Influence of Age on Medicare Expenditures and Medical Care in the Last Year of Life

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Abstract
There is great interest in the cost of medical care in the last year of life. Expenditures for Medicare beneficiaries who die each year are approximately 5 times as high per person as for survivors.1 However, Medicare expenditures for Medicare beneficiaries in the last year of life decrease as age increases; this pattern has been found in studies of data from 1976,1 1978,2 1988,1 and 1992.3 To understand this phenomenon, we examined the pattern of expenditures with age in more detail, stratifying 1996 Medicare data by sex, race, comorbidity, use of hospice care, place and cause of death, and type of health care services used. In addition, we have examined changes in the aggressiveness of medical care with age, as judged by the frequency of admissions to a hospital and to care in an intensive care unit (ICU), and by the use of aggressive interventions such as ventilators, pulmonary artery monitors, cardiac catheterization, and dialysis.

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