Context Expenditures for Medicare beneficiaries in the last year of life decrease
with increasing age. The cause of this phenomenon is uncertain.
Objectives To examine this pattern in detail and evaluate whether decreases in
aggressiveness of medical care explain the phenomenon.
Design, Setting, and Patients Analysis of sample Medicare data for beneficiaries aged 65 years or
older from Massachusetts (n = 34 131) and California (n = 19 064)
who died in 1996.
Main Outcome Measure Medical expenditures during the last year of life, analyzed by age group,
sex, race, place and cause of death, comorbidity, and use of hospital services.
Results For Massachusetts and California, respectively, Medicare expenditures
per beneficiary were $35 300 and $27 800 among those aged 65 through
74 years vs $22 000 and $21 600 for those aged 85 years or older.
The pattern of decreasing Medicare expenditures with age is pervasive, persisting
throughout the last year of life in both states for both sexes, for black
and white beneficiaries, for persons with varying levels of comorbidity, and
for those receiving hospice vs conventional care, regardless of cause and
site of death. The aggressiveness of medical care in both Massachusetts and
California also decreased with age, as judged by less frequent hospital and
intensive care unit admissions and by markedly decreasing use of cardiac catheterization,
dialysis, ventilators, and pulmonary artery monitors, regardless of cause
of death. Decrease in the cost of hospital services accounts for approximately
80% of the decrease in Medicare expenditures with age in both states.
Conclusions Medicare expenditures in the last year of life decrease with age, especially
for those aged 85 years or older. This is in large part because the aggressiveness
of medical care in the last year of life decreases with increasing age.