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PLoS One. 2015 Mar 26;10(3):e0121759. doi: 10.1371/journal.pone.0121759. eCollection 2015.

The health care cost of dying: a population-based retrospective cohort study of the last year of life in Ontario, Canada.

Author information

1
Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario; Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.
2
Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada; Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
3
Department of Medicine and Department of Critical Care Medicine, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Ontario.
4
Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada.
5
Institute for Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada.
6
Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada.
7
Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario; Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.

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.

PMID:
25811195
PMCID:
PMC4374686
DOI:
10.1371/journal.pone.0121759
[Indexed for MEDLINE]
Free PMC Article

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