End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported

Area of Science:

• Health Economics
• Public Health
• Gerontology

Background:

• End-of-life medical spending is a significant, yet imprecisely measured, component of healthcare expenditure.
• Previous research has often focused on the final months of life, potentially underestimating total end-of-life costs.

Purpose of the Study:

• To accurately measure the composition and magnitude of medical spending in the three years preceding death across multiple high-income countries.
• To differentiate between spending on life-extending interventions and spending on managing chronic conditions at the end of life.

Main Methods:

• Analysis of detailed healthcare data from 2009-2011 in nine countries/regions: Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and Quebec (Canada).
• Calculation of medical spending in the last twelve months and the last three calendar years before death.
• Comparison of end-of-life spending with spending at other life stages.

Main Results:

• Medical spending at the end of life was consistently high across all studied countries relative to spending at other ages.
• Spending in the final twelve months constituted a modest share of aggregate spending (8.5% in the US to 11.2% in Taiwan).
• Spending in the final three calendar years was substantial, reaching 24.5% of total expenditure in Taiwan, indicating prolonged care needs.

Conclusions:

• High aggregate medical spending is significantly influenced by the management of chronic conditions, which are associated with shorter life expectancies.
• End-of-life care costs are driven more by ongoing management of chronic diseases than by intensive, last-minute life-saving interventions.
• Understanding the drivers of end-of-life spending is crucial for healthcare policy and resource allocation, particularly concerning chronic disease management.