TY  - JOUR
AU  - Kessler,Daniel
AU  - McClellan,Mark B.
TI  - Advance Directives and Medical Treatment at the End of Life
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 9955
PY  - 2003
Y2  - September 2003
UR  - http://www.nber.org/papers/w9955
L1  - http://www.nber.org/papers/w9955.pdf
N1  - Author contact info:
Daniel Kessler
Hoover Institution
Stanford University
434 Galvez Mall
Stanford, CA  94305
Tel: 650/723-0596
E-Mail: fkessler@stanford.edu

Mark B. McClellan
Director, Engelberg Center for Health Care Reform
Senior Fellow, Economic Studies
Leonard .D. Schaeffer Director's Chair in
Health Policy ,The Brookings Institution
1775 Massachusetts avenue, N.W.
Washington, DC 20036
Tel: (202) 741-6567
Fax: NA
E-Mail: mmcclellan@brookings.edu
M2  - featured in NBER digest on 2004-01-01
AB  - To assess the consequences of advance medical directives -- which explicitly specify a patient's preferences for one or more specific types of medical treatment in the event of a loss of competence    we analyze the medical care of elderly Medicare beneficiaries who died between 1985-1995. We compare the care of patients from states that adopted laws enhancing incentives for compliance with advance directives and laws requiring the appointment of a health care surrogate in the absence of an advance directive to the care of patients from states that did not. We report three key findings. First, laws enhancing incentives for compliance significantly reduce the probability of dying in an acute care hospital. Second, laws requiring the appointment of a surrogate significantly increase the probability of receiving acute care in the last month of life, but decrease the probability of receiving nonacute care. Third, neither type of law leads to any savings in medical expenditures.
ER  -