Advanced Illness & End-Of-Life Care.

Health care systems worldwide are facing macro-scale changes involving advanced illness and end-of-life care that could affect both the quality of care and the quality of life for patients and their caregivers. For example, growth in mortality from cancer and Alzheimer disease, along with the increased prevalence of multiple morbidities for those near the end of life, raise questions about how the health system will provide adequate care and pain relief for patients, and addresses the needs of their caregivers-many of whom are unpaid family members. In addition, despite a growing tendency for people to prefer hospice and other lower-intensity options to cope with advanced illness and the relatively small share of excess spending that goes to individuals near the end of life, cost remains a concern. This is particularly true in the United States, where per capita medical spending in the last twelve months of life is $80,000-substantially higher than in comparable developed nations.