One of the persistent mysteries of medicine is why the cost of dying is higher for African Americans and Hispanics than it is for white people. A group from the University of Michigan has released a study that aimed to explore this phenomenon. Unfortunately, despite controlling for as many factors as they could, and despite finding some connection with end-of-life care, they were unable to successfully pin down a potential culprit.
The study looked at total Medicare expenditures for the last 180 days of life for 5,548 whites, 1,030 black, 331 Hispanic adults, and 196 adults of other races/ethnicities. Initially, the results showed that blacks paid an average of 35% more ($13,522) and Hispanics paid 42% ($16,341) more than whites. However, controls had to be made for various demographics, socioeconomic, geographic, medical, and end-of-life factors. After the number-crunching, it was found that African Americans were spending an average of $8,047 and that Hispanics were spending an average of $6,855 more than whites.
The reason that end-of-life care was given a larger focus by the researchers is because “patient preference” in end-of-life situations was the last factor remaining after all others were controlled for. Calculating and controlling for end-of-life preferences required looking into things like advanced directives (such as living wills), how end-of-life treatment was or was not discussed, how expected a death was, and other ways that could be used to help determine how patient preferences were expressed.
Unfortunately, even after trying to account for so many different parts of patient preference in end-of-life care, cost discrepancies still remained. This suggests that there are still unaccounted for contributors to the situation. This is uncommon since, with other types of care, the factors the researchers examined are normally able to explain most of any observed disparities.
Although it was unable to figure out why Medicare costs for end-of-life care among African Americans and Hispanics are higher, this study should not be considered a failure. While it can be critiqued for having an overrepresentation of white people (78% of subjects) which may have skewed matters, the underlying finding that there is still more to the situation left unexplored remains. Hopefully this research will help inform future, targeted inquiries that can get closer to finding the answer.
Byhoff, E., et al., “Racial and Ethnic Differences in End-of-Life Medicare Expenditures,” Journal of the American Geriatrics Society, 2016; 10.1111/jgs.14263.