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Out-of-pocket spending in the last year of life

From "The Risk of Out-of-Pocket Health Care Expenditure at End of Life," by Samuel Marshall, Kathleen M. McGarry, and Jonathan S. Skinner:

Spending in the last year of life is estimated to be $11,618 on average, with the 90th percentile equal to $29,335, the 95th percentile $49,907, and the 99th equal to $94,310. These spending measures represent a substantial fraction of liquid wealth for decedents. Total out-of-pocket expenditures are strongly positively related to wealth and weakly related to income.

By Ezra Klein  |  July 14, 2010; 9:04 AM ET
Categories:  Health Economics  
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the moral of the story....
appreciate each day of precious, good health,
and the energy to participate in the things that you love to do.

Posted by: jkaren | July 14, 2010 9:27 AM | Report abuse

Obviously, for a small cut, say 1.2%, in average life expectancy, our society could save some big bucks. Berwick is the man to look into it, don't you think?

Posted by: msoja | July 14, 2010 9:51 AM | Report abuse

This once again leads to the question that no HCR pundit ever answered: when is it determined to be the last year of your life? It's a trick question, we only know after you're dead. If you spend $100k out of pocket to fight cancer and live another 10 years, it's not the last year of your life. If you don't survive, it is the last year of your life.

The "cherry picking-ness" of this type of study presumes that people know beforehand what their last year of life is but spend money foolishly nonetheless. No one knows going in, so spending decisions are much less informed.

Posted by: philly211 | July 14, 2010 10:42 AM | Report abuse

In other words, the medical community will find out how much money you have, and not let you die until they have taken all of it.

I have a copy of Final Exit in reserve, and intend to use it when the time comes. I did not work my -ss off my whole life to make the payments on a bunch of health care executives' Mercedes.

Posted by: guesswhosue | July 14, 2010 11:32 AM | Report abuse

Philly: As you get into your 80s and 90s, it is pretty clear that you are closer to the last year of your life and that whatever extension you get from aggressive treatment is likely to have diminishing returns, even apart from the severe discomfort of many treatments. Spending lots to combat cancer in your 50s is different than spending it in your 80s or later.

I think three things need to happen. First, older people need to talk about these issues with their doctor and family and get advance directives so that everyone is on the same page when the inevitable comes. Second, more younger (under 60) people ought to spend some time around really old and even dying people if they have no such experience so that they have a better idea what they are talking about.

And finally, we as a society and the medical profession too need to understand that the cause of death is life--ALL life ends in death, and that is just how it is. It is not something to be feared and resisted. What is important is first living a good life while you have it and then minimizing pain as death approaches. Not staving it off at all costs, because that just won't work. Making it as comfortable as possible for all concerned.

The cost savings are just the side benefit.

Posted by: Mimikatz | July 14, 2010 12:12 PM | Report abuse

--"The cost savings are just the side benefit."--

I volunteer Mimikatz to save society some money, first.

Posted by: msoja | July 14, 2010 3:52 PM | Report abuse

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