Les dépenses de soins remboursés durant la dernière année de vie, en 2008, en France

Ricci, P.; Mezzarobba, M.; Blotière, Pierre-Olivier; Polton, Dominique

doi:10.1016/j.respe.2012.04.007

Cited by 9 publications

(5 citation statements)

References 13 publications

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“…Our results show that acute hospital care was the main cost driver, representing 54% of total spending, whatever the main diagnosis class, and that spending of the last year of life markedly differed between diagnosis classes. There is a growing trend in end-of life expenditures per patient which represented 22,000 € (2015 current €)/patient in 2008 and 28 000 € in 2015 (5).…”

Section: Discussionmentioning

confidence: 99%

“…[4] In 2008, an estimate for France reported that end-of life care represented 10.5% of yearly health expenditures. [5] An international comparison in 2017 found that spending during the last 12 months of life ranged from 8.5% (USA) to 11.2% (Taiwan) of aggregate spending. [1] Authors also found that, although spending during the last 12 months of life was not wasteful, the money could be expended to provide better care.…”

Section: Introductionmentioning

confidence: 99%

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End-of life medical spending and care pathways in the last 12 months of life: A comprehensive analysis of the national claims database in France

Nze Ossima,

Szfetel,

Denoyel

et al. 2023

Medicine

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Background: To inform policy makers on efficient provision of end-of-life care, we estimated the 12-month medical expenditures of French decedents in 2015. Methods: We estimated total medical expenditures by service type and diagnosis category, and analyzed care pathways for breast cancer, dementia, chronic obstructive lung disease. Results: 501,121 individuals died in 2015, 59% of whom were in a hospital at the time of death. The aggregated spending totaled 9% of total health expenditures, a mean of €28,085 per capita, 44% of which was spent during the last 3 months of life. Hospital admissions represented over 70% of total expenditures; 21.3% of the population used hospital palliative care services in their last year of life. Analyses performed on breast cancer, dementia and lung disease found that differences in care pathways markedly influenced spending and were not simply explained by patients characteristics. Conclusion: Diagnoses and care trajectories, including repeated hospital stays, are the main drivers of the last year of life expenditures. Our data suggests that early identification of patients requiring palliative care and community-based end-of-life service delivery is feasible and could better support patients, families and caregivers with constant or reduced costs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

End-of life medical spending and care pathways in the last 12 months of life: A comprehensive analysis of the national claims database in France

Nze Ossima,

Szfetel,

Denoyel

et al. 2023

Medicine

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“…The medical spending considered were those during the calendar year of death. In France, the average annual expenditure for cancer patients 1 year before death was estimated at €36,589 in 2008 [20]. Moreover, spending concentration around several expenditure items has also been studied.…”

Section: Introductionmentioning

confidence: 99%

Evolution of health care utilization and expenditure during the year before death in 2015 among people with cancer: French snds-based cohort study

et al. 2021

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Background Cancer patients have one of the highest health care expenditures (HCE) at the end of life. However, the growth of HCE at the end of life remains poorly documented in the literature. Objective To describe monthly reimbursed expenditure during the last year of life among cancer patients, by performing detailed analysis according to type of expenditure and the person’s age. Method Data were derived from the Système national des données en santé (SNDS) [national health data system], which comprises information on ambulatory and hospital care. Analyses focused on general scheme beneficiaries (77% of the French population) treated for cancer who died in 2015. Results Average reimbursed expenditure during the last year of life was €34,300 per person in 2015, including €21,100 (62%) for hospital expenditure. "Short-stays hospital" and "rehabilitation units" stays expenditure were €14,700 and €2000, respectively. Monthly expenditure increased regularly towards the end of life, increasing from 12 months before death €2000 to €5200 1 month before death. The highest levels of expenditure did not concern the oldest people, as average reimbursed expenditure was €50,300 for people 18–59 years versus €25,600 for people 80–90 years. Out-of-pocket payments varied only slightly according to age, but increased towards the end of life. Conclusion A marked growth of HCE was observed during the last 4 months of life, mainly driven by hospital expenditure, with a more marked growth for younger people.

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“…Many of these patients benefit from high-level and costly treatments throughout their lives, particularly at the final stage of their illness. 2 , 3 Most of these treatments are prescribed as “home treatments” to keep the patients at home as long as possible. This strategy is in accordance with the desire expressed by most patients to spend the last part of their lives at home and is reinforced by political and economic strategies intended to develop ambulatory care and home treatments.…”

Section: Introductionmentioning

confidence: 99%

“…The risk of not respecting the wishes of the patient and of aggressive and futile therapy is considerable, and specific treatments, such as analgesia, sedation, or anxiolysis, are not necessarily well mastered in these palliative situations. 2 …”

Section: Introductionmentioning

confidence: 99%

Palliative Care and Prehospital Emergency Medicine

et al. 2014

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Palliative care, which is intended to keep patients at home as long as possible, is increasingly proposed for patients who live at home, with their family, or in retirement homes. Although their condition is expected to have a lethal evolution, the patients—or more often their families or entourages—are sometimes confronted with sudden situations of respiratory distress, convulsions, hemorrhage, coma, anxiety, or pain. Prehospital emergency services are therefore often confronted with palliative care situations, situations in which medical teams are not skilled and therefore frequently feel awkward.We conducted a retrospective study about cases of palliative care situations that were managed by prehospital emergency physicians (EPs) over a period of 8 months in 2012, in the urban region of Lausanne in the State of Vaud, Switzerland.The prehospital EPs managed 1586 prehospital emergencies during the study period. We report 4 situations of respiratory distress or neurological disorders in advanced cancer patients, highlighting end-of-life and palliative care situations that may be encountered by prehospital emergency services.The similarity of the cases, the reasons leading to the involvement of prehospital EPs, and the ethical dilemma illustrated by these situations are discussed. These situations highlight the need for more formal education in palliative care for EPs and prehospital emergency teams, and the need to fully communicate the planning and implementation of palliative care with patients and patients’ family members.

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Les dépenses de soins remboursés durant la dernière année de vie, en 2008, en France

Cited by 9 publications

References 13 publications

End-of life medical spending and care pathways in the last 12 months of life: A comprehensive analysis of the national claims database in France

End-of life medical spending and care pathways in the last 12 months of life: A comprehensive analysis of the national claims database in France

Evolution of health care utilization and expenditure during the year before death in 2015 among people with cancer: French snds-based cohort study

Palliative Care and Prehospital Emergency Medicine

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