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Influence of Age on Medicare Expenditures and Medical Care in the Last Year of Life
Norman G. Levinsky, MD;
Wei Yu, PhD;
Arlene Ash, PhD;
Mark Moskowitz, MD;
Gail Gazelle, MD;
Olga Saynina, MA,MBA;
Ezekiel J. Emanuel, MD,PhD
JAMA. 2001;286:1349-1355.
Context Expenditures for Medicare beneficiaries in the last year of life decrease with increasing age. The cause of this phenomenon is uncertain.
Objectives To examine this pattern in detail and evaluate whether decreases in aggressiveness of medical care explain the phenomenon.
Design, Setting, and Patients Analysis of sample Medicare data for beneficiaries aged 65 years or older from Massachusetts (n = 34 131) and California (n = 19 064) who died in 1996.
Main Outcome Measure Medical expenditures during the last year of life, analyzed by age group, sex, race, place and cause of death, comorbidity, and use of hospital services.
Results For Massachusetts and California, respectively, Medicare expenditures per beneficiary were $35 300 and $27 800 among those aged 65 through 74 years vs $22 000 and $21 600 for those aged 85 years or older. The pattern of decreasing Medicare expenditures with age is pervasive, persisting throughout the last year of life in both states for both sexes, for black and white beneficiaries, for persons with varying levels of comorbidity, and for those receiving hospice vs conventional care, regardless of cause and site of death. The aggressiveness of medical care in both Massachusetts and California also decreased with age, as judged by less frequent hospital and intensive care unit admissions and by markedly decreasing use of cardiac catheterization, dialysis, ventilators, and pulmonary artery monitors, regardless of cause of death. Decrease in the cost of hospital services accounts for approximately 80% of the decrease in Medicare expenditures with age in both states.
Conclusions Medicare expenditures in the last year of life decrease with age, especially for those aged 85 years or older. This is in large part because the aggressiveness of medical care in the last year of life decreases with increasing age.
Author Affiliations: Health Care Research Unit, Section of General Internal Medicine (Drs Ash and Moskowitz), Department of Medicine (Drs Levinsky, Ash, and Moskowitz), Boston University School of Medicine, Boston, Mass; Health Economics Resource Center of Health Services Research and Development Services and Center for Cooperative Studies in Health Services, US Department of Veterans Affairs, Menlo Park, Calif (Dr Yu); Palliative and Supportive Medicine Program, Harvard Vanguard Medical Associates, Boston, Mass (Dr Gazelle); National Bureau of Economic Research, Palo Alto, Calif (Ms Saynina); and Department of Clinical Bioethics, National Institutes of Health, Bethesda, Md (Dr Emanuel).
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