End-of-Life Medical Treatment Choices: Do Survival Chances and Out-of-Pocket Costs Matter?
- 25 April 2008
- journal article
- other
- Published by SAGE Publications in Medical Decision Making
- Vol. 28 (4), 511-523
- https://doi.org/10.1177/0272989X07312713
Abstract
Background . Out-of-pocket medical expenditures incurred prior to the death of a spouse could deplete savings and impoverish the surviving spouse. Little is known about the public's opinion as to whether spouses should forego such end-of-life (EOL) medical care to prevent asset depletion. Objectives . To analyze how elderly and near elderly adults assess hypothetical EOL medical treatment choices under different survival probabilities and out-of-pocket treatment costs. Methods . Survey data on a total of 1143 adults, with 589 from the Asset and Health Dynamics Among the Oldest Old (AHEAD) and 554 from the Health and Retirement Study (HRS), were used to study EOL cancer treatment recommendations for a hypothetical anonymous married woman in her 80s. Results . Respondents were more likely to recommend treatment when it was financed by Medicare than by the patient's own savings and when it had 60% rather than 20% survival probability. Black and male respondents were more likely to recommend treatment regardless of survival probability or payment source. Treatment uptake was related to the order of presentation of treatment options, consistent with starting point bias and framing effects. Conclusions . Elderly and near elderly adults would recommend that the hypothetical married woman should forego costly EOL treatment when the costs of the treatment would deplete savings. When treatment costs are covered by Medicare, respondents would make the recommendation to opt for care even if the probability of survival is low, which is consistent with moral hazard. The sequence of presentation of treatment options seems to affect patient treatment choice.Keywords
This publication has 20 references indexed in Scilit:
- Health Care System Factors Affecting End-of-Life CareJournal of Palliative Medicine, 2005
- Palliative Care Outcomes Research: The Next StepsJournal of Palliative Medicine, 2005
- Impending widowhood and health care spendingSocial Science Research, 2004
- The Economic Burden of Health Care, Funeral, and Burial Expenditures at the End of LifeJournal of Consumer Affairs, 2004
- Describing treatment effects to patientsJournal of General Internal Medicine, 2003
- Interaction terms in logit and probit modelsEconomics Letters, 2003
- The Use of Advance Directives in End-of-life Decision MakingAmerican Behavioral Scientist, 2002
- Do ordering effects matter in willingness-to-pay studies of health care?Journal of Health Economics, 2002
- Effect of Framing as Gain versus Loss on Understanding and Hypothetical Treatment Choices: Survival and Mortality CurvesMedical Decision Making, 2002
- Pooling states in the multinomial logit modelJournal of Econometrics, 1991