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Health Aff (Millwood). 2017 Jul 1;36(7):1211-1217. doi: 10.1377/hlthaff.2017.0174.

End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported.

Author information

1
Eric B. French is a professor of economics at University College London; codirector of the ESRC Centre for the Microeconomic Analysis of Public Policy, Institute for Fiscal Studies; and Research Fellow at the Centre for Economic Policy Research, all in the United Kingdom.
2
Jeremy McCauley is a PhD student at University College London.
3
Maria Aragon is a research fellow in the Centre for Health Economics, University of York, in the United Kingdom.
4
Pieter Bakx is an assistant professor in the Institute of Health Policy and Management, Erasmus University Rotterdam, in the Netherlands.
5
Martin Chalkley is a professor in the Centre for Health Economics, University of York.
6
Stacey H. Chen is an associate professor in the National Graduate Institute for Policy Studies, in Tokyo, Japan.
7
Bent J. Christensen is director of the Dale T. Mortensen Center and a professor in the Department of Economics and Business Economics, Aarhus University, in Denmark.
8
Hongwei Chuang is an associate professor in the Graduate School of Economics and Management at Tohoku University, in Sendai, Japan.
9
Aurelie Côté-Sergent is a research professional at the Center for Interuniversity Research and Analysis of Organizations (CIRANO), in Montreal, Quebec.
10
Mariacristina De Nardi is a professor of economics at University College London; a senior economist and research advisor at the Federal Reserve Bank of Chicago, in Illinois; a research fellow at the Centre for Economic Policy Research, in Paris, France; an international research fellow at the Institute for Fiscal Studies, in London; and a faculty research fellow at the National Bureau of Economic Research, in Cambridge, Massachusetts.
11
Elliott Fan is an assistant professor in the Department of Economics at National Taiwan University, in Taipei.
12
Damien Échevin is a research professor at the Université de Sherbrooke, in Quebec.
13
Pierre-Yves Geoffard is a professor at the Paris School of Economics (CNRS), and a research fellow at the Centre for Economic Policy Research.
14
Christelle Gastaldi-Ménager is deputy head of the Department of Studies on Patients and Diseases, National Health Insurance Fund for Salaried Workers, in Paris.
15
Mette Gørtz is an associate professor in the Department of Economics, University of Copenhagen, in Denmark.
16
Yoko Ibuka is an associate professor in the Department of Economics and Management, Tohoku University.
17
John B. Jones is a senior economist and research advisor at the Federal Reserve Bank of Richmond, in Virginia.
18
Malene Kallestrup-Lamb is an assistant professor in the Department of Economics and Business Economics, Aarhus University.
19
Martin Karlsson is a professor of economics at the University of Duisburg-Essen, Germany.
20
Tobias J. Klein is an associate professor in the Department of Econometrics and Operations Research, Tilburg University, in the Netherlands.
21
Grégoire de Lagasnerie is a health economist at the National Health Insurance Fund for Salaried Workers.
22
Pierre-Carl Michaud is a professor in the Department of Applied Economics, HEC Montreal.
23
Owen O'Donnell is a professor in the Erasmus School of Economics, Erasmus University Rotterdam, and at the University of Macedonia, in Thessaloniki, Greece.
24
Nigel Rice is a professor in the Centre for Health Economics and Department of Economics and Related Studies, University of York.
25
Jonathan S. Skinner is the James O. Freedman Presidential Professor of Economics in the Department of Economics at Dartmouth and a professor in the Department of Family and Community Medicine, Geisel School of Medicine, and at the Dartmouth Institute for Health Policy and Clinical Practice, all in Hanover, New Hampshire.
26
Eddy van Doorslaer is a professor in the Institute of Health Policy and Management, Erasmus School of Economics, Erasmus University Rotterdam.
27
Nicolas R. Ziebarth is an assistant professor in the Department of Policy Analysis and Management, Cornell University, in Ithaca, New York.
28
Elaine Kelly (e.kelly@ifs.org.uk) is a senior research economist at the Institute for Fiscal Studies, in London.

Abstract

Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009-11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies.

KEYWORDS:

Cost of Health Care; Developed World < International/global health studies; Financing Health Care; Health Spending; Organization and Delivery of Care

PMID:
28679807
DOI:
10.1377/hlthaff.2017.0174
[Indexed for MEDLINE]
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