title: Age and gender differences in medicare expenditures and service utilization at the end of life for lung cancer decedents.
abstract: OBJECTIVE
  Gender and age differences in medical care are well documented. We examined age and gender differences in Medicare expenditures for lung cancer decedents in the last year of life (LYOL) through a cross-sectional study of Medicare administrative and claims data.
  
  
  METHODS
  Participants were aged Medicare beneficiaries (>or=68) with lung cancer, who were covered by Parts A and B for 36 months before death (1996-1999; n = 13,120). Regression techniques were used to estimate age and gender differences in mean Medicare utilization and expenditures in the LYOL overall and by type of service, conditional on use: inpatient, outpatient, physician, skilled nursing facility (SNF), home health, and hospice, controlling for demographic, clinical, geographic, and supply characteristics.
  
  
  RESULTS
  Women were more likely than men to use inpatient, SNF, home health, and hospice services. Women's average expenditures were approximately dollars 1,900 greater than men's, with differences attributed to higher average expenditures for SNF, home health, and hospice. Older cohorts used fewer inpatient and outpatient services and used more SNF and hospice services in their LYOL. Average Medicare expenditures were significantly lower in older cohorts (dollars 8,487 less for those age >or=85 at death than for those 68-74). Adjusting for age explains most of the gender differences in average Medicare expenditures. Remaining gender differences vary across age cohorts, with larger gender differences in social-supportive service expenditures among those 68-74 and 75-84 and outpatient and physician services among those 75-84 and >or=85.
  
  
  CONCLUSIONS
  Our findings suggest that gender disparities in expenditures are generally small at the end of life for lung cancer decedents, particularly among the older cohorts. As expected, the bigger observed differences are by age although the direction of the association is not consistent across types of service. Higher expenditures for women on social-supportive services may reflect fewer informal supports for older women compared with men.
authors.affiliation: RAND Corporation, Santa Monica, California, USA. lisa@rand.org
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Shugarman
authors.forename: Chloe E
authors.initials: CE
authors.lastname: Bird
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Schuster
authors.forename: Joanne
authors.initials: J
authors.lastname: Lynn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures / Q000592:standards*; D017051:Hospice Care / Q000191:economics; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000191:economics; D017063:Outcome Assessment, Health Care; D012051:Reimbursement Mechanisms / Q000191:economics; D017678:Sex Distribution; D012944:Social Support; D013727:Terminal Care / Q000191:economics* / Q000706:statistics & numerical data; D019452:Terminally Ill / Q000706:statistics & numerical data*; D014481:United States