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Are we spending too much on health care at end of life?

Written by Diane Archer

A new study in Science, by Amy Finkelstein et al., suggests that we may not be spending too much on health care at the end of life. Rather, we may be spending a lot on health care when people have costly and complex conditions. Sometimes, with that spending, we end up extending people’s lives and sometimes people end up dying. Since it’s often impossible to know whether treatment will be successful, we should not be reducing health care spending on people whom we may believe are at the end of life.

The researchers find that because we generally do not know when someone will die, we cannot assume that end-of-life spending is wasteful. In many cases our spending on people with costly conditions saves lives.

One in 20 people with Medicare die each year. And 25 percent of Medicare spending happens in people’s last year of life. But, Medicare spending on people who are most likely to die in a given year is less than 5 percent.

Notably, the authors found that it is extremely hard to predict who will live and who will die each year. As it turns out, people who die within a year do not have a terribly high risk of dying when they are admitted to hospital. They are slightly less likely to die within the year. Even knowing a lot about a patient gives you only 50 -50 odds of knowing whether he or she will die. There is little ability to differentiate between the people in need of complex care who will live and the ones who will die.

The authors suggest that we still need to understand health care quality better, as well as which health care interventions work to improve health and which do not, for people with the costliest conditions. Simply assuming that we need to stop spending as much on care at the end of life is wrong.

Here’s more from Just Care:

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1 Comment

  • It only matters how much it costs if you are an insurance company or a politician who caters to insurance companies.

    For their sake I looked up the numbers. $672 billion in 2016 for 47.8 million people. $168 billion for the last year of life. Approximately 2 million die each year. $84000 per person. The cost for those who don’t die is about $11,000. I love my Medicare. It makes me secure. It allows me to be healthy and see Doctors when I need to.

    The government did the wrong thing in 1964. The took the high cost of health care off the back of insurance companies. Medicare is a great way to insure seniors. Now it’s time too cut the rest of America loose and share it with them.

    So the working man pays 2.88% (including company) for the tax that pays for this. Since Medicare is about half of the cost of all our health care a number like 6% could cover us all. I like 2% for the worker and the rest for the employer. Employers will like this because it is much less than they are paying for insurance.

    15 Senators and 77 Congressmen support Medicare as an option for all. 75% of the public thinks this is a positive idea.

    Once we have a national healthcare system we can begin to control the outcomes. We do spend too much on people with several complex ailments, but only because we pay too little on managing the factors leading us into our poor health.

    And the idea that this is socialist and we can’t afford it? That’s the koolaid talking.

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