WASHINGTON, May 31 (Reuters Health) - Despite advances in medical care,
Medicare spending on beneficiaries in the last year of life has changed little
in the past two decades, according to a report released Wednesday.
The study released by the Medicare Payment Advisory Commission (MedPAC)
found that end-of-life care accounted for about a quarter of program spending
between 1994 and 1998. That was similar to earlier estimates from Medicare
officials using data from 1976 to 1988.
The study also found that the claim that spending on the dying vastly
outpaces other costs is a myth. Medicare payments for the last year of life
averaged just over $26,000 in 1997 dollars, researchers found, about six times
what Medicare spent for other beneficiaries.
Another myth, said the study's principal author, is that spending on the
dying is largely for unnecessary care. In most cases, the actual date of death
was unpredictable, Dr. Christopher Hogan of Direct Research LLC, pointed out.
The costs "are really for care of very sick people who happened to have died,"
rather than care of the dying per se, he said in an interview with Reuters
Health.
Hogan added that one of the findings that surprised him was the widespread
use of hospice care for Medicare beneficiaries with cancer. By 1998, the study
found, more than half of all Medicare beneficiaries who died of cancer used
hospice services. "Hospice has become mainstream," Hogan said. "Now it's the
accepted place for people to go to die."
The study did find some disparities, however.
For example, it found that end-of-life costs for members of minority groups
were more than 25% higher than for others. While more minorities, particularly
African Americans, are likely to suffer from end-stage renal disease, which is
particularly costly to treat, that "contributes to but does not fully explain"
the high average costs for minority decedents, the report indicates. Hogan said
the higher costs for African Americans could not be explained immediately, and
would likely be the subject of further research.
Costs for end-of-life care also varied according to where beneficiaries
live, the researchers found. Spending was higher in urban areas, as well as in
areas with higher numbers of hospital beds and physicians per capita. That held
true even after adjusting for Medicare's differing payments in various
locations.
The study was conducted by researchers from Direct Research LLC, the Center
to Improve Care for the Dying at RAND, the Health Research and Educational
Trust, and the National Cancer Institute, with funding from the Agency for
Healthcare Research and Quality.
