Query: Must we continue to spend a major part of all Medicare spending on ineffective medical treatment during the last year of life? Or, asked another way: Are we doing Grandpa and Grandma a favor by keeping them marginally alive with no quality of life?
We’ve all heard the scenario; 85 year old Grandpa Ike has been taken to the emergency room for the 8th time in the last 6 months and after staying in the hospital for two weeks or so, has returned alive, but in a ever more weakened condition. While he was at the hospital, Ike was subjected to every sort of diagnostic test available, and through dozens of heroic medical interventions was returned home. This is an area of Medicare expenditures which hasn’t been studied lately. Most of the available studies go back 10 years or so, but the study below is illustrative of the general findings:
Medical Expenditures during the Last Year of Life: Findings from the 1992–1996 Medicare Current Beneficiary Survey Donald R Hoover, Stephen Crystal, Rizie Kumar, Usha Sambamoorthi, and Joel C Cantor. Article citations within the text are omitted here. The numbering is mine.
1. The elderly (65 years of age and older) have consumed more than 33 percent of health care spending; 2. Their medical expenses are substantially higher in the last year of life;. 3. While only 5 percent of elderly Medicare beneficiaries have died annually, the percentage of elderly Medicare expenditures spent on persons in the last year of life fluctuates between 27 percent and 31 percent; 4. Mean annual Medicare expenditures for the last 12 months of life in the elderly rose from $1,924 in 1976 to about $23,000 in 1995, but the portion of Medicare expenditures spent on beneficiaries in the last year of life did not change during this time period.
This study is available in full at, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464043/
Another study points out:
“Medicare, the health insurance program for the elderly, spends nearly 30 percent of its budget on beneficiaries in their final year of life. Slightly more than half of Medicare dollars are spent on patients who die within two months. … 40 percent of Medicare dollars cover care for people in the last month.” How Much Do We Spend On End of Life Care? http://www.thirteen.org/bid/sb-howmuch.html
I recently went to a funeral for a woman of 91, who spent the entire last year of her life in a hospital bed tied to a feeding tube and other medicine infusions; she ultimately died of multiple organ failure. Before her final hospitalization she had made endless visits to the hospital for what proved to be ineffective treatment leading ultimately to her total loss of mobility and freedom.
Should we continue doing this to the elderly? Before my father died in January, he kept begging the people at the hospital to let him go home. They kept him there until he died. They said that they were going to make him better. He was 92 years old, with almost absent kidney function, no ability to walk due to a fractured hip replacement that became infected, and moderate dementia. Were they really going to make him better? He had no life left, and ultimately died of the infection of the hip replacementIsn’t it time to put the cabosh on heroics that only enrich the medical providers and impoverish the nation?