Identification Of Four Unique Spending Patterns Among Older Adults In The Last Year Of Life Challenges Standard Assumptions.
The assumption that health care spending skyrockets at the end of life might suggest that policy makers should target the last few months of life to control costs. However, spending patterns leading up to death have not been fully examined. We applied a new methodology to administrative claims data for older Medicare beneficiaries who died in 2012 to characterize trajectories of health care spending in the last year of life. After adjustment, we identified four unique spending trajectories among decedents: 48.7 percent had high persistent spending, 29.0 percent had moderate persistent spending, 10.2 percent had progressive spending, and 12.1 percent had late rise spending. High spending throughout the full year before death (approximately half of all decedents) was associated with having multiple chronic conditions but not any specific diseases. These findings suggest that spending at the end of life is a marker of general spending patterns often set in motion long before death.
Matthew Allen Davis (mattadav@umich.edu) is an assistant professor in the Department of Systems, Populations, and Leadership at the University of Michigan School of Nursing, in Ann Arbor; a faculty affiliate of the University of Michigan Institute for Social Research; and an adjunct assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, in Lebanon, New Hampshire.
Matthew Allen
MA
Davis
Brahmajee K. Nallamothu is an associate professor in the Department of Internal Medicine in the Division of Cardiovascular Medicine at the University of Michigan Medical School, an investigator at the Center for Clinical Management Research at the Ann Arbor VA Medical Center, and director of the Michigan Center for Health Analytics and Medical Prediction.
Brahmajee K
BK
Nallamothu
Mousumi Banerjee is a research professor of biostatistics at the University of Michigan School of Public Health.
Mousumi
M
Banerjee
Julie P. W. Bynum is an associate professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.
Julie P W
JP
Bynum
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D015577:Geriatric Assessment; D005102:Health Expenditures; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D016019:Survival Analysis; D013727:Terminal Care / Q000191:economics* / Q000639:trends; D013997:Time Factors; D014481:United States
Elderly; Health care costs; Medicare; end-of-life care