Rural-Urban Differences in Costs of End-of-Life Care for the Last 6 Months of Life Among Patients with Breast, Lung, or Colorectal Cancer

Abstract

Purpose: The purpose of this study was to examine rural-urban differences in utilization and expenditures in the last 6 months of life for patients with breast, lung, or colorectal cancer. Methods: The study used a 5% sample of the 2013 Medicare Research Identifiable Files to study utilization and expenditures for beneficiaries with breast, lung, or colorectal cancer during the last 6 months before death (n = 6,214). End of life expenditures were calculated as the sum of total Medicare expenditures for inpatient, outpatient, physician, home health, hospice, and skilled nursing facility costs during the last 6 months of life. Findings: For each type of cancer, total Medicare expenditures in the last 6 months of life were lower for rural decedents compared to their urban counterparts. During the last 6 months of life, median Medicare expenditures were lower for rural decedents for breast cancer ($21,839 vs $25,698), lung cancer ($22,814 vs $27,635), and colorectal cancer ($24,156 vs $28,035; all differences significant at P