Care in last year of life less costly than thought, study finds
- As the population ages, there is lots of talk about end-of-life medical costs and how to control them, but spending in the last 12 months of life is actually lower than previously thought, according to a new study in Health Affairs.
- Researchers analyzed healthcare data for 2009-2011 in the U.S., eight other countries and the Canadian province of Quebec to understand the type and amount of medical spending in the last three years of life.
- Aggregate spending during the last 12 months of life ranged from 8.5% in the U.S. to 11.2% in Taiwan. But spending in the last three years of life hit 24.5% in Taiwan, suggesting that high end-of-life costs are due more to managing chronic conditions than last-gasp efforts, the authors say.
The study showed that the U.S. was just above midway on hospital spending per deceased and had the smallest share of decedents who actually died in the hospital. Still, mean per capital medical spending in the last 12 months of life averaged about $80,000 in the U.S. and hospital spending accounted for 44.2% of that amount — versus 36.3% of spending in the last three years. During the last three years, more was spent on nursing homes and long-term care than in hospitals.
But while the U.S. spends less than other countries on end-of-life care, it devotes as much or more of its GDP to end-of-life care, the study notes. The researchers looked at end-of-life costs in Denmark, England, France, Germany, the Netherlands, Japan, Taiwan, Quebec province and the U.S.
“The task of containing or reducing end-of-life spending likely requires a multifaceted approach by policymakers and clinicians,” the authors wrote. “For people near death, an appropriate mix of long-term care, hospice and home care would ensure that only those patients who wanted and need to be in hospitals were treated there. The primary payoff would be better quality care, along with modestly lower costs.”
Efforts to rein in end-of-life costs are fueling interest in palliative care. A recent Kaiser Family Foundation report found that about 25% of Medicare dollars are spend on beneficiaries in the last year of life for hospital stays, post-acute care and hospice.
Increasingly, hospitals are using palliative care teams to reduce stress and improve quality of life for patients and their families during complex and serious illnesses. “There’s no question that palliative care teams reduce avoidable crises and rationalize the care so that patients get only the care they want and need,” Diane Meier, director of the Center to Advance Palliative Care, told Healthcare Dive earlier this year.
Digital health companies are also targeting the aging population with technologies that help the elderly age safely in place and avoid unnecessary emergency room visits or costly nursing home stays. These include products like Reemo, which captures steps, sleep patterns, heart rate and other motions in real-time and relays them to providers and caregivers, and the Anywhere Help Button, a mobile GPS emergency response system marketed by MobileHelp.
While gains in life expectancy have fueled concerns about runaway healthcare spending on an ever-growing elderly population, those gains may have a limit. A study last fall in the journal Nature suggests human longevity likely caps out in the low 120s.