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Health Aff (Millwood). 2016 Jul 1;35(7):1316-23. doi: 10.1377/hlthaff.2015.1419. Epub 2016 Jun 15.

Identification Of Four Unique Spending Patterns Among Older Adults In The Last Year Of Life Challenges Standard Assumptions.

Author information

1
Matthew Allen Davis (mattadav@umich.edu) is an assistant professor in the Department of Systems, Populations, and Leadership at the University of Michigan School of Nursing, in Ann Arbor; a faculty affiliate of the University of Michigan Institute for Social Research; and an adjunct assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, in Lebanon, New Hampshire.
2
Brahmajee K. Nallamothu is an associate professor in the Department of Internal Medicine in the Division of Cardiovascular Medicine at the University of Michigan Medical School, an investigator at the Center for Clinical Management Research at the Ann Arbor VA Medical Center, and director of the Michigan Center for Health Analytics and Medical Prediction.
3
Mousumi Banerjee is a research professor of biostatistics at the University of Michigan School of Public Health.
4
Julie P. W. Bynum is an associate professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.

Abstract

The assumption that health care spending skyrockets at the end of life might suggest that policy makers should target the last few months of life to control costs. However, spending patterns leading up to death have not been fully examined. We applied a new methodology to administrative claims data for older Medicare beneficiaries who died in 2012 to characterize trajectories of health care spending in the last year of life. After adjustment, we identified four unique spending trajectories among decedents: 48.7 percent had high persistent spending, 29.0 percent had moderate persistent spending, 10.2 percent had progressive spending, and 12.1 percent had late rise spending. High spending throughout the full year before death (approximately half of all decedents) was associated with having multiple chronic conditions but not any specific diseases. These findings suggest that spending at the end of life is a marker of general spending patterns often set in motion long before death.

KEYWORDS:

Elderly; Health care costs; Medicare; end-of-life care

Comment in

PMID:
27307350
PMCID:
PMC5046841
DOI:
10.1377/hlthaff.2015.1419
[Indexed for MEDLINE]
Free PMC Article

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