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The Health Care Cost of Dying: A Population-Based Retrospective Cohort Study of the Last Year of Life in Ontario, Canada

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  • Peter Tanuseputro
  • Walter P Wodchis
  • Rob Fowler
  • Peter Walker
  • Yu Qing Bai
  • Sue E Bronskill
  • Douglas Manuel

Abstract

Background: Coordinated and appropriate health care across sectors is an ongoing challenge, especially at the end-of-life. Population-level data on end-of-life health care use and cost, however, are seldom reported across a comprehensive array of sectors. Such data will identify the level of care being provided and areas where care can be optimized. Methods: This retrospective cohort study identified all deaths in Ontario from April 1, 2010 to March 31, 2013. Using population-based health administrative databases, we examined health care use and cost in the last year of life. Results: Among 264,755 decedents, the average health care cost in the last year of life was $53,661 (Quartile 1-Quartile 3: $19,568-$66,875). The total captured annual cost of $4.7 billion represents approximately 10% of all government-funded health care. Inpatient care, incurred by 75% of decedents, contributed 42.9% of total costs ($30,872 per user). Physician services, medications/devices, laboratories, and emergency rooms combined to less than 20% of total cost. About one-quarter used long-term-care and 60% used home care ($34,381 and $7,347 per user, respectively). Total cost did not vary by sex or neighborhood income quintile, but were less among rural residents. Costs rose sharply in the last 120 days prior to death, predominantly for inpatient care. Interpretation: This analysis adds new information about the breadth of end-of-life health care, which consumes a large proportion of Ontario’s health care budget. The cost of inpatient care and long-term care are substantial. Introducing interventions that reduce or delay institutional care will likely reduce costs incurred at the end of life.

Suggested Citation

  • Peter Tanuseputro & Walter P Wodchis & Rob Fowler & Peter Walker & Yu Qing Bai & Sue E Bronskill & Douglas Manuel, 2015. "The Health Care Cost of Dying: A Population-Based Retrospective Cohort Study of the Last Year of Life in Ontario, Canada," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-11, March.
  • Handle: RePEc:plo:pone00:0121759
    DOI: 10.1371/journal.pone.0121759
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    References listed on IDEAS

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    1. Felder, Stefan & Meier, Markus & Schmitt, Horst, 2000. "Health care expenditure in the last months of life," Journal of Health Economics, Elsevier, vol. 19(5), pages 679-695, September.
    2. Häkkinen, Unto & Martikainen, Pekka & Noro, Anja & Nihtilä, Elina & Peltola, Mikko, 2008. "Aging, health expenditure, proximity to death, and income in Finland," Health Economics, Policy and Law, Cambridge University Press, vol. 3(2), pages 165-195, April.
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    1. Sanjay K Murthy & Paul D James & Lilia Antonova & Mathieu Chalifoux & Peter Tanuseputro, 2017. "High end of life health care costs and hospitalization burden in inflammatory bowel disease patients: A population-based study," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-14, May.
    2. Michael Lebenbaum & Joyce Cheng & Claire Oliveira & Paul Kurdyak & Juveria Zaheer & Rebecca Hancock-Howard & Peter C. Coyte, 2020. "Evaluating the Cost Effectiveness of a Suicide Prevention Campaign Implemented in Ontario, Canada," Applied Health Economics and Health Policy, Springer, vol. 18(2), pages 189-201, April.
    3. Donna M. Wilson & Ye Shen & Begoña Errasti-Ibarrondo & Stephen Birch, 2018. "The Location of Death and Dying Across Canada: A Study Illustrating the Socio-Political Context of Death and Dying," Societies, MDPI, vol. 8(4), pages 1-7, November.
    4. Borja García-Lorenzo & Ania Gorostiza & Nerea González & Igor Larrañaga & Maider Mateo-Abad & Ana Ortega-Gil & Janika Bloemeke & Oliver Groene & Itziar Vergara & Javier Mar & Sarah N. Lim Choi Keung &, 2023. "Assessment of the Effectiveness, Socio-Economic Impact and Implementation of a Digital Solution for Patients with Advanced Chronic Diseases: The ADLIFE Study Protocol," IJERPH, MDPI, vol. 20(4), pages 1-14, February.
    5. Alessandro Gasparini & Keith R. Abrams & Jessica K. Barrett & Rupert W. Major & Michael J. Sweeting & Nigel J. Brunskill & Michael J. Crowther, 2020. "Mixed‐effects models for health care longitudinal data with an informative visiting process: A Monte Carlo simulation study," Statistica Neerlandica, Netherlands Society for Statistics and Operations Research, vol. 74(1), pages 5-23, February.
    6. Chandoevwit, Worawan & Phatchana, Phasith, 2018. "Inpatient care expenditure of the elderly with chronic diseases who use public health insurance: Disparity in their last year of life," Social Science & Medicine, Elsevier, vol. 207(C), pages 64-70.
    7. Donna M. Wilson & Ryan Brow & Robyn Playfair & Begoña Errasti-Ibarrondo, 2018. "What Is the “Right” Number of Hospital Beds for Palliative Population Health Needs?," Societies, MDPI, vol. 8(4), pages 1-7, November.

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