Of Four Paths to the End of Life, One Is Far Pricier Than Others

The findings of a new Medicare study conflict with popular ideas about which patients cost the most health care dollars in the last year of life — and where potential cost savings lie.

Last-ditch, high-tech heroic treatments. Days in the hospital intensive care unit. You might think this is what makes dying in America so expensive — and that it’s where we should focus efforts to spend the nation’s health care dollars more wisely.

But a new study finds that for nearly half of older Americans, the pattern of high spending on health care was already in motion a full year before they died.

That was due to the care they received for multiple chronic health conditions, including many doctor visits and regular hospital stays over the year, not just in their final days.

As a result, the study shows, the last year of life for this large group of seniors costs the Medicare system five times as much as the care received by the much smaller group of seniors who have a sudden burst of very expensive care in their last few weeks of life. The findings have clear implications for efforts to improve care, and contain the growth of costs, at the end of life.