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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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