Age and Gender Differences in Medicare Expenditures and Service Utilization at the End of Life for Lung Cancer Decedents

Shugarman, Lisa R.; Bird, Chloe E.; Schuster, Cynthia R.; Lynn, Joanne

doi:10.1016/j.whi.2008.02.008

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Volume 18, Issue 3 , Pages 199-209, May 2008

Age and Gender Differences in Medicare Expenditures and Service Utilization at the End of Life for Lung Cancer Decedents

Lisa R. Shugarman, PhD
- RAND Corporation, Santa Monica, California
- Lisa R. Shugarman, PhD, is a health services researcher and gerontologist with the RAND Corporation in Santa Monica, CA. She works extensively on policy issues related to Medicare, disparities in health care, long-term care, and health care at the end of life.
- Correspondence to: Lisa R. Shugarman, PhD, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138.
Chloe E. Bird, PhD
- RAND Corporation, Santa Monica, California
- Chloe E. Bird, PhD, is a sociologist with interests in how social contexts shape health and health trajectories. In her new book, Gender and Health: The Effects of Constrained Choice and Social Policies, she and her coauthor Patricia Rieker integrate social and biological models to improve understanding of how differences in men's and women's lives contribute to differences in their health.
Cynthia R. Schuster, MPP
- RAND Corporation, Santa Monica, California
- Cynthia R. Shuster, MPP, was a research assistant at the RAND Corporation in Santa Monica, CA, while completing this manuscript. Her research interests are in public healthcare programs and issues of equity.
Joanne Lynn, MD, MS
- RAND Corporation, Arlington, Virginia
- Joanne Lynn, MD, MA, MS, was a health services researcher and geriatrician at RAND in Arlington, VA, at the time of this work. She is now Medical Officer in the Quality Measurement and Health Assessment Group, Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services in Baltimore, Maryland. Her work has focused upon improving care for persons living with eventually fatal chronic conditions.

Received 5 April 2007; accepted 27 February 2008.

Purpose

Gender and age differences in medical care are well documented. We examined age and gender differences in Medicare expenditures for lung cancer decedents in the last year of life (LYOL) through a cross-sectional study of Medicare administrative and claims data.

Methods

Participants were aged Medicare beneficiaries (≥68) with lung cancer, who were covered by Parts A and B for 36 months before death (1996–1999; n = 13,120). Regression techniques were used to estimate age and gender differences in mean Medicare utilization and expenditures in the LYOL overall and by type of service, conditional on use: inpatient, outpatient, physician, skilled nursing facility (SNF), home health, and hospice, controlling for demographic, clinical, geographic, and supply characteristics.

Results

Women were more likely than men to use inpatient, SNF, home health, and hospice services. Women's average expenditures were approximately $1,900 greater than men's, with differences attributed to higher average expenditures for SNF, home health, and hospice. Older cohorts used fewer inpatient and outpatient services and used more SNF and hospice services in their LYOL. Average Medicare expenditures were significantly lower in older cohorts ($8,487 less for those age ≥85 at death than for those 68–74). Adjusting for age explains most of the gender differences in average Medicare expenditures. Remaining gender differences vary across age cohorts, with larger gender differences in social-supportive service expenditures among those 68–74 and 75–84 and outpatient and physician services among those 75–84 and ≥85.

Discussion and Conclusions

Our findings suggest that gender disparities in expenditures are generally small at the end of life for lung cancer decedents, particularly among the older cohorts. As expected, the bigger observed differences are by age although the direction of the association is not consistent across types of service. Higher expenditures for women on social-supportive services may reflect fewer informal supports for older women compared with men.