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End-of-Life Medical Spending In Last Twelve Months of Life is Lower than Previously Reported

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  • Eric French, University College London, United Kingdom
  • Maria Aragon, University of York, United Kingdom
  • Jeremy Mccauley, University College London, United Kingdom
  • Pieter Bakx, Erasmus University Rotterdam, Netherlands
  • Martin Chalkley, University of York, United Kingdom
  • Stacey H. Chen, National Graduate Instiute for Policy Studies, Tokyo, Japan
  • Bent Jesper Christensen
  • Hongwei Chuang, Tohoku University, Japan
  • Aurelie Côté-Sergent, Center for Interuniversity Research and Analysis of Organizations (CIRANO), Montreal, Quebec, Canada
  • Mariacristina De Nardi, University College London, United Kingdom
  • Elliott Fan, National Taiwan University, Taiwan
  • Damien Échevin, Universite de Sherbrooke, Canada
  • Pierre-Yves Geoffard, Paris School of Economics (CNRS), France
  • Christelle Gastaldi-Ménager, National Health Insurance Fund for Salaried Workers, Paris, France
  • Mette Gørtz, University of Copenhagen
  • ,
  • Yoko Ibuka, Tohoku University, Japan
  • John B. Jones, Federal Reserve Bank of Richmond, Virginia, United States
  • Malene Kallestrup-Lamb
  • Martin Karlsson, University of Duisburg-Essen, Germany
  • Tobias J. Klein, Tilburg University, Netherlands
  • Grégoire de Lagasnerie, National Health Insurance Fund for Salaried Workers, Paris, France
  • Pierre-Carl Michaud, HEC Montreal, Canada
  • Owen O’Donnell, Erasmus University Rotterdam, Netherlands
  • Nigel Rice, University of York, United Kingdom
  • Jonathan S. Skinner, Dartmouth College, United States
  • Eddy van Doorslaer, Erasmus University Rotterdam, Netherlands
  • Nicolas R. Ziebarth, Cornell Univsersity, United States
  • Elaine Kelly, Institute for Fiscal Studies, London, United Kingdom

Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009-11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies.

Original languageEnglish
JournalHealth Affairs
Pages (from-to)1211–1217
Number of pages7
Publication statusPublished - 2017

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