In 2013, a study was published that looked at medical spending by older adults in the last five years of their lives. It found that “25% of subjects’ expenditures exceeded baseline total household assets.” It reinforced the cost conclusions of a 2009 study by David Himmelstein and colleagues showing that “62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5,000, or 10% of pretax family income.”2 Himmelstein’s study also noted that “most medical debtors were well educated, owned homes, and had middle-class occupations.”
It is possible to get a picture of how costs billed to the general population diverge by looking at what different hospitals charge Medicare.
The map displays the cost differences among hospitals involved in the Medicare Inpatient Prospective Payment System and offers useful insights into the relative costs around New England.
The dataset covers about 60% of all Medicare-covered inpatient visits by recording the charges for the 100 most common acute inpatient services. The map shows each county’s weighted difference in charges relative to the regional average. The weighted average cost per inpatient visit in New England is $24,099, about $11,000 less than the national average. (Eighteen counties lacked a medical center that reported to Medicare.) New Haven County had inpatient procedures costing on average $10,947 more than the rest of the region. Barnstable County in Massachusetts had the most affordable procedures, which cost an average of $9,172 less than the regional benchmark.
Source: Centers for Medicare & Medicaid Services, www.cms.gov.
 Amy S. Kelley et al., “Out-of-Pocket Spending in the Last Five Years of Life,” Journal of General Internal Medicine 4 (September 5, 2012).
 David Himmelstein, Deborah Thorne, Elizabeth Warren, and Steffie Woolhandler, “Medical Bankruptcy in the United States, 2007: Results of a National Study,” American Journal of Medicine (March 2009).
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