Why is End-of-Life Spending So High? Evidence from Cancer Patients / Dan Zeltzer, Liran Einav, Amy Finkelstein, Tzvi Shir, Salomon M. Stemmer, Ran D. Balicer.

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Zeltzer, Dan

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Material type: Text

TextSeries: Working Paper Series (National Bureau of Economic Research) ; no. w28162.Publication details: Cambridge, Mass. National Bureau of Economic Research 2020.Description: 1 online resource: illustrations (black and white)Subject(s):

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Abstract: The concentration of healthcare spending at the end of life is widely documented but poorly understood. To gain insight, we focus on patients newly diagnosed with cancer. They display the familiar pattern: even among cancer patients with similar initial prognoses, monthly spending in the year post diagnosis is over twice as high for those who die within the year than those who survive. This elevated spending on decedents is almost entirely driven by higher inpatient spending, particularly low-intensity admissions, which rise as the prognosis deteriorates. However, even for patients with very poor prognoses at the time of admission, most low-intensity admissions do not result in death, making it difficult to target spending reductions. We also find that among patients with the same cancer type and initial prognosis, end-of-life spending is substantially more elevated for younger patients compared to older patients, suggesting that treatment decisions are not exclusively present-focused. Taken together, these results provide a richer understanding of the sources of high end-of-life spending, without revealing any natural "remedies."

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Item type	Home library	Collection	Call number	Status	Date due	Barcode	Item holds
Working Paper	Biblioteca Digital	Colección NBER	nber w28162 (Browse shelf(Opens below))	Not For Loan

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December 2020.

The concentration of healthcare spending at the end of life is widely documented but poorly understood. To gain insight, we focus on patients newly diagnosed with cancer. They display the familiar pattern: even among cancer patients with similar initial prognoses, monthly spending in the year post diagnosis is over twice as high for those who die within the year than those who survive. This elevated spending on decedents is almost entirely driven by higher inpatient spending, particularly low-intensity admissions, which rise as the prognosis deteriorates. However, even for patients with very poor prognoses at the time of admission, most low-intensity admissions do not result in death, making it difficult to target spending reductions. We also find that among patients with the same cancer type and initial prognosis, end-of-life spending is substantially more elevated for younger patients compared to older patients, suggesting that treatment decisions are not exclusively present-focused. Taken together, these results provide a richer understanding of the sources of high end-of-life spending, without revealing any natural "remedies."