Health-care costs at end of life exceed total assets for 25 percent of Medicare population

As many as a quarter of Medicare recipients spend more than the total value of their assets on out-of-pocket health care expenses during the last five years of their lives, according to researchers at Mount Sinai School of Medicine. They found that 43 percent of Medicare recipients spend more than their total assets minus the value of their primary residences. The findings appear online in the current issue of the Journal of General Internal Medicine.

The amount of spending varied with the patient's illness. Those with dementia or Alzheimer's disease spent the most for health care, averaging $66,155, or more than twice that of patients with gastrointestinal disease or cancer, who spent an average of $31,069. Dementia patients often require special living arrangements, which accounts for the sizeable difference in cost.

"Medicare provides a significant amount of health care coverage to people over 65, but it does not cover co-payments, deductibles, homecare services, or non-rehabilitative nursing home care," said the study's lead author, Amy S. Kelley, MD, Assistant Professor of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine. "I think a lot of people will be surprised by how high these out-of-pocket costs are in the last years of life."

The researchers based their findings on 2002-2008 data that was collected from the Health and Retirement Study, a biennial survey of 26,000 Americans over the age of 50, which is supported by the National Institute on Aging, and the Social Security Administration. They examined 3,209 Medicare recipients during their last five years of life, and compared their out-of-pocket health care expenditures with their total household assets. The study found that the average spending for all participants was $38,688, with more than 75 percent of households spending at least $10,000. The top quarter of participants spent an average of $101,791.

"There are a number of schools of thought on how to rein in Medicare costs, including requiring larger financial contributions from the elderly," said Dr. Kelley. "Prior to this study there was not a lot of data on the extent of out-of-pocket spending. This information can serve as an important tool to help individuals set realistic expectations for end-of-life health care costs, and for government officials to use in discussing Medicare policies."

This study was funded by the National Institute on Aging. Dr. Kelley also receives funding from the Hartford Foundation. Researchers from University of California Los Angeles Department of Economics, Dartmouth College Department of Economics, and The Dartmouth Institute for Health Policy and Clinical Practice also contributed to this study.

The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of the leading medical schools in the United States. The Medical School is noted for innovation in education, biomedical research, clinical care delivery, and local and global community service. It has more than 3,400 faculty in 32 departments and 14 research institutes, and ranks among the top 20 medical schools both in National Institutes of Health (NIH) funding and by U.S. News & World Report.

The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation's oldest, largest and most-respected voluntary hospitals. In 2012, U.S. News & World Report ranked The Mount Sinai Hospital 14th on its elite Honor Roll of the nation's top hospitals based on reputation, safety, and other patient-care factors. Mount Sinai is one of 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and by U.S. News & World Report and whose hospital is on the U.S. News & World Report Honor Roll. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.

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