Spending Patterns for End-of-Life Care Set in Motion 1 Year Before Death

The cost of dying in America has skyrocketed over the years. Now, findings from a new study by University of Michigan researchers challenge general assumptions about health care spending toward the end of life.

Matthew Allen Davis, PhD, MPH, and colleagues realized that the spending patterns leading up to death had not been fully researched. By using 2012 data from the Centers for Medicare & Medicaid Services, Davis and his team were able to analyze information from nearly 100,000 randomly sampled participants. They drew their sample from data on nearly 1.3 million Americans aged 66 to 99 years who had died during the study period. The results were published in Health Affairs (published online June 15, 2016; doi:10.1377/hlthaff.2015.1419).

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The team identified 4 unique spending trajectories among the deceased. High persistent spending made up nearly half of the studied group at 48.7%. These were the people whose Medicare costs added up to approximately $59,394 in their last year of life due to outpatient visits, trips to medical specialists, and nursing facility stays. The next group, 29% of the total participants, had moderate persistent spending, which included costs of about $18,408 in their final year. Those who had progressive spending made up 10.2% of the group and spent around $37,036 throughout their last year. And 12.1% had late-rise spending, with their health care costing approximately $11,166 within their last year. 

While the study did not incorporate prescription drug cost and out-of-pocket spending, the results showed that high spending throughout a full year before death was more closely associated with having multiple chronic conditions than with having a specific disease. The last year of life for this group of patients cost the Medicare system 5 times as much as the care received by the much smaller group who had a sudden burst of expensive care in their last few weeks of life.

Davis was surprised by the results, saying: “We were expecting to find the most common pattern to be explosive health care spending in the final months of life… Our research points to having to do a better job taking care of people who have multiple chronic conditions in a way that maintains or improves the quality of care they receive, but with cost in mind.”—Nina Farrell