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This paper reports on an excellent study, which provides very valuable information on patterns of costs. However, the authors draw conclusions that are not justified, and other evidence suggests may be wrong. A body of literature shows that for acute medical care proximity to death is more important than age as a factor in determining costs (eg. Lubitz and Riley 1993). It is clear that nursing home costs are high for elderly people, but there is little evidence that this is growing rapidly. We need to be very cautious about extrapolation from cross sectional studies to the effects of ageing and suggesting dramtic effects (Barer et al 1995). They are much more complicated.
Lubitz J.G. and Riley G.F (1993) Trends in medicare payments in the last year of life. New England Journal of Medicine 328:1092-1096
Barer M.L., Evans R.G. and Hertzman C (1995) Avalanche or Glacier?: Health Care and the Demographic Rhetoric. Canadian Journal on Aging 14:193-224
No competing interests
16 July 1998
Professor of Health Policy
London School of Hygiene and Tropical Medicine, (on sabbatical at Univerity of British Columbia)