Aging Clinical and Experimental Research

, Volume 26, Issue 3, pp 315–317 | Cite as

Mandating advance directives

Short Communication

Abstract

As the population ages, end-of-life care (EOLC) costs become an increasingly pressing subject. Advance directives (ADs) are legal documents that allow individuals to convey their decisions about EOLC. Although ADs have been shown to reduce EOLC costs, most people do not have ADs. To address this issue, we propose that Congress instruct the Centers for Medicare and Medicaid Services to collect ADs from Medicare beneficiaries. Because ADs can improve care and reduce unnecessary spending, this solution would likely be attractive to a broad coalition of support from providers, insurers, and the public.

Keywords

Advance directives End-of-life care Policy 

Notes

Acknowledgments

Financial support provided by Rhode Island Public Health Institute and Arnold P. Gold Foundation.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Dohm Arlene (2000) Guaging the labor force effects of retiring baby-boomers. Mon Lab Rev 123:17Google Scholar
  2. 2.
    Vincent GK, Velkoff VA, US Census Bureau (2010) The next four decades: the older population in the United States: 2010 to 2050: Population Estimates and Projections. http://www.census.gov/prod/2010pubs/p25-1138.pdf. Accessed 6 June 2013
  3. 3.
    Shrestha LB (2006) CRS Report for Congress: life expectancy in the United States. http://aging.senate.gov/crs/aging1.pdf. Accessed 16 April 2013
  4. 4.
    Keehan S, Sisko A, Truffer C et al (2008) TRENDS: health spending projections through 2017: the baby-boom generation is coming to medicare. Health Aff 27:w145–w155CrossRefGoogle Scholar
  5. 5.
    Burner ST, Waldo DR, McKusick DR (1992) National health expenditures projections through 2030. Health Care Financ Rev 14(1):1–29PubMedGoogle Scholar
  6. 6.
    Riley GF, Lubitz JD (2010) Long-term trends in medicare payments in the last year of life. Health Serv Res 45(2):565–576PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Conwell LJ, Cohen JW Characteristics of people with high medical expenses in the US civilian noninstitutionalized population, 2002. March 2005. Rockville, MD: Agency for Healthcare Research and Quality. http://meps.ahrq.gov/mepsweb/data_files/publications/st73/stat73.pdf. Accessed 12 June 2013
  8. 8.
    Hoover DR, Crystal S, Kumar R, Sambamoorthi U, Cantor JC (2002) Medical expenditures during the last year of life: findings from the 1992–1996 medicare current beneficiary survey. Health Serv Res 37(6):1625–1642PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Reinhardt UE (2003) Does the aging of the population really drive the demand for health care? Health Aff (Millwood) 22:27–39CrossRefGoogle Scholar
  10. 10.
    Zhang B, Wright AA, Huskamp HA et al (2009) Health care costs in the last week of life: associations with end-of-life conversations. Arch Intern Med 169(5):480–488PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Peres JR (2011) Public policy in palliative and end-of-life care. In: Altilio T, Otis-Green S (eds) Oxford textbook of palliative social work. Oxford University Press, New York, pp 753–770CrossRefGoogle Scholar
  12. 12.
    Kaiser Family Foundation. Medicare Spending and Financing: A Primer: 2011 and 2012 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Supplementary Medical Insurance Trust Funds. 2012. www.cms.gov/Research-Statistics-Data-and-Systems/StatisticsTrends-and-Reports/ReportsTrustFunds/Downloads/TR2012.pdf. Accessed 6 June 2013
  13. 13.
    Congressional Budget Office (2012) The 2012 Long Term Budget Outlook. http://cbo.gov/publication/43288. Accessed 8 May 2013
  14. 14.
    CDC (2011) Healthy Aging: Helping People to Live Long and Productive Lives and Enjoy a Good Quality of Life. National Center for Chronic Disease Prevention and Health Promotion. http://www.cdc.gov/chronicdisease/resources/publications/AAG/aging.htm. Accessed 12 June 2013
  15. 15.
    Robert Wood Johnson Foundation (2010) Chronic Care: Making the case for ongoing care. www.rwjf.org/pr/product.jsp?id=50968. Accessed 8 May 2013
  16. 16.
    Wolff JL, Starfield B, Anderson G (2002) Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 162(20):2269–2276PubMedCrossRefGoogle Scholar
  17. 17.
    Stevenson D (2008) Planning for the future—long-term care and the 2008 election. N Engl J Med 358:1985–1987PubMedCrossRefGoogle Scholar
  18. 18.
    Fleischman RJ, Mullins RJ, McConnell KJ, Hedges JR, Ma OJ, Newgard CD (2012) Is futile care in the injured elderly an important target for cost savings? J Trauma Acute Care Surg 73(1):146–151PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Emanuel EJ (1996) Cost savings at the end of life. What do the data show? JAMA 275(24):1907–1914PubMedCrossRefGoogle Scholar
  20. 20.
    Teno JM, Licks S, Lynn J et al (1997) Do advance directives provide instructions that direct care? J Am Geriatr Soc 45:508–512PubMedGoogle Scholar
  21. 21.
    Teno J, Lynn J, Wenger N et al (1997) Advance directives for seriously-ill hospitalized patients: effectiveness with the Patient Self-Determination Act and the SUPPORT intervention. J Am Geriatr Soc 45:500–507PubMedGoogle Scholar
  22. 22.
    California Healthcare Foundation (2012) Final Chapter: Californians’ Attitudes and Experiences with Death and Dying. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/F/PDF%20FinalChapterDeathDying.pdf. Accessed 26 April 2013
  23. 23.
    Virmani J, Schneiderman LJ, Kaplan RM (1994) Relationship of advance directives to physician-patient communication. Arch Intern Med 154:909–913PubMedCrossRefGoogle Scholar
  24. 24.
    Emanuel LL, Barry MJ, Stoeckle JD, Ettelson LM, Emanuel EJ (1991) Advance directives for medical care–a case for greater use. N Engl J Med 324(13):889–895PubMedCrossRefGoogle Scholar
  25. 25.
    Pew Research Center for the People & the Press (2006) Strong public support for right to die: more Americans discussing—and planning—end-of-life treatment. http://www.people-press.org/2006/01/05/strong-public-support-for-right-to-die/. Accessed 24 April 2013
  26. 26.
    American Geriatrics Society (2011) Statement regarding the value of advance care planning. http://www.americangeriatrics.org/files/documents/Adv_Resources/AGS.Statement.On.Advance.Care.Planning.01.2011.pdf. Accessed 14 October 2013

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  1. 1.Warren Alpert Medical SchoolBrown UniversityProvidenceUSA
  2. 2.Warren Alpert Medical School and Center for Gerontology and Health Care ResearchBrown UniversityProvidenceUSA

Personalised recommendations