Health Expenses for Medicare Beneficiaries in Last Year of Life Decline With Age, Study Finds

Health care expenditures for Medicare beneficiaries in the last year of life decrease significantly as age increases, primarily because "aggressiveness of medical care" declines with age, according to a study, called "Influence of Age on Medical Expenditures and Medical Care in the Last Year of Life," published in the Sept. 19 issue of the Journal of the American Medical Association. To examine the cost and extent of care in the last year of life, researchers, led by Dr. Norman Levinsky of the Boston University Medical School, analyzed 34,131 Medicare beneficiaries from Massachusetts and 19,064 from California who died in 1996. Considering such factors as sex, race and place and cause of death and calculating expenditures by using the sum of payments from the Centers for Medicare and Medicaid Services for each Medicare beneficiary, the researchers determined that in Massachusetts, spending in the last year of life declined from $35,300 for those who died between the ages of 65 to 74 to $22,000 for those ages 85 and older. In California, the costs for the respective groups dropped from $27,800 to $21,600. This pattern was "pervasive" for all beneficiaries regardless of personal characteristics, including whether hospice care was used. In both states, a decrease in the cost of hospital services accounted for 80% of the decrease in expenditures, as measures such as cardiac catheterization, dialysis and intensive care unit visits were less frequent for older beneficiaries in the last year of life. While the number of hospitalizations increased by 30% between the two age groups, the actual cost of the hospitalizations declined 50%, leading to the drop in overall expenditures. The researchers conclude that the "pattern of decreasing expenditures with age may represent appropriate clinical decisions by patients, their families and their physicians to curtail unreasonably aggressive care in older patients who are unlikely to benefit from such care" (Levinsky et al., JAMA, 9/19).