Influence of age on medicare expenditures and medical care in the last year of life
Influence of age on medicare expenditures and medical care in the last year of life
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DOI：
10.1001/jama.286.11.1349
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发表时间：
2001-09-19
影响因子：
120.7
通讯作者：
Emanuel, EJ
中科院分区：
文献类型：
--
作者：
Levinsky, NG;Yu, W;Emanuel, EJ
医疗保险受益人在生命最后一年的支出随着年龄的增长而减少。这种现象的原因是不确定的。目的详细检查这种模式，并评估是否减少侵略性的医疗保健解释的现象。设计，设置，来自马萨诸塞州（n=34131）和加州（n=19064）的65岁或以上受益人的样本医疗保险数据分析主要结果测量生命最后一年的医疗费用，按年龄组、性别、种族、死亡地点和原因、合并症和医院服务的使用进行分析。结果分别在马萨诸塞州和加州，在65岁至74岁的人群中，每个受益人的医疗保险支出分别为35300美元和27800美元，而85岁以上的人群为22000美元和21600美元。随着年龄的增长，医疗保险支出减少的模式是普遍存在的，在两个州的生命的最后一年，无论是男性还是女性，无论是黑人还是白色受益人，无论是患有不同程度的合并症的人，无论是接受临终关怀还是接受传统护理，无论死亡的原因和部位如何。马萨诸塞州和加州的医疗保健积极性也随着年龄的增长而下降，这一点可以从医院和重症监护室的入院频率降低以及心导管插入术、透析、呼吸机和肺动脉监测器的使用显著减少（无论死因如何）来判断。在医院服务的成本下降约占80%的医疗保险支出的减少，随着年龄的增长，在这两个state.Conclusions医疗保险支出在生命的最后一年随着年龄的增长而减少，特别是那些年龄在85岁或以上。这在很大程度上是因为在生命的最后一年，随着年龄的增长，医疗保健的侵略性下降。
Context Expenditures for Medicare beneficiaries in the last year of life decrease with increasing age. The cause of this phenomenon is uncertain.Objectives To examine this pattern in detail and evaluate whether decreases in aggressiveness of medical care explain the phenomenon.Design, Setting, and Patients Analysis of sample Medicare data for beneficiaries aged 65 years or older from Massachusetts (n=34131) and California (n=19064) who died in 1996.Main Outcome Measure Medical expenditures during the last year of life, analyzed by age group, sex, race, place and cause of death, comorbidity, and use of hospital services.Results For Massachusetts and California, respectively, Medicare expenditures per beneficiary were $35300 and $27800 among those aged 65 through 74 years vs $22000 and $21600 for those aged 85 years or older. The pattern of decreasing Medicare expenditures with age is pervasive, persisting throughout the last year of life in both states for both sexes, for black and white beneficiaries, for persons with varying levels of comorbidity, and for those receiving hospice vs conventional care, regardless of cause and site of death. The aggressiveness of medical care in both Massachusetts and California also decreased with age, as judged by less frequent hospital and intensive care unit admissions and by markedly decreasing use of cardiac catheterization, dialysis, ventilators, and pulmonary artery monitors, regardless of cause of death. Decrease in the cost of hospital services accounts for approximately 80% of the decrease in Medicare expenditures with age in both states.Conclusions Medicare expenditures in the last year of life decrease with age, especially for those aged 85 years or older. This is in large part because the aggressiveness of medical care in the last year of life decreases with increasing age.