Researchers at the Palo Alto Medical Foundation for Health Care, Research and Education, Palo Alto, Calif., carried out a critical review and evaluation of the literature on high-cost illness published between 1982 and 1992.
As national health expenditures on Medicare rose during the 1970s and 1980s, studies had shown that medical costs were high in the months immediately preceding death.
Some researchers had concluded from these studies that limiting high-technology medical care for terminally ill patients would result in significant cost savings to the Medicare program.
According to an article on the findings of this literature review that appeared in the Milbank Quarterly in 1994:
- Studies conducted during this period "do not support the hypothesis that it is high-cost, high-technology treatment of patients who die that has driven up medical care costs."
- Additionally, the studies reviewed "suggest that neither hospice care nor advance directives are likely to have a major impact on the costs of dying, except possibly advance directives executed before a patient is admitted to the hospital."
- Project Director Anne A. Scitovsky suggests that a major reason for the high medical costs at the end of life is the uncertainty of prognosis in seriously ill elderly patients.
- The article concludes that to reduce overall health care spending as well as expenditures at the end of life, what is required is "a closer patient-physician relationship, and a change in our expectations of what medical care can do for us and especially our attitude toward death."