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End-of-Life Medical Treatment Choices: Do Survival Chances and Out-of-Pocket Costs Matter?

Population Aging Research Center of the Population Studies Center, University of Pennsylvania, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

José A. Pagán, PhD

Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, Department of Economics and Finance, College of Business Administration, University of Texas-Pan American, Edinburg, Texas

Beth J. Soldo, PhD

Population Aging Research Center of the Population Studies Center, University of Pennsylvania

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.

Key Words: end-of-life care • Medicare • heuristics and biases • oncology • willingness to pay.

This version was published on July 1, 2008

Medical Decision Making, Vol. 28, No. 4, 511-523 (2008)
DOI: 10.1177/0272989X07312713


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