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Taking a Second Look at End-of-Life Medicare Health Costs

Study finds the vast majority of patient deaths are not expected; focus should be on quality of care, say researchers

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Researchers say there should be a greater focus on quality of care for very sick patients.
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Researchers have taken aim at a common complaint about health care spending, especially publicly funded Medicare: that one quarter of it is spent on patients in their last year of life. While that assertion is true, the researchers say that it ignores the fact that in more than 9 in 10 cases, the patients were not expected to die in that short a time span.

“That one-quarter of Medicare spending in the United States occurs in the last year of life is commonly interpreted as waste,” research authors wrote in a report on a study of such spending published in the journal Science. “But this interpretation presumes knowledge of who will die and when.… Those who end up dying are not the same as those who were sure to die.”

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Their evidence is based on the records of almost 6 million Medicare enrollees. Based on projected mortality rates depending on their physical condition, the records indicate that more than 90 percent of patients who ended up dying within a given year were actually more likely to live than to die.

In sum, the research authors wrote: “We find there are only a few individuals for whom … death is near certain.”

Instead of focusing on overall end-of-life costs, researchers urged, there should be a “focus on quality of care for very sick patients — identifying the impact of specific health care interventions on survival rates” as well as on their palliative effects.

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