Three essays on end-of-life care in the U.S.

The cost, as well as quality of End-of-Life (EOL) care, is a pressing health policy concern in the U.S. With an aging population and prolonged periods of terminal illness, the need for affordable and good quality EOL care is increasing. Payment and policy reforms and a shift in cultural attitude have brought about considerable changes to the processes of EOL care including where the care is being provided, who is providing it, and who is financing it. Despite considerable spending incurred during terminal days and the growth of hospice and palliative care, concerns remain about the quality of care and support that terminally ill individuals and families receive.

EOL quality is a multidimensional construct and capturing it accurately is a challenge in itself. However, this is an important task since efforts to improve one aspect of EOL care may result in unintentional impediments to certain other aspects. In the first aim of the dissertation, I examine a way to capture the different dimensions of EOL quality simultaneously among decedents. Another challenging undertaking is to capture both intended and unintended consequences of policies and reforms that may influence EOL outcomes. The second and third aims are directed at exploring the influence of a state policy - Medical Marijuana Legalization (MML) and its influence on certain dimensions of EOL care.