The High Costs of Dying

ONE OF the most widely quoted statistics in medical circles continues to be the observation that 28% of Medicare expenditures are incurred in the last year of life. Discussions of the high cost of health care frequently return to the data about the 5.9% of elderly Medicare patients who die each year: of the Medicare funds spent on their treatment, about 40% goes for care given in the last 30 days of life and 50% for care in the last 60 days.¹These calculations, originally based on 1976 data and essentially unchanged in 1988,²continue to astound and enrage physicians who attribute cost-control measures in other areas of medicine to excessive spending on dying patients. The furor over the high economic cost of dying parallels concern over the high emotional cost of dying. A significant segment of the public believes that doctors cruelly and needlessly prolong the lives