Bioethics Blogs

Making Progress in Improving End-of-Life Care

This past week the JAMA Network and
the Kaiser Family Foundation published a one-page graphic providing the latest
data and information about Medicare patients and end-of-life care. JAMA.
2016;316(17):1754. In 2014, there were 2.6 million total deaths in the US; 2.1
million or about 80% of the total were persons covered by Medicare. These 2.1
million 2014 Medicare decedents accounted for 13.5% of all Medicare spending.
That is about $35,529 per Medicare beneficiary who died in 2014. Other Medicare
beneficiaries – those who did not die in 2014 – cost the system about $9,121
per person. This is a remarkable difference from 1978, when Medicare decedents
in the last year of life accounted for 28% of program expenditures. Lubitz JD,
Riley GF. Trends in Medicare payments in the last year of life. N Engl J Med.
1993;328(15):1092-1096. Interestingly, the percentage between 1978 and 1988 did
not change.

The
new data show that trends have changed over the intervening decades. One of the
more definitive descriptions of Medicare expenditures for beneficiaries in the
last year of life was published in the New England Journal of Medicine in 1993.
Lubitz JD, Riley GF. Trends in Medicare payments in the last year of life. N
Engl J Med. 1993;328(15):1092-1096. In some respects the data may not be
exactly the same, for example, one compares payments in calendar years, and the
other the last 12 months of patients’ lives; but the trends are fairly clear
anyway:

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.