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Medical Care at the End of Life: Diseases, Treatment Patterns, and Costs


  • Alan M. Garber
  • Thomas E. MaCurdy
  • Mark C. McClellan


In recent years, the use of Medicare-covered home health care and hospice services has grown dramatically. Hospice care, like much home health and nonacute hospital care, is designed to meet the needs of dying patients, who are known to generate disproportionately large costs of care. How has use of these services by dying Medicare beneficiaries changed over time? How has it varied by disease? Does recent experience suggest that these services have helped save the Medicare program money by displacing hospital care and other costly services? To address these questions, we examined linked Medicare claims files from 1988 to 1995, determining the location of death, days of use of services, and expenditures for the care of beneficiaries in the final months of life. We found that use of hospice and home health services by decedents grew rapidly over the eight-year study period, and especially rapidly among patients who died with a predictably terminal illness such as lung cancer. Among the elderly who have such illnesses, these alternatives to acute hospital care have reduced the use of hospital care near the very end of life. Most of the growth in these services in the year or two before death, however, appears to involve additional Medicare-covered services. As a result, utilization of Medicare-covered home health and hospice care by dying beneficiaries has increased over time, with an associated reduction in the proportion of deaths occurring in acute-care hospitals. But as the use of non-hospital services has grown, the growth in Medicare expenditures for hospital services at the end of life has not slowed appreciably, nor has there been a marked change in the intensity of end-of-life treatment for Medicare beneficiaries dying of more acute illnesses or requiring substantial supportive care.

Suggested Citation

  • Alan M. Garber & Thomas E. MaCurdy & Mark C. McClellan, 1998. "Medical Care at the End of Life: Diseases, Treatment Patterns, and Costs," NBER Working Papers 6748, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:6748
    Note: AG HC

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    Cited by:

    1. Rettenmaier, Andrew J. & Wang, Zijun, 2006. "Persistence in Medicare reimbursements and personal medical accounts," Journal of Health Economics, Elsevier, vol. 25(1), pages 39-57, January.
    2. Tim Miller, 2001. "Increasing longevity and medicare expenditures," Demography, Springer;Population Association of America (PAA), vol. 38(2), pages 215-226, May.
    3. Baoping Shang & Dana Goldman, 2008. "Does age or life expectancy better predict health care expenditures?," Health Economics, John Wiley & Sons, Ltd., vol. 17(4), pages 487-501.
    4. Payne, Greg & Laporte, Audrey & Foot, David K. & Coyte, Peter C., 2009. "Temporal trends in the relative cost of dying: Evidence from Canada," Health Policy, Elsevier, vol. 90(2-3), pages 270-276, May.
    5. David Johnson & Jongsay Yong, 2006. "Costly Ageing Or Costly Deaths? Understanding Health Care Expenditure Using Australian Medicare Payments Data ," Australian Economic Papers, Wiley Blackwell, vol. 45(1), pages 57-74, March.
    6. Christian Salas & James P. Raftery, 2001. "Econometric issues in testing the age neutrality of health care expenditure," Health Economics, John Wiley & Sons, Ltd., vol. 10(7), pages 669-671.
    7. repec:jns:jbstat:v:227:y:2007:i:5-6:p:578-602 is not listed on IDEAS
    8. Postler Andreas, 2010. "Gesundheitspolitik – Grundrisse einer nachhaltigen und gerechten Finanzierung der Gesetzlichen Krankenversicherung / Health policy – outline for a sustainable and fair financing of Germany’s statutory," ORDO. Jahrbuch für die Ordnung von Wirtschaft und Gesellschaft, De Gruyter, vol. 61(1), pages 267-286, January.
    9. Alfons Palangkaraya & Jongsay Yong, 2009. "Population ageing and its implications on aggregate health care demand: empirical evidence from 22 OECD countries," International Journal of Health Economics and Management, Springer, vol. 9(4), pages 391-402, December.

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    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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