@article {12426, title = {Advance directives completion and hospital out-of-pocket expenditures.}, journal = {Journal of Hospital Medicine}, volume = {17}, year = {2022}, pages = {437-444}, abstract = {

INTRODUCTION: Health care costs remain high at the end of life. It is not known if there is a relationship between~advance directive (AD) completion and hospital out-of-pocket costs. This analysis investigated whether AD completion was associated with lower hospital out-of-pocket costs at end of life.

METHODS: We used Health and Retirement Study participants who died between 2000 and 2014 (N = 9228) to examine the association between AD completion status and hospital out-of-pocket spending in the last 2 years of life through the use of a two-part model controlling for socioeconomic status, death-related characteristics and health insurance coverage.

RESULTS: About 44\% of decedents had completed ADs. Having an AD was significantly associated with $673 lower hospital out-of-pocket costs, with a higher magnitude of savings among younger decedents. Decedents who completed ADs 3 months or less before death had higher out-of-pocket costs ($1854 on average) than those who completed ADs more than 3 months before death ($1176 on average).

CONCLUSIONS: AD completion was significantly associated with lower hospital out-of-pocket costs, with greater out-of-pocket savings among younger decedents. Early AD completers experienced lower costs than decedents who completed ADs closer to death.

}, keywords = {advance directive, health care cost, Out-of-pocket medical expenses}, issn = {1553-5606}, doi = {10.1002/jhm.12839}, author = {Zhu, Yujun and Enguidanos, Susan} }