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I am aware that EOL care is a large part of the costs of our system. However, one thing I have not heard is any definitive evidence that that is materially diff

I am aware that EOL care is a large part of the costs of our system. However, one thing I have not heard is any definitive evidence that that is materially different in the US vs. e.g. Canada or the UK. This study suggests that your interpretation is not correct: https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0174 https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0174 Mean end of life spending is only marginally higher in the U.S. than in other countries.

antattack 5y ago
From the study (~1980 data) [1]: Cost of care in the last year of life in USA varied from study to study, between US$40,000 to US$95,776. Extrapolated cost for Canada: 6,758.2 [1]https://www.longwoods.com/content/20878/healthcare-quarterly/costs-of-end-of-life-care-findings-from-the-province-of-saskatchewan https://www.longwoods.com/content/20878/healthcare-quarterly...
- asdfasgasdgasdg 5y ago
  That number is the total cost for all people who died in Canada, extrapolated from Saskatchewan data, in millions of dollars. 6.7B dollars, that is. Considering something like 300k people die in Canada each year, that's around 20k per capita. (This is seriously mixing units because the population of Canada has increased a lot since the study you cited.) In any case, it's not the correct number. Quebec data from the study I cited showed 60k per capita on hospital alone, with incomplete data to characterize the remainder of the costs.
slownews45 5y ago
I thought something like 25% of medicare spending was in last year of life spending. I've also heard that something like 5% of folks generate 50% of costs. So the argument has been that because in the US total expenditure can go so high (ie, we will easily spend $10M on one person where other countries won't) that you end up with a serious spike as a result of last year of life and extraordinary effort costs. Other countries have less variance (including income inequality)
- asdfasgasdgasdg 5y ago
  Yep, I'm aware of the argument, and I think you've stated it correctly. But the data I was able to find does not seem to support it.

antattack 5y ago

From the study (~1980 data) [1]: Cost of care in the last year of life in USA varied from study to study, between US$40,000 to US$95,776. Extrapolated cost for Canada: 6,758.2 [1]https://www.longwoods.com/content/20878/healthcare-quarterly/costs-of-end-of-life-care-findings-from-the-province-of-saskatchewan https://www.longwoods.com/content/20878/healthcare-quarterly...

asdfasgasdgasdg 5y ago
That number is the total cost for all people who died in Canada, extrapolated from Saskatchewan data, in millions of dollars. 6.7B dollars, that is. Considering something like 300k people die in Canada each year, that's around 20k per capita. (This is seriously mixing units because the population of Canada has increased a lot since the study you cited.) In any case, it's not the correct number. Quebec data from the study I cited showed 60k per capita on hospital alone, with incomplete data to characterize the remainder of the costs.

slownews45 5y ago

I thought something like 25% of medicare spending was in last year of life spending. I've also heard that something like 5% of folks generate 50% of costs. So the argument has been that because in the US total expenditure can go so high (ie, we will easily spend $10M on one person where other countries won't) that you end up with a serious spike as a result of last year of life and extraordinary effort costs. Other countries have less variance (including income inequality)

asdfasgasdgasdg 5y ago
Yep, I'm aware of the argument, and I think you've stated it correctly. But the data I was able to find does not seem to support it.