The findings have big implications for taxpayers, because they suggest that the outlook for the Medicare program as America's baby boomers grow old is not as dire as some policy-makers feared.
Given projections saying the baby boom generation will bankrupt the Medicare trust fund in about 25 years, politicians and economists have wondered whether the increasing longevity of healthier senior citizens would increase or reduce Medicare spending.
The answer is neither, say researchers at the National Center for Health Statistics. They found medical expenses from age 70 until death averaged $140,700, with little difference between active, long-lived senior citizens and disabled ones - except for those already in a nursing home.
"The basic lesson of our study is that although healthy people live longer, they don't cost more in the long run," said Jim Lubitz, acting chief of the Aging Studies Branch in the statistics center's Office of Analysis, Epidemiology and Health Promotion. "Improving health should be the overall goal of our health care policy, but it's not going to save the Medicare system."
Sandra Decker, a researcher at the International Longevity Center-USA, said Medicare costs will rise because of the sheer number of beneficiaries, not their longer life span.
"It means, yes, we'll spend more on Medicare, but maybe not as much more as we thought," she said.
Lubitz said the study should give a boost to efforts by government and doctors to encourage middle-aged and elderly people to improve their health by getting more exercise, eating better and not smoking.
Uwe Reinhardt, a professor and health economist at Princeton University, said 70-year-olds today have far fewer disabilities than their counterparts a couple of decades ago, when economist Victor R. Fuchs first reported that longevity does not affect health-care spending much. Reinhardt said the new study provides updated numbers on those costs.
The study was reported in Thursday's New England Journal of Medicine.
Lubitz and colleagues, using Medicare and other billing records and interviews about health status from 16,964 Medicare beneficiaries surveyed from 1992 through 1998, used complex statistical calculations to determine average longevity and end-of-life costs.
They found someone healthy and mobile at age 70 could expect to live 14.3 more years and accumulate about $136,000 in medical costs, in 1998 dollars, over those years. Someone with at least one limitation in daily activities, such as not being able to bathe or use the toilet unassisted, could be expected to live 11.6 years more, with cumulative medical expenses of about $145,000.
Senior citizens with no limitations ran up an average of $4,600 a year in health care costs, compared with $8,500 a year for people with moderate disabilities, $14,100 for those with more severe disabilities and $45,400 for nursing home patients.
People active at age 70 would average nearly nine more years with little or no limitation, followed by nearly five years with significant limitations and a final eight months in a nursing home. Those already in a nursing home by 70 might improve enough to return home briefly, but would spend most of their remaining 5½ years in a nursing home.
Decker noted that while better medicine and lifestyle have made senior citizens healthier over the past few decades, the study's findings may not be valid 20 years from now because of the epidemic of obesity, diabetes and heart disease among middle-aged Americans.
And preventive-medicine expert Dr. Donald B. Louria of University of Medicine and Dentistry of New Jersey in Newark said life span could soon be well over 100 for healthier senior citizens, pushing up cumulative medical costs.
Average life expectancy in this country hit a record 77.2 years in 2001, and by 2030, the number of Americans 65 or older will reach 71 million, according to the Centers for Disease Control and Prevention.
"Longer life in itself will not add to Medicare costs," Harvard economist David M. Cutler wrote in an editorial. But "Social Security costs increase with longevity. In total, therefore, aging will result in increased public spending."
By Linda A. Johnson