FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 328:1092-1096 April 15, 1993 Number 15 Next

	Full Text Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

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.

Source Information

The statements contained in this report are solely those of the authors and do not necessarily reflect the views or policies of the Health Care Financing Administration.

From the Health Care Financing Administration, 6325 Security Blvd., Rm. 2504, Oak Meadows Bldg., Baltimore, MD 21207, where reprint requests should be addressed to Mr. Lubitz.

Full Text of this Article

This article has been cited by other articles:

• Iecovich, E., Carmel, S. (2009). Differences in Accessibility, Affordability, and Availability (AAA) of Medical Specialists Among Three Age-Groups of Elderly People in Israel. J Aging Health 21: 776-797 [Abstract]  
• Tang, S. T., Wu, S.-C., Hung, Y.-N., Huang, E.-W., Chen, J.-S., Liu, T.-W. (2009). Trends in quality of end-of-life care for Taiwanese cancer patients who died in 2000-2006. Ann Oncol 20: 343-348 [Abstract] [Full Text]  
• Yabroff, K. R., Lamont, E. B., Mariotto, A., Warren, J. L., Topor, M., Meekins, A., Brown, M. L. (2008). Cost of Care for Elderly Cancer Patients in the United States. JNCI J Natl Cancer Inst 100: 630-641 [Abstract] [Full Text]  
• Tamir, O., Singer, Y., Shvartzman, P. (2007). Taking care of terminally-ill patients at home the economic perspective revisited. Palliat Med 21: 537-541 [Abstract]  
• Shnoor, Y., Szlaifer, M., Aoberman, A. S., Bentur, N. (2007). The Cost of Home Hospice Care for Terminal Patients in Israel. AM J HOSP PALLIAT CARE 24: 284-290 [Abstract]  
• Hanratty, B., Burstrom, B., Walander, A., Whitehead, M. (2007). Changes in income in the years before death: a record linkage study in Stockholm County. J. Epidemiol. Community Health 61: 447-448 [Full Text]  
• Anderson, K., Jacobson, J. S., Heitjan, D. F., Zivin, J. G., Hershman, D., Neugut, A. I., Grann, V. R. (2006). Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation.. ANN INTERN MED 144: 397-406 [Abstract] [Full Text]  
• Westerhout, W. M. T. (2006). Does Ageing Call for a Reform of the Health Care Sector?. CESifo Economic Studies 52: 1-31 [Abstract] [Full Text]  
• Daviglus, M. L., Liu, K., Pirzada, A., Yan, L. L., Garside, D. B., Greenland, P., Manheim, L. M., Dyer, A. R., Wang, R., Lubitz, J., Manning, W. G., Fries, J. F., Stamler, J. (2005). Cardiovascular Risk Profile Earlier in Life and Medicare Costs in the Last Year of Life. Arch Intern Med 165: 1028-1034 [Abstract] [Full Text]  
• McGarry, K., Schoeni, R. F. (2005). Widow(er) Poverty and Out-of-Pocket Medical Expenditures Near the End of Life. Journals of Gerontology Series B: Psychological Sciences and Social Science 60: S160-S168 [Abstract] [Full Text]  
• Cassell, J. (2005). Miracles of Modern Medicine/Casualties of Modern Medicine. Qual Health Res 15: 555-563 [Abstract]  
• Bach, P. B., Schrag, D., Begg, C. B. (2004). Resurrecting Treatment Histories of Dead Patients: A Study Design That Should Be Laid to Rest. JAMA 292: 2765-2770 [Abstract] [Full Text]  
• Rady, M. Y, Johnson, D. J (2004). Admission to intensive care unit at the end-of-life: is it an informed decision?. Palliat Med 18: 705-711 [Abstract]  
• Wood, K. A., Marik, P. E. (2004). ICU Care at the End of Life. Chest 126: 1403-1406 [Full Text]  
• Cowan, J. D. (2004). Hospital charges for a community inpatient palliative care program. AM J HOSP PALLIAT CARE 21: 177-190 [Abstract]  
• Flory, J., Young-Xu, Y., Gurol, I., Levinsky, N., Ash, A., Emanuel, E. (2004). Place Of Death: U.S. Trends Since 1980. Health Aff (Millwood) 23: 194-200 [Abstract] [Full Text]  
• Yabroff, K R., Mandelblatt, J. S, Ingham, J. (2004). The quality of medical care at the end-of-life in the USA: existing barriers and examples of process and outcome measures. Palliat Med 18: 202-216 [Abstract]  
• Johnson, R. J., Gallagher, T. J., Wolinsky, F. D. (2004). The Influence of the End of Life on the Extent of Informal Help Received by Older Adults. Research on Aging 26: 259-283 [Abstract]  
• Campbell, D. E., Lynn, J., Louis, T. A., Shugarman, L. R. (2004). Medicare Program Expenditures Associated with Hospice Use. ANN INTERN MED 140: 269-277 [Abstract] [Full Text]  
• McCarthy, E. P., Burns, R. B., Davis, R. B., Phillips, R. S. (2003). Barriers to Hospice Care Among Older Patients Dying With Lung and Colorectal Cancer. JCO 21: 728-735 [Abstract] [Full Text]  
• Yang, Z., Norton, E. C., Stearns, S. C. (2003). Longevity and Health Care Expenditures: The Real Reasons Older People Spend More. Journals of Gerontology Series B: Psychological Sciences and Social Science 58: S2-10 [Abstract] [Full Text]  
• Buntin, M. B., Huskamp, H. (2002). What Is Known About the Economics of End-of-Life Care for Medicare Beneficiaries?. Gerontologist 42: 40-48 [Abstract] [Full Text]  
• Emanuel, E. J., Ash, A., Yu, W., Gazelle, G., Levinsky, N. G., Saynina, O., McClellan, M., Moskowitz, M. (2002). Managed Care, Hospice Use, Site of Death, and Medical Expenditures in the Last Year of Life. Arch Intern Med 162: 1722-1728 [Abstract] [Full Text]  
• The CDC Diabetes Cost-effectiveness Group, (2002). Cost-effectiveness of Intensive Glycemic Control, Intensified Hypertension Control, and Serum Cholesterol Level Reduction for Type 2 Diabetes. JAMA 287: 2542-2551 [Abstract] [Full Text]  
• Busse, R, Krauth, C, Schwartz, F W (2002). Use of acute hospital beds does not increase as the population ages: results from a seven year cohort study in Germany. J. Epidemiol. Community Health 56: 289-293 [Abstract] [Full Text]  
• LUCE, J. M., RUBENFELD, G. D. (2002). Can Health Care Costs Be Reduced by Limiting Intensive Care at the End of Life?. Am. J. Respir. Crit. Care Med. 165: 750-754 [Full Text]  
• Moody, L. E., Small, B. J., Jones, C. B. (2002). Advance Directives Preferences of Functionally and Cognitively Impaired Nursing Home Residents in the United States. Journal of Applied Gerontology 21: 103-118 [Abstract]  
• Hill, J. W., Futterman, R., Duttagupta, S., Mastey, V., Lloyd, J. R., Fillit, H. (2002). Alzheimer's disease and related dementias increase costs of comorbidities in managed Medicare. Neurology 58: 62-70 [Abstract] [Full Text]  
• Hershman, D., Sundararajan, V., Jacobson, J. S., Heitjan, D. F., Neugut, A. I., Grann, V. R. (2002). Outcomes of Tamoxifen Chemoprevention for Breast Cancer in Very High-Risk Women: A Cost-Effectiveness Analysis. JCO 20: 9-16 [Abstract] [Full Text]  
• Young, D. S., Sachais, B. S., Jefferies, L. C. (2002). Effect of Disease Complications on Hospital Costs. Clin. Chem. 48: 140-149 [Abstract] [Full Text]  
• Cutler, D. M. (2001). Declining Disability Among The Elderly. Health Aff (Millwood) 20: 11-27 [Abstract] [Full Text]  
• Levinsky, N. G., Yu, W., Ash, A., Moskowitz, M., Gazelle, G., Saynina, O., Emanuel, E. J. (2001). Influence of Age on Medicare Expenditures and Medical Care in the Last Year of Life. JAMA 286: 1349-1355 [Abstract] [Full Text]  
• Hogan, C., Lunney, J., Gabel, J., Lynn, J. (2001). Medicare Beneficiaries' Costs Of Care In The Last Year Of Life. Health Aff (Millwood) 20: 188-195 [Abstract] [Full Text]  
• Barzilai, N., Shuldiner, A. R. (2001). Searching for Human Longevity Genes: The Future History of Gerontology in the Post-genomic Era. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 56: 83M-87 [Abstract] [Full Text]  
• Raphael, C., Ahrens, J., Fowler, N. (2001). Financing end-of-life care in the USA. JRSM 94: 458-461 [Full Text]  
• Huang, J., Zhou, S., Groome, P., Tyldesley, S., Zhang-Solomans, J., Mackillop, W. J. (2001). Factors Affecting the Use of Palliative Radiotherapy in Ontario. JCO 19: 137-144 [Abstract] [Full Text]  
• ALBERT, R. K. (2001). The Buck Stops Here. Am. J. Respir. Crit. Care Med. 163: 9-10 [Full Text]  
• Mapel, D. W., Hurley, J. S., Frost, F. J., Petersen, H. V., Picchi, M. A., Coultas, D. B. (2000). Health Care Utilization in Chronic Obstructive Pulmonary Disease: A Case-Control Study in a Health Maintenance Organization. Arch Intern Med 160: 2653-2658 [Abstract] [Full Text]  
• Teno, J. M. (2000). Advance Directives for Nursing Home Residents: Achieving Compassionate, Competent, Cost-effective Care. JAMA 283: 1481-1482 [Full Text]  
• Liao, Y., McGee, D. L., Cao, G., Cooper, R. S. (2000). Quality of the Last Year of Life of Older Adults: 1986 vs 1993. JAMA 283: 512-518 [Abstract] [Full Text]  
• Woolf, S. H. (1999). The Need for Perspective in Evidence-Based Medicine. JAMA 282: 2358-2365 [Abstract] [Full Text]  
• Sloan, F. A., Taylor, D. H. Jr (1999). Private and Public Choices in End-of-Life Care. JAMA 282: 2078-2078 [Full Text]  
• Weiss, S. C. (1999). Economics, Ethics, and End-of-Life Care. JAMA 282: 2076-2076 [Full Text]  
• Esper, P., Hampton, J. N., Finn, J., Smith, D. C., Regiani, S., Pienta, K. J. (1999). A new concept in cancer care: The supportive care program. AM J HOSP PALLIAT CARE 16: 713-722 [Abstract]  
• Higginson, I. J (1999). Evidence based palliative care. BMJ 319: 462-463 [Full Text]  
• Hamel, M. B., Teno, J. M., Goldman, L., Lynn, J., Davis, R. B., Galanos, A. N., Desbiens, N., Connors, A. F. Jr., Wenger, N., Phillips, R. S., for the SUPPORT Investigators, (1999). Patient Age and Decisions To Withhold Life-Sustaining Treatments from Seriously Ill, Hospitalized Adults. ANN INTERN MED 130: 116-125 [Abstract] [Full Text]  
• Bradley, E. H., Rizzo, J. A. (1999). Public Information and Private Search: Evaluating the Patient Self-Determination Act. Journal of Health Politics, Policy and Law 24: 239-273 [Abstract]  
• Russell, L. B. (1998). Prevention and Medicare Costs. NEJM 339: 1158-1160 [Full Text]  
• Emanuel, E. J., Battin, M. P. (1998). What Are the Potential Cost Savings from Legalizing Physician-Assisted Suicide?. NEJM 339: 167-172 [Full Text]  
• Smeenk, F. W J M, van Haastregt, J. C M, de Witte, L. P, Crebolder, H. F J M (1998). Effectiveness of home care programmes for patients with incurable cancer on their quality of life and time spent in hospital: systematic review. BMJ 316: 1939-1944 [Abstract] [Full Text]  
• Mustard, C. A., Kaufert, P., Kozyrskyj, A., Mayer, T. (1998). Sex Differences in the Use of Health Care Services. NEJM 338: 1678-1683 [Abstract] [Full Text]  
• Johnson, F. R., Desvousges, W. H., Ruby, M. C., Stieb, D., De Civita, P. (1998). Eliciting Stated Health Preferences: An Application to Willingness to Pay for Longevity. Med Decis Making 18: S57-S67 [Abstract]  
• LANTOS, J. D., MOKALLA, M., MEADOW, W. (1997). Resource Allocation in Neonatal and Medical ICUs . Epidemiology and Rationing at the Extremes of Life. Am. J. Respir. Crit. Care Med. 156: 185-189 [Abstract] [Full Text]  
• Ahronheim, J. C., Morrison, R. S., Baskin, S. A., Morris, J., Meier, D. E. (1996). Treatment of the Dying in the Acute Care Hospital: Advanced Dementia and Metastatic Cancer. Arch Intern Med 156: 2094-2100 [Abstract]  
• Brock, D. B., Foley, D. J., Salive, M. E. (1996). Hospital and Nursing Home Use in the Last Three Months of Life. J Aging Health 8: 307-319 [Abstract]  
• Emanuel, E. J. (1996). Cost Savings at the End of Life: What Do the Data Show?. JAMA 275: 1907-1914 [Abstract]  
• Cooper, R. A. (1995). Perspectives on the Physician Workforce to the Year 2020. JAMA 274: 1534-1543 [Abstract]  
• Chelluri, L., Grenvik, A., Silverman, M. (1995). Intensive Care for Critically Ill Elderly: Mortality, Costs, and Quality of Life: Review of the Literature. Arch Intern Med 155: 1013-1022 [Abstract]  
• Lubitz, J., Beebe, J., Baker, C. (1995). Longevity and Medicare Expenditures. NEJM 332: 999-1003 [Abstract] [Full Text]  
• Berwick, D. M. (1994). Eleven Worthy Aims for Clinical Leadership of Health System Reform. JAMA 272: 797-802 [Abstract]  
• Heuser, M. D., Hazzard, W. R. (1994). Geriatric Medicine. JAMA 271: 1675-1677 [Abstract]  
• Mitchell, A., Hunter, D., Blackhurst, D., Stroud, C., Lee, B. (1994). Hospice Care: The Cheaper Alternative. JAMA 271: 1576-1577 [Abstract]  
• Emanuel, E. J., Emanuel, L. L. (1994). The Economics of Dying -- The Illusion of Cost Savings at the End of Life. NEJM 330: 540-544 [Full Text]  
• (1993). MEDICARE EXPENDITURES IN THE LAST YEAR OF LIFE REMAIN STABLE. JWatch General 1993: 7-7 [Full Text]  
• Friedenberg, R. M. (2001). Euthanasia. Radiology 221: 576-580 [Full Text]