Many ethnic minority beneficiaries receive fewer medical services and spend less on health care throughout most of their lives than white patients, yet on average they have higher costs in their last 6 months of life. Why is this so?
A recent study involving nearly 160,000 Medicare patients and records on their final 6 months of treatment investigates this trend and poses several hypotheses. The study finds that although disease death rates for elderly African Americans and Latinos are similar to those for whites, their Medicare costs involved in end-of-life care are significantly higher. Average Medicare costs for white patients in the last 6 months of life are about $20,000. Average costs for African Americans, however, rise about 30% to $26,704, and costs for Latinos rise close to 60% to $31,702.
African Americans and Latinos are significantly more likely to be admitted to an intensive care unit in the final 6 months of life than whites. Also, a larger proportion of minorities receive more intensive and invasive procedures, such as resuscitation and cardiac conversion, mechanical ventilation, and gastrostomy for nutrition. Whites, however, are more likely to receive inpatient cancer chemotherapy. Whites also are more likely to use Medicare’s hospice benefit, which accounts for some reduction in costs.
Researchers from Boston University School of Medicine, Lown Cardiovascular Research Foundation in Massachusetts, and the Department of Bioethics at the National Institutes of Health who conducted this study state that this increased cost at the end of life is a symptom of a bigger problem. They question whether medical resources for African American and Latino patients are being misallocated over a lifetime, with these populationsreceiving more treatment at the end, when there is little chance of improving or extending life.
Data and other studies on health disparities suggest this misallocation of resources between whites and other ethnic populations is one cause in health differentials. For example, the Kaiser Family Foundation (KFF) recently published its fact sheet, Key Health and Health Care Indicators by Race/Ethnicity and State. Among several health indictors for California, it shows that the diabetes mortality rate for African Americans is 47% higher than that for whites. It also shows that while 12.2% of whites are uninsured, 20.9% of African Americans and 33.5% of Latinos are uninsured, which definitely results in fewer medical resources being available for these populations.
A recent study on health disparities documents how health status improves across all ethnicities after people turn age 65 and many become eligible for Medicare, reported in Reuters. In the study of more than 6,000 middle-aged and elderly Americans, their blood pressure, cholesterol and blood sugar control all improved once they were Medicare eligible, a result many are using to advocate for universal health care coverage.
Both of these findings support the question of a misallocation of medical resources to minority populations over their lifetime. The KFF fact sheet shows disparities in health indicators (through mortality rates and access to insurance) and the study reported in Reuters shows that once health care insurance is available (e.g., people have Medicare), their health improves. Yet, how does this tie back to the finding of higher end-of-life health care costs for minorities? After a life time of having less access to medical resources, end-of-life health care costs may naturally be greater due to having more extensive and complex health conditions.
Researchers from the study on higher end-of-life health care costs for minority beneficiaries also offer some other hypotheses, as published in the March 9 Archives of Internal Medicine. One hypothesis speculates that part of the cost discrepancy may be associated with geography, with many minorities living in areas with higher rates of hospital use. Another hypothesis states that patient preferences may be one factor. Past studies have found that ethnic minorities are more reluctant than whites to have do-not-resuscitate orders and more likely to request life-sustaining measures in their final months.
In addition to all the hypotheses, misallocation of medical resources comes down to addressing issues of racism, particularly institutionalized racism and white privilege that for some can go unseen, except through the glaring symptoms of health and socio-economic disparities. According to research compiled by the Alliance for Health Reform, a health care resource organization based in Washington, D.C., about one third of Americans identify themselves as racial or ethnic minorities. That figure is expected to climb to more than 50% by 2042. Addressing racism and creating health care equality is essential for the health and vitality of all beneficiaries and for our whole nation. For a detailed discussion and educational resources on race, racism and white privilege, see our articles: