Identification Of Four Unique Spending Patterns Among Older Adults In The Last Year Of Life Challenges Standard Assumptions

Health Aff (Millwood). 2016 Jul 1;35(7):1316-23. doi: 10.1377/hlthaff.2015.1419. Epub 2016 Jun 15.


The assumption that health care spending skyrockets at the end of life might suggest that policy makers should target the last few months of life to control costs. However, spending patterns leading up to death have not been fully examined. We applied a new methodology to administrative claims data for older Medicare beneficiaries who died in 2012 to characterize trajectories of health care spending in the last year of life. After adjustment, we identified four unique spending trajectories among decedents: 48.7 percent had high persistent spending, 29.0 percent had moderate persistent spending, 10.2 percent had progressive spending, and 12.1 percent had late rise spending. High spending throughout the full year before death (approximately half of all decedents) was associated with having multiple chronic conditions but not any specific diseases. These findings suggest that spending at the end of life is a marker of general spending patterns often set in motion long before death.

Keywords: Elderly; Health care costs; Medicare; end-of-life care.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cause of Death
  • Cohort Studies
  • Databases, Factual
  • Female
  • Geriatric Assessment*
  • Health Expenditures*
  • Humans
  • Male
  • Medicare / economics*
  • Medicare / statistics & numerical data
  • Predictive Value of Tests
  • Survival Analysis
  • Terminal Care / economics*
  • Terminal Care / trends
  • Time Factors
  • United States