Health care costs in the last year of life--the Dutch experience.

Health expenditure depends heavily on age. Common wisdom is that the age pattern is dominated by costs in the last year of life. Knowledge about these costs is important for the debate on the future development of health expenditure. According to the 'red herring' argument traditional projection methods overestimate the influence of ageing because improvements in life expectancy will postpone rather than raise health expenditure. This paper has four objectives: (1) to estimate health care costs in the last year of life in the Netherlands; (2) to describe age patterns and differences between causes of death for men and women; (3) to compare cost profiles of decedents and survivors; and (4) to use these figures in projections of future health expenditure. We used health insurance data of 2.1 million persons (13% of the Dutch population), linked at the individual level with data on the use of home care and nursing homes and causes of death in 1999. On average, health care costs amounted to 1100 Euro per person. Costs per decedent were 13.5 times higher and approximated 14,906 Euro in the last year of life. Most costs related to hospital care (54%) and nursing home care (19%). Among the major causes of death, costs were highest for cancer (19,000 Euro) and lowest for myocardial infarctions (8068 Euro). Between the other causes of death, however, cost differences were rather limited. On average costs for the younger decedents were higher than for people who died at higher ages. Ten per cent of total health expenditure was associated with the health care use of people in their last year of life. Increasing longevity will result in higher costs because people live longer. The decline of costs in the last year of life with increasing age will have a moderate lowering effect. Our projection demonstrated a 10% decline in the growth rate of future health expenditure compared to conventional projection methods.

[1]  S. Felder,et al.  Ageing of population and health care expenditure: a red herring? , 1999, Health economics.

[2]  Liming Cai,et al.  Health, life expectancy, and health care spending among the elderly. , 2003, The New England journal of medicine.

[3]  S. Felder,et al.  Life Expectancy and Health Care Expenditures in the 21st Century: A New Calculation for Germany Using the Costs of Dying , 2004 .

[4]  C. Hertzman,et al.  Age, costs of acute and long-term care and proximity to death: evidence for 1987-88 and 1994-95 in British Columbia. , 2000, Age and ageing.

[5]  H. Brockmann,et al.  Why is less money spent on health care for the elderly than for the rest of the population? Health care rationing in German hospitals. , 2002, Social science & medicine.

[6]  H. Horiguchi,et al.  Impact of age and procedure on resource use for patients with ischemic heart disease. , 2008, Health policy.

[7]  B. van Hout,et al.  Costs in the Last Year of Life in the Netherlands , 2001, Inquiry : a journal of medical care organization, provision and financing.

[8]  Sally C Stearns,et al.  Time to include time to death? The future of health care expenditure predictions. , 2004, Health economics.

[9]  S. Felder Costs of dying: alternatives to rationing. , 1997, Health policy.

[10]  E. Norton,et al.  Longevity and health care expenditures: the real reasons older people spend more. , 2003, The journals of gerontology. Series B, Psychological sciences and social sciences.

[11]  T. Perls Acute care costs of the oldest old. , 1997, Hospital practice.

[12]  J. Lynn,et al.  Profiles of Older Medicare Decedents , 2002, Journal of the American Geriatrics Society.

[13]  J. Lubitz,et al.  Three decades of health care use by the elderly, 1965-1998. , 2001, Health affairs.

[14]  Henry S. Shryock,et al.  The Methods and Materials of Demography. , 1973 .

[15]  E. Emanuel Cost savings at the end of life. What do the data show? , 1996, JAMA.

[16]  L Groom,et al.  Age and proximity to death as predictors of GP care costs: results from a study of nursing home patients. , 2000, Health economics.

[17]  J. Polder,et al.  Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study , 1998, BMJ.

[18]  E. Emanuel,et al.  The economics of dying. The illusion of cost savings at the end of life. , 1994, The New England journal of medicine.

[19]  S. Felder,et al.  Population Ageing and Health Care Expenditure: New Evidence on the “Red Herring” , 2004 .

[20]  Alastair Gray,et al.  Ageing and health-care expenditure: the red herring argument revisited. , 2004, Health economics.

[21]  A. Gray,et al.  Health care expenditures and ageing: an international comparison. , 2003, Applied health economics and health policy.

[22]  Ivar Sønbø Kristiansen,et al.  Future health care costs--do health care costs during the last year of life matter? , 2002, Health policy.

[23]  R. Harmer The high cost of dying , 1963 .

[24]  P. Zweifel,et al.  The Impact of Aging on Future Healthcare Expenditure , 2006 .

[25]  J Lubitz,et al.  Longevity and Medicare expenditures. , 1995, The New England journal of medicine.

[26]  J. Lubitz,et al.  Trends in Medicare payments in the last year of life. , 1993, The New England journal of medicine.

[27]  L. Deliens,et al.  End-of-life decision-making in six European countries: descriptive study , 2003, The Lancet.

[28]  R. Prihoda,et al.  The use and costs of Medicare services by cause of death. , 1987, Inquiry : a journal of medical care organization, provision and financing.

[29]  A. Scitovsky "The high cost of dying" revisited. , 1994, The Milbank quarterly.