Health Affairs: Medical spending during final 12 months of life less than previously expected

Reducing healthcare spending in the last 12 months of life will have "only a modest" effect on total medical spending, according to a study published in Health Affairs.

Researchers from multiple countries, led by Eric French, a professor of economics at University College London, analyzed individual-level medical spending using data sets from eight countries: Denmark, England, France, Germany, Japan, the Netherlands, Taiwan and the U.S., as well as the Canadian province of Quebec. Study authors used two measures — spending in the last 12 months of life and spending in the last three calendar years of life — to estimate aggregate annual medical spending in the final years of life for each geographical region. The study assessed data from 2009 to 2011.

The research found medical spending in the final 12 months of life reflected 8.5 percent to 11.2 percent of overall medical spending in the eight countries and Quebec. Among the studied countries, the U.S. fell to the bottom of the ranking. Researchers noted the U.S. "is a clear outlier in total medical spending as a share of GDP, but the share of U.S. healthcare spending that goes to people in the last 12 months of life is toward the bottom of the range of estimates for the nine countries that we studied."

Instead, researchers found spending in the last three years of life represented up to 24.5 percent of overall medical spending across the study countries. The study authors said 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."

The authors added the "task of containing or reducing end-of-life spending likely requires a multifaceted approach by policymakers and clinicians. For people near death, an appropriate mix of long-term care, hospice and home care would ensure that only those patients who wanted and needed to be in hospitals were treated there. The primary payoff would be better quality care, along with modestly lower costs."

Researchers acknowledged some study limitations, including incomplete health data as well as not adjusting for cause of death and the quality of care.  

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