The Burden of Health Care Costs in the Last 5 Years of Life

Background—Common diseases, particularly dementia, entail large social costs, previously well described for the U.S. population. Less is known about end-of-life costs of specific diseases and the associated financial risk for individual households. Objective—To examine social costs and financial risks faced by Medicare beneficiaries five years before death. Design—Retrospective cohort. Setting—Health and Retirement Study. Participants—Medicare fee-for-service beneficiaries, aged 70 years or older, who died 2005-2010 (N = 1702), stratified into four cohorts: individuals with high probability of dementia, or with either heart disease, cancer, or other causes of death. Measurements—Total social costs and its components: Medicare, Medicaid, private insurance, out-of-pocket, and informal care, measured over the last 5 years of life; and out-of-pocket spending as a proportion of household wealth. Corresponding Author: Amy S. Kelley, MD MSHS, 1 Gustave L. Levy Place, Box 1070, New York, NY 10029, Office: 212-241-2631, Fax: 212-426-9108, [email protected]. Amy S. Kelley: Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine, 1 Gustave L. Levy Place, Box 1070, New York, NY 10029 Kathleen McGarry: University of California Los Angeles, Department of Economics, Box 951477 8283 Bunche, Los Angeles, CA 90095-1477 Rebecca Gorges: Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine, 1 Gustave L. Levy Place, Box 1070, New York, NY 10029 Jonathan S. Skinner: Dartmouth College, Department of Economics, 6106 Rockefeller Hall Hanover, NH 03755 Protocol: Not available Statistical Code: Available to interested readers by contacting Dr. Kelley at [email protected] Data: Available only by application for restricted data use to the HRS and CMS. Reprint requests: Amy S. Kelley: 1 Gustave L. Levy Place, Box 1070, New York, NY 10029 HHS Public Access Author manuscript Ann Intern Med. Author manuscript; available in PMC 2016 May 17. Published in final edited form as: Ann Intern Med. 2015 November 17; 163(10): 729–736. doi:10.7326/M15-0381. A uhor M anscript