Background Increased attention is being paid to the amount andtypes of medical services rendered in the period before death.There is a popular impression that a greater share of resourcesis being devoted to dying patients than in the past. We examinedtrends in the proportion of Medicare expenditures for persons65 years old or older in their last year of life to determinewhether there were any changes from 1976 to 1988.
Methods Using Medicare program data for 1976, 1980, 1985, and1988, we classified Medicare payments according to whether theywere made for people in their last year of life (decedents)or for survivors. We also assigned expenses for care in thelast year of life according to intervals of 30 days before theperson'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-yearin 1976 to $13,316 in 1988. However, Medicare payments for decedentsas 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 expressedas a percentage of payments for the last year also held steadyat about 52 percent. Furthermore, the pattern of lower paymentsfor older as compared with younger decedents also prevailedthroughout the study period.
Conclusions The same forces that have acted to increase overallMedicare expenditures have affected care for both decedentsand survivors. There is no evidence that persons in the lastyear of life account for a larger share of Medicare expendituresthan 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.
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