Healthcare use and costs in the last year of life: a national population data linkage study

Abstract

BackgroundPeople who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain.ObjectivesTo describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life.MethodsRetrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274 048).ResultsSecondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last 3 months. The mean cost was £10 000. Cause of death was associated with differing patterns of healthcare use: dying of cancer was preceded by the greatest number of hospital admissions and dementia the least. Greater age was associated with lower admission rates and cost. There was higher resource use in the urban areas. No difference was observed by deprivation.ConclusionsHospitalisation near the end of life was least frequent for older people and those living rurally, although length of stay for both groups, when they were admitted, was longer. Research is required to understand if variation in hospitalisation is due to variation in the quantity or quality of end-of-life care available, varying community support, patient preferences or an inevitable consequence of disease-specific needs.

Costs for Statutorily Insured Dental Services in Older Germans 2012–2017

“…The costs for general healthcare in the elderly has been found to increase with proximity to death, and has been associated with sex [ 2 , 3 , 4 ], place of living [ 1 , 4 , 5 ], SES [ 6 ] or age, as described [ 2 , 4 , 7 , 8 ]. In the present evaluation, we assessed costs for dental services provided to the very old by one statutory insurer in Germany.…”

“…Knowledge on costs in this group and drivers of it are useful for health services planning, but also to assist developing targeted interventions for improving health at increased efficiency. Compared with medical costs throughout most of the life course, end-of-life costs have been found to be high, mainly driven by repeated inpatient (hospital) admissions [ 1 ]. Costs have been associated with aspects like sex (with ambiguous data finding either male or female individuals experiencing higher medical costs towards the end of life) [ 2 , 3 , 4 ], the place of living (with costs being higher in more urban and affluent areas) [ 1 , 4 , 5 ], socio-economic status (SES, with costs being higher in more affluent high-SES groups) [ 6 ] or age (with end-of-life costs being consistently higher in younger-dying individuals than those dying older) [ 2 , 4 , 7 , 8 ].…”

Heterogeneity in Longitudinal Healthcare Utilisation by Older Adults: A Latent Transition Analysis of the Irish Longitudinal Study on Ageing

“…Age alone has been shown to exhibit a weak relationship with healthcare costs ( Howdon & Rice, 2018 ), with the relationship between age and health also shown to vary across birth cohorts ( Mason et al, 2015 ). Healthcare utilisation increases in the final year of life ( Diernberger et al, 2021 ; Ní Chróinín et al., 2018 ). Time to death has been shown to have a significant relationship with healthcare expenditure and may serve as a proxy for morbidity ( Howdon & Rice, 2018 ).…”

Palliative care is increasing, but curative care is growing even faster in the last months of life

“…3 Planned primary and hospital care for disease management also rise steeply in the last trimester in England and Canada. 4,5 Figure 2 illustrates this by plotting the monthly frequency of medical service episodes that patients receive in their last year of life. This reveals the great increase in the number of episodes of 'curative' care as death approaches.…”