Rural-urban differences in end-of-life medical care cost in older cancer patients

The objective of this study was to examine whether the cost for end-of-life care for elderly cancer patients was significantly different between rural and urban communities. We analyzed Medicare data for approximately 200,000 older adults (≥66 year old) who had been diagnosed with lung, colorectal, female breast, or prostate cancer and died in 2008. The cost of end-of-life care was quantified as Medicare payments for the last 12 months of care including hospice, inpatient, outpatient, and home health care. End-of-life costs were examined separately for the four cancer sites and linear regression was used to estimate rural-urban differences after adjusting for demographic variables, socioeconomic status, and comorbidities. On average, the last year of medical care for these cancer patients cost Medicare more than $50,000 per patient. Regression results suggested that patients in rural areas spent less in their last one year of life on medical care than their urban counterparts. Patients from minority groups, younger age groups, those with a high socioeconomic status, and those with more complications spent more in their last year of life. The lower Medicare spending in the last year of life for the rural patients suggests disparities in end-of-life care. A further study that delineates the source of the rural-urban difference can help us better understand whether it indicates limited access to appropriate level of palliative care and assist in finding effective policies to reduce the urban-rural disparities.