCBS expenses of 1992-1996 decedents >=65 years at death estimated mean/probability of LY costs and timing of LY expenditures; both overall and by payer/service. Robust covariance algorithms incorporating cluster/repeated measure effects were used. From these models, death probability and overall costs; mean/probability of annual expenditures for persons >=65 years not in LY of life were estimated.
Results: While 5.5% of 1992-96 MCBS person-years were LY; 26.2% (95% CI: 22.6-30.3%) of Medicare versus 17.8% (16.0-19.9%) of non-Medicare expenses occurred in LY. Among LY expenses, 37.9% (32.1-44.8%) of Medicare compared to 17.7% (14.3-21.8%) of non-Medicare occurred in LM. Costs for all medical payers and services except dental were higher during LY.
Discussion: While non-Medicare costs are higher in LY, the difference is substantially less than that for Medicare costs implying less potential to control non-Medicare costs by reducing End-Of-Life expenditures. LY Medicare costs concentrate in the LM reflecting acute inpatient services while non-Medicare costs spread throughout the LY reflecting chronic treatment of sicker individuals.
Learning Objectives: "At the conclusion of the session, the participant (learner) in this session will be able to:
Keywords: Cost Issues, End-of-Life Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.