Health costs of final month of life: $14K

The average person generates $14,000 in health-care costs during the last 30 days of his or her life, often receiving high-impact hospital treatment that may only make their passing more difficult, a new Canadian study concludes.

The landmark research, a rare attempt to put a price tag on the care that immediately precedes death, highlights the need to shift treatment of the dying out of acute-care facilities, argue the authors.

The analysis of Ontario data found that close to $5 billion a year is spent in that province alone on the care of people in their last year — about 10 per cent of the overall health budget — and $1.3 billion on their last month.

Close to half that expense stems from admission to acute-care hospitals, despite widespread agreement that many patients should get palliative or home care in their final days.

“To make the case for improved end-of-life care, we thought that looking at costs — and specifically at costs that could be prevented — would be a powerful tool to change policy,” said Dr. Peter Tanuseputro, a family physician who coauthored the study in the journal PLOS One. “I think most people would want to die at home and spend their last days at home.… (But) it often happens in an acutecare hospital.”

Tanuseputro and colleagues from the Universities of Toronto and Ottawa said their analysis of health-care data in Ontario from 2010-13 may be the first to examine end-of-life spending across a variety of health sectors for such a large population.

They found the province’s average, annual cost of caring for people in the year before their death was $4.7 billion, the numbers mounting annually.

The average cost per patient was $54,000, and spending soared in the final few months and weeks.

Hospital in-patient services ate up by far the largest chunk of money, at 43 per cent, followed by long-term care, 15.5 per cent, doctor costs, 10 per cent, and homecare, 8.3 per cent. Fewer than one in 10 of those ending up in hospital was there for palliative services.

It is difficult to say what portion of hospital costs could be cut out with more appropriate treatment, but other research has indicated that only about one in four deaths comes unexpectedly, Tanuseputro said.

“For the majority of the dying population, you can kind of see when death is coming within the last month or two,” he said. “Unfortunately, that is also the time we see, still, the increase in hospital costs.”

Many admissions could be avoided by providing additional palliative care at home, perhaps by training more family physicians in that sort of service, he said. As of now, only one in five people receive any kind of home visit by a doctor in their last year, according to other research by his group.

The results show that it is the process of dying specifically, not the aging population in general, that will increasingly put a strain on health budgets as baby boomers get older, said Livio Di Matteo, a health economist at Lakehead University in Thunder Bay, Ont.