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End-of-Life Treatment Costs Decreased in Recent Years

Analysis finds that reduction factored in slower increase in Medicare spending

Couple working out a budget while sitting on the living room sofa

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En español | Reversing an upward trend, end-of-life medical care costs declined in the first five years of this decade, researchers at the Dartmouth Institute for Health Policy and Clinical Practice determined.

In the most recent issue of JAMA Internal Medicine, researchers reported on their analysis and review of Medicare expenditures.

Spending in several categories — durable medical equipment, hospice, physician costs, and home health, inpatient and outpatient care — all increased in the last two years of life for those who died from 2004 to 2009 and then decreased for those who died from 2010 to 2014, the analysis found.

“Contrary to other studies,” the authors wrote, “we found that per-capita end-of-life spending is decreasing” and also helping drive down overall Medicare spending growth.

“We were surprised to find this kind of downward trend in per capita spending,” William Weeks, M.D., the study leader and a professor at Dartmouth’s Geisel School of Medicine, told the Valley News newspaper in Lebanon, N.H.

Among those who died during the time studied (4.3 percent of all Medicare enrollees), their change in costs accounted for more than half the “expenditure reductions attributable to practice changes.”

“But for that, care costs would have accelerated,” Weeks told the newspaper.

While not certain why end-of-life costs decreased in those five years, Weeks offered a few possible explanations, among them were the enactment of the Affordable Care Act, because of fewer medical interventions due to the increase in advance directives instructing caregivers not to take extraordinary efforts to prolong life, and patients being more cognizant of costs because of the financial crisis.

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