Racial and Ethnic Differences in End-of-Life Medicare Expenditures

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d6802716e188">Objectives</h5> <p id="P1">To determine to what extent racial and ethnic variation in Medicare spending during the last six months of life are explained by demographic, social support, socioeconomic, geographic, medical and EOL planning factors. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d6802716e193">Design</h5> <p id="P2">Retrospective cohort study</p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d6802716e198">Setting</h5> <p id="P3">Health and Retirement Study (HRS)</p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d6802716e203">Participants</h5> <p id="P4">7,105 decedents who participated in the Health and Retirement Study between 1998–2012 and previously consented to survey linkage with Medicare claims. </p> </div><div class="section"> <a class="named-anchor" id="S5"> <!-- named anchor --> </a> <h5 class="section-title" id="d6802716e208">Measurements</h5> <p id="P5">Total Medicare expenditures in the last 180 days of life by race and ethnicity, controlling for demographic factors, social supports, geography, illness burden, and EOL planning factors including presence of advance directives, discussion of EOL treatment preferences, and whether death had been expected. </p> </div><div class="section"> <a class="named-anchor" id="S6"> <!-- named anchor --> </a> <h5 class="section-title" id="d6802716e213">Results</h5> <p id="P6">Our analysis included 5548 (78.1%) non-Hispanic white, 1030 (14.5%) non-Hispanic black, 331 (4.7%) Hispanic, and 196 (2.8%) adults of other race/ethnicity. Unadjusted results suggest that average Medicare expenditures for black decedents was $13,522 (35%, p &lt;0.001) more than for whites, while Medicare expenditures for Hispanics was $16,341 (42%, p&lt;0.001) more at EOL. Controlling for demographic, socioeconomic, geographic, medical and EOL specific factors, the Medicare expenditure difference between groups reduced to $8,047 (22%, p&lt;0.001) more for black and $6,855 (19%, p&lt;0.001) more for Hispanic decedents compared to non-Hispanic whites’ expenditures. The expenditure differences between groups remained statistically significant across all models. </p> </div><div class="section"> <a class="named-anchor" id="S7"> <!-- named anchor --> </a> <h5 class="section-title" id="d6802716e218">Conclusion</h5> <p id="P7">Racial and ethnic differences in Medicare spending in the last six months of life are not fully explained by patient-level factors, including EOL planning factors. Future research should focus on broader systemic, organizational and provider level factors to explain these differences. </p> </div>