Study Debunks Notion That Large Chunks of Medicare Go to Patients Near Death

A study published in Science found that while Medicare spending is concentrated among people who die, there is very little spending on those whose death within the year is highly likely, reports ScienceDaily . "Very little money is spent on people who we know with high probability are going to die in a short amount of time," says Massachusetts Institute of Technology Professor Amy Finkelstein. She also notes to the extent that such cases exist, "they're just not the drivers of bulk spending." The researchers examined a random sample of nearly 6 million Medicare enrollees who were in the program as of Jan. 1, 2008. For survivors, the study analyzed healthcare spending for all of 2008; for people who died in 2008, it examined spending over the year before death. The researchers demonstrated that fewer than 10 percent of people who die in a given year have a predicted 12-month mortality rate over 50 percent. Even when people are hospitalized in what turns out to be their final year, fewer than 4 percent have a predicted 12-month mortality rate of 80 percent or higher at the time of hospitalization. The analysis indicates the apparent focus of spending on last-year-in-life persons is a byproduct of the fact that even relatively low-mortality health scenarios for seniors will include a certain number of deaths, not that the individual treatment decisions represent longshots. Furthermore, the fact that we spend more money on sick people represents 30 percent to 50 percent of the concentration of spending on people in their last year of life.