Health Care Expenditures at End-of-Life and Long Term Care / Aging
1. Banaszak-Holl, J; Mor, V. Differences in Patient Demographics and Expenditures Among Medicare Hospice Providers. The Hospice Journal; 1996; 11:3:1-19.[Annotation]
This is a comparative study using a randomized 5% sample of all hospice Medicare beneficiaries identified from the Continuous Medical History Sample. The Continuous Medical History Sample examines the differences in demographics and Medicare expenditures for beneficiaries in 4 different types of hospice programs: hospital, skilled nursing, home health, and freestanding. The authors report a greater growth in the use of hospice care in hospitals and nursing homes. This growth in hospice care also revealed a greater increase in minority and female use. The authors conclude that the increase in institutional use was the result of the expansion of the hospice Medicare benefit; however, the cost savings remains greater in home-based rather than institutional-based hospices. The authors discuss indications of differences in costs among providers of the same type. [Pub Med]
2. Hogan, C; Lunney, J; Gabel, J; Lynn, J. Medicare Beneficiaries’ Costs of Care in the Last Year of Life. Health Affairs, Data Watch; 2001; 20:4:188-195.[Annotation]
The authors profiled the end-of-life costs for Medicare beneficiaries in the last year of life. They found that the cost for persons who died was only slightly higher than for survivors with similar diagnoses and characteristics. Thirty-eight percent of Medicare beneficiaries had some nursing home stay in the last year of life. Hospice use among Medicare decedents rose from 11% in 1994 to 19% in 1998, and half of Medicare decedents who died from cancer utilized hospice. African Americans had much higher (28%) end-of-life costs than others. [Pub Med]
3. Lunney, JR; Lynn, J; Hogan, C. Profiles of Older Medicare Decedents. Journal of the American Geriatrics Society; 2002; 50:1108-1112.[Annotation]
This report utilizes Medicare claims data for a 0.1% random sample of all expenditures of Medicare beneficiaries from 1993-1998. The sample contained 7,966 decedents. The authors evaluate a scheme to clinically classify decedents into 4 end-of-life categories: sudden death, terminal illness, organ failure, and frailty. Health care use and costs were compared for each category. The differences among the categories were used to evaluate expenditures and develop strategies to improve care at the end-of-life. The results show that the categories represented 92% of the decedents across substantial clinical differences and captured the patterns of demographics, care delivery, and Medicare expenditures. While this analysis does not include non-Medicare expenses, the diagnoses within the frail group (which comprised more than 50% of all groups) suggests a high prevalence of need for nursing home care, assistance with activities of daily living, and 24-hour supervision. [Pub Med]
4. Yang, Z; Norton, EC; Stearns, SC. Longevity and Health Care Expenditures: The Real Reasons Older People Spend More. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences; 2003; 58B:1:S2-S10.[Annotation]
In this longitudinal analysis, the authors compare the age and time of death of 25,994 elderly Medicare beneficiaries to health care expenditures using person-month level data from the 1992-1998 Medicare Current Beneficiary Survey Cost and Files. The survey combined demographics and insurance coverage with Medicare claims data and self-report survey information on resource use and health care expenditures, including nursing home and prescription drugs. The authors look at differences in expenditures at times close to death and times not close to death. The results show that time close to death is the main reason for higher inpatient care expenditures, whereas aging is the main reason for higher long-term care expenditures. [Pub Med]
