Age and Gender Differences in Medicare Expenditures at the End of Life for Colorectal Cancer Decedents

PURPOSE AND METHODS: The authors examined age and gender differences in Medicare expenditures for colorectal cancer decedents in the last year of life (LYOL) through a cross-sectional study of Medicare administrative and claims data. Participants were aged Medicare beneficiaries (68+ years) with colorectal cancer, who were covered by Parts A and B for 36 months before death (1996-1999, n = 6657). The authors estimated differences in mean Medicare utilization and expenditures in the LYOL overall and by type of service (inpatient, outpatient, physician, skilled nursing facility [SNF], home health, and hospice). RESULTS: Women were more likely than men to use inpatient services, SNF services, home health, and hospice in the LYOL. Average expenditures for women were $1600 higher than for men, which were attributed to higher average expenditures on home health and hospice services. Among decedents aged 68-74 who used inpatient care, inpatient expenditures were higher for women than men. Older cohorts were less likely to use inpatient and outpatient services and more likely to use SNF services. Average Medicare expenditures were significantly lower in older cohorts. CONCLUSIONS: Most of the gender differences in average Medicare expenditures were explained by gender differences in age and the lower average expenditures on older decedents with colorectal cancer. Remaining gender differences varied across age cohorts and were largest among those aged 68-74. Higher expenditures for women on each of the social supportive services (SNF, home health, and hospice), even among those who used a particular type of service, may reflect a lack of informal supports for older women compared with men.