DIMACS TR: 2004-27
Medical Expenditures During The Last Year On Life: Findings From The 1992-96 Medicare Current
Authors: Donald R. Hoover, Stephen Crystal, Rizie Kumar, Usha Sambamoorthi and Joel C. Cantor
OBJECTIVE: To compare medical expenditures for the elderly (≥65 years old)
over the last year of life with those for non-terminal years. DATA SOURCE:
1992-96 Medicare Current Beneficiary Survey (MCBS) data from about 10,000 elderly persons each year.
STUDY DESIGN: Medical expenditures for the last year of life and non-terminal years by source of payment and type of care were estimated using robust covariance linear model approaches applied to MCBS data.
DATA COLLECTION: The MCBS is a panel survey of a complex weighted multilevel random sample of Medicare beneficiaries. A structured questionnaire is administered at four month intervals to collect all medical costs by payer and service. Medicare costs are validated by claims records.
PRINCIPAL FINDINGS: From 1992-96, mean annual medical expenditures (1996 dollars) for persons 65 and older were $37,581 during the last year of life versus $7,365 for non-terminal years.
Mean total last year of life expenditures did not differ greatly by age at death. However, non-Medicare last year of life expenditures were higher and Medicare last year of life expenditures were lower for those dying at older ages.
Last year of life expenses constituted 22% of all medical, 26% of Medicare, 18% of all non-Medicare expenditures and 25% of Medicaid expenditures.
CONCLUSIONS: While health services delivered near the end of life will continue to consume large portions of medical dollars, the portion paid by non-Medicare
sources will likely rise as the population ages. Policies promoting improved
allocation of resources for end of life care may not affect non-Medicare
expenditures, which disproportionately support chronic and custodial care.
KEY WORDS: End of life, elderly, health care expenditures, Medicare, Medicai
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