I just got a call from a researcher with the ABC "Nightline" program who was looking for some statistics on costs of care for the end of life in the United States. Here are some eye-openers that I use when speaking on this subject. These mostly are drawn from Joanne Lynn's excellent book Sick To Death (pp. 28-31). (I steal some of my best material from Joanne.) In the U.S., Federal funding patterns dominate most of the care for end of life. As with many things, if you "follow the money" you will get some insight on why things work the way they do.
Les' "Top Ten" soundbites on costs of end-of-life care:
1. 83% of Americans die while covered by Medicare. (Hogan et al., 2000)
2. Medicare's payments average about $28,000 in the last year of a person's life. (Emanuel et al. 2002)
3. Given that Medicare now pays about half of the costs (Maxwell, Moon, and Segal 2001; Lubitz et al. 2003), the average total cost is around $50,000 for the last year of life.
4. Medicare's costs for the last year of life have been stable at about 26 percent of the program budget for two decades (Hoover et al. 2002).
5. A 70-year old healthy person with no functional limitations will spend about $136,000 in Medicare-covered services (hospitals, physicians, rehabilitation, durable equipment) during a life expectancy of fourteen more years, living with a functional limitation for six of those additional years. A 70-year old who is limited in at least one activity of daily living (such as mobility, toileting, feeding) will spend about $145,000 in Medicare coverage during a life expectancy of twelve more years, having a functional limitation ofr nearly eight years of that time. (Lubitz et al. 2003)
6. On average, people now are seriously ill for much more than one year (Lynn, Blanchard, et al. 2002); two years is probably the average for self-care disability, but some are disabled for more than a decade.
7. Of the $1.2 trillion spent in 2001 on personal health care, about $0.1 trillion went to nursing-home care (Walker 2002), and $0.9 trillion went to the noninstitutional care of those with chronic conditions (Anderson, Horvath, and Anderson 2002). In constant dollars, these expenditures were expected to double before 2040, even without the inclusion of prescription drugs in Medicare (Hoffman and Rice 1995, 9).
8. In fiscal year 2000, Medicaid paid for 45% of the $137 billion annual cost of institutional long-term care (U. S. Congress 2002). The Congressional Budget Office forecasts that the cost of long-term care will reach $207 billion in 2020 and $346 billion in 2040. (Congressional Budget Office 1999) These costs risk bankrupting state budgets, which currently devote 20 percent of expenditures to Medicaid, while spending on all health care constitutes about 30% of state spending (National Association of State Budget Officers 2003).
9. In the 1960s, when Medicare started, only 9 percent (17 million) of the population was 65 or older. In 2000, 12 percent (35 million) of the population was 65 and older. In 2030, projections are that 22 percent (eighty million) of people in the U. S. will be 65 and older. (U. S. Census Bureau 2000)
10. More than half of personal bankruptcy cases arise from health-care costs (Jacoby, Sullivan, and Warren 2001)
What this all means is that costs of care at the end of life are a train wreck waiting to happen unless we do something about the entire model of care.