BUSTED: The Myth of High-Cost End-of-Life Care

July 11, 2018

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First, about Trump’s choice for the Supreme Court: While Judge Brett Kavanaugh has issued superb rulings on many topics, he’s been less stellar on health care. For example, he essentially ruled that senior Americans are obligated to enroll in Medicare. Thus CCHF is engaged in a campaign to cut this link between Medicare and Social Security. And Judge Brett Kavanaugh’s actions and rationale helped uphold the ACA (aka Obamacare).

Now, to my commentary: Is care at the end of life a waste of money? It has often been said, “Twenty-five percent of spending occurs in the last year of life.” The point of this claim is that we’re wasting money on those who are dying. It further supports rationing care to the elderly; redistributing dollars from the elderly to the young; and physician-facilitated suicide and euthanasia.

A new study, called “Predictive Modeling of U.S. Health Care Spending in Late Life,” blows holes in the “waste of money” assertions. Three economists and one physician found that the patients with the highest one-year mortality risk account for less than 5 percent of spending, far short of the claimed 25 percent. The researchers were most surprised by the fact that many of those at the greatest risk do not die. Death is highly unpredictable. Says economist Amy Finkelstein: “We spend money on sick people—some of them die, some of them recover . . . Maybe some recover, in part, because of what we spent on them.”

Or as Dr. Stephanie Harman, who works in palliative care and biomedical ethics at Stanford says, “Just because someone is seriously ill with an uncertain prognosis doesn’t mean that their health care spending is wasteful.”

Similar results from earlier studies have been ignored by the media and others. A 2017 study titled “End-of-Life Medical Spending in Last Twelve Months of Life is Lower Than Previously Reported” suggests switching the focus from spending for end-of-life care to “reducing the costs of caring for people with chronic conditions” because 24.5% of overall cost are in the last three years of life.

Even earlier, a 2015 study under the title “The Myth Regarding the High Cost of End-of-Life Care,” found the following about the care of high-cost, seriously ill individuals: “the cost of caring for individuals in their last year of life accounts for only 13% of total annual health care spending. That is, although the majority of decedents are in the highest cost group, the majority of individuals in that group are not in their last year of life. Specifically, we estimate that only 11% of individuals in the highest cost group are in their last year of life.”

ACTION ITEM: Take the opportunity to correct this falsehood whenever it pops up!

Bringing the truth to light,

Twila Brase, RN, PHN
President and Co-founder

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