Health care costs in the last year of life—The Dutch experience

Polder, J.J.; Barendregt, Jan J.; Oers, Hans van

doi:10.1016/j.socscimed.2006.04.018

Cited by 220 publications

(202 citation statements)

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“…If all lifetime health care costs are included in an economic evaluation, the distinction between related and unrelated diseases becomes irrelevant, which opens up alternative ways to estimate health care costs. Moreover, since a large part of lifetime health care expenditure depends on time to death (Zweifel et al, 1999;Polder et al, 2006) this implies that probably more costs are then labelled 'related' than currently assumed in most cost effectiveness analyses, which usually only include the costs of diseases that are treated with the intervention. Modelling costs exclusively conditional on age and time to death seems to have most value for economic evaluations that track costs and effects over the follow-up period and use modelling to extrapolate lifelong health gains.…”

Section: Discussionmentioning

confidence: 99%

“…They analysed the relationship between age and health care expenditure and found that health care expenditure depends importantly on proximity to death rather than age. Since higher average health care costs at older age are caused mainly by the fact that relatively many elderly people die, with associated intensive healthcare use and costs in the last period of life, they dubbed this the 'red herring' hypothesis Gray, 2004a,b Hakkinen et al, 2008;Spillman and Lubitz, 2000;Polder et al, 2006). Obviously, these results have direct relevance for the question of how to include unrelated medical costs in added life years in economic evaluations.…”

Section: Introductionmentioning

confidence: 99%

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Economic evaluation and the postponement of health care costs

et al. 2011

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Economic evaluation and the postponement of health care costs van Baal, P.H.; Feenstra, T.L.; Polder, Johan; Hoogenveen, R.T.; Brouwer, W. Published in: Health Economics Document version:Publisher's PDF, also known as Version of record General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.-Users may download and print one copy of any publication from the public portal for the purpose of private study or research -You may not further distribute the material or use it for any profit-making activity or commercial gain -You may freely distribute the URL identifying the publication in the public portal Take down policyIf you believe that this document breaches copyright, please contact us providing details, and we will remove access to the work immediately and investigate your claim. SUMMARYThe inclusion of medical costs in life years gained in economic evaluations of health care technologies has long been controversial. Arguments in favour of the inclusion of such costs are gaining support, which shifts the question from whether to how to include these costs. This paper elaborates on the issue how to include cost in life years gained in cost effectiveness analysis given the current practice of economic evaluations in which costs of related diseases are included. We combine insights from the theoretical literature on the inclusion of unrelated medical costs in life years gained with insights from the so-called 'red herring' literature. It is argued that for most interventions it would be incorrect to simply add all medical costs in life years gained to an ICER, even when these are corrected for postponement of the expensive last year of life. This is the case since some of the postponement mechanism is already captured in the unadjusted ICER by modelling the costs of related diseases. Using the example of smoking cessation, we illustrate the differences and similarities between different approaches. The paper concludes with a discussion about the proper way to account for medical costs in life years gained in economic evaluations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Economic evaluation and the postponement of health care costs

et al. 2011

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“…Patients often receive excessive care at the end of life, resulting in mounting medical expenses (2)(3)(4)(5). PTD can skew the effects of population aging on medical expenses due to the high mortality rate and greater end-of-life medical demands of the elderly (6).…”

Section: Introductionmentioning

confidence: 99%

“…The PTD phenomenon varies among different age groups, costs, and categories of disease. Polder et al (4) and Shugarman et al (7) concluded that in the Netherlands and the United States, the average medical expenses in the last year of life were greater for people dying at younger ages (< 70) than older decedents. Gozalo et al (8) found that hospice care can substitute for acute medical care at the end of life.…”

Section: Introductionmentioning

confidence: 99%

Tracking hospital costs in the last year of life ― The Shanghai experience

Zhu

Wang

et al. 2018

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“…Claims data for 13 per cent of the Dutch population in 1999 have been used to estimate that 10% of total health spending is concentrated in the last year of life (Polder et al, 2006). We update this estimate using more recent and comprehensive data, and extend the analysis to expenses incurred in the last three years of life.…”

Section: Introductionmentioning

confidence: 99%

Spending on Health Care in the Netherlands: Not Going So Dutch

2017

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in AbstractThe Netherlands is among the top spenders on health in the OECD. We document the lifecycle profile, concentration and persistence of this expenditure using claims data covering both curative and long-term care expenses for the full Dutch population. Spending on health care is strongly concentrated: the one per cent of individuals with the highest levels of expenditure account for one quarter of the aggregate in any one year. Averaged over three years, the top one per cent still accounts for more than a fifth of the total, indicating a very high degree of persistence in the largest expenses. Spending on long-term care, which amounts to one third of all expenditure on health care, is even more concentrated: the top one per cent accounts for more than half of total spending on this type of care. Average expenditure rises steeply with age and even more so with proximity to death. Spending on individuals in their last year of life absorbs one tenth of aggregate health care expenditure. In a given year, spending on health care is highly skewed toward individuals with lower incomes. Average expenditure on the poorest fifth is more than three times that on the richest fifth. Spending on long-term care is five times more concentrated on the poor. Policy Points1. Spending on health care is highly concentrated on a small share of the population and is strongly persistent over time. 2. Public spending on long-term care is high and is even more concentrated and persistent. 3. In any given year, health spending is highly skewed towards poorer individuals. 4. The high concentration and persistence imply substantial interpersonal redistribution. 5. Steeply rising health expenditures with age and proximity to death imply substantial intrapersonal redistribution across the life cycle. JEL Codes: D12, I13, I14

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Health care costs in the last year of life—The Dutch experience

Cited by 220 publications

References 22 publications

Economic evaluation and the postponement of health care costs

Economic evaluation and the postponement of health care costs

Tracking hospital costs in the last year of life ― The Shanghai experience

Spending on Health Care in the Netherlands: Not Going So Dutch

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