Abstract
Accumulating research shows that decedents’ costs are high, they increase towards death, and they comprise a large proportion of total lifetime costs. The objectives of this paper are (i) to examine the Israeli pattern of medical care cost during the 12 months prior to death by gender, age, and chronic conditions, and (ii) to examine the implications of the results for the Israeli risk adjustment scheme. For the first objective, we used 12 month follow-up data on a cohort of decedents. For the second objective, we supplemented the data with a cross-section of enrollees (survivors and decedents in 2004). With regard to the first objective, we found that the broad Israeli patterns of cost match previous studies from other countries. With respect to the second objective, we argue that since the cost during the last 12 months of life is very high and is concentrated among relatively few persons, in order to prevent any adverse incentives caused by the combination of age-based risk adjustment and segmentation of end-of-life health care, death should be introduced into the existing retrospective risk-sharing arrangement.
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References
Beeuwkes-Buntin M., Garber A., McClellan M., Newhouse J. P. (2004) The cost of decedents in the Medicare program: implications for payments to Medicare + Choice plans. Health Services Research 39: 111–130
Emanuel E. J., Emanuel L. L. (1994) The economics of dying: The illusion of cost savings at the end of life. The New England Journal of Medicine 330: 540–544
Felder S., Meier M., Schmitt H. (2000) Health care expenditure in the last months of life. Journal of Health Economics 19: 679–695
Gopffarth, D., & Schmidt D. (2009, December). Risk-adjusted payments to deceased—lessons from Germany. Paper presented at the 10th RAN meeting, Jerusalem.
Hogan C., Lunney J., Gabel J., Lynn J. (2001) Medicare beneficiaries’ costs of care in the last year of life. Health Affairs 20: 188–195
Hoover D. R., Crystal S., Kumar S., Sambamoorthi U., Cantor J. C. (2002) Medical expenditures during the last year of life: Findings from the 1992–1996 Medicare Current Beneficiary Survey. Health Services Research 37: 1625–1642
Lubitz J. D., Riley G. F. (1993) Trends in Medicare payments in the last year of life. New England Journal of Medicine 328: 1092–1096
McCarthy E.P., Burns R.B., Ngo-Metrzger Q. et al (2003) Hospice use among Medicare managed care and fee-for-service patients dying with cancer. JAMA 289: 2238–2245
Polder J. J., Barendregt J. J., Oers H. (2006) Health care costs in the last year of life—the Dutch experience. Social Science and Medicine 63: 1720–1731
Stooker T., van Acht J. W., van Barneveld E. M., van Vliet R. C., van Hout B. A., Hessing D. J. et al (2001) Costs in the last year of life in the Netherlands. Inquiry 38: 73–80
van de Ven W., & Ellis R. (2000). Risk adjustment in competitive health insurance markets. In: A. J. Culyer & J. P. Newhouse (Eds.), Handbook of Health Economics (Vol. 1A). Amsterdam: Elsevier Science.
van Vliet R. C. J. A., Lamers L. M. (1998) The high cost of death: Should plans get higher payments when members die?. Medical Care 36: 1451–1460
Viring B. A., Fisher E. S., McBean A. M., Kind S. (2001) Hospice use in Medicare managed care and fee-for-service systems. The American Journal of Managed Care 7: 777–786
Zweifel P., Felder S., Meiers M. (1999) Ageing of population and health care expenditure: A red herring?. Health Economics 8: 485–496
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Shmueli, A., Messika, D., Zmora, I. et al. Health care costs during the last 12 months of life in Israel: estimation and implications for risk-adjustment. Int J Health Care Finance Econ 10, 257–273 (2010). https://doi.org/10.1007/s10754-010-9080-4
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DOI: https://doi.org/10.1007/s10754-010-9080-4