End-of-life health care still a conundrum
IT is conventional wisdom that end-of-life care is an increasingly huge proportion of health care spending. I've often heard it said that people spend more on health care in the year before they die than they do in the entire rest of their lives. If we don't address these costs, the story goes, we can never control health care inflation.
Wrong. Here are the real numbers. The roughly 6 percent of Medicare patients who die each year do make up a large proportion of Medicare costs: 27 to 30 percent. But this figure has not changed significantly in decades. And the total number of Americans, not just older people, who die every year - less than 1 percent of the population - account for much less of total health care spending, just 10 to 12 percent.
The more important issue is that just because we spend a lot on end-of-life care does not mean we can save a lot. We do know that costs for dying patients vary widely among hospitals, which suggests that we can do better. And yet no one can reliably say what specific changes would significantly lower costs. There is no body of well-conducted research studies that has proved how to save 5, 10, much less 20 percent.
Recent studies find that hospice may reduce costs in the last year of life for cancer patients by 10 to 20 percent. But they find no savings from hospice care for patients who die of other conditions, like emphysema or heart failure. No one is sure why hospice care doesn't save more. It may be because patients are enrolled in hospice care too late, or because hospice services themselves are labor-intensive and not cheap.