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Patterns of health care use and expenditure during the last 6 months of life in Belgium: Differences between age categories in cancer and non-cancer patients

  • Gielen, Birgit
  • Remacle, Anne
  • Mertens, Raf
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    Objectives We analysed end-of-life care in Belgium to examine potential age variation in place of death, transitions between care settings, health care utilisation and public expenditure in the last 6 months of life.Methods Administrative data of one sickness fund were used, and analysed through regression analysis and analysis of variance. The study population comprised 40,794 individuals (age > 40 years).Results Several indicators showed that the end-of-life of older people, especially of those aged >=90 years, differs from that of younger individuals. Older persons more likely died in a care home, were less transferred between care settings, and stayed less days in hospital. On the other hand, older persons used more home care services, and had more contacts with the general practitioner. Differences between age categories were equally observed for last week's end-of-life care. Opposite to the trend for cancer patients, the odds of having a palliative home care allowance increased with age for non-cancer patients. Public expenditure for the oldest old was lower as compared to the younger decedents, but dependent on place of death.Conclusion Several aspects of end-of-life care in Belgium appear to be influenced by age. In view of ageing of the population, these findings can be of interest to decision makers.

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    File URL: http://www.sciencedirect.com/science/article/B6V8X-4YRGJ60-1/2/5ec386bd04d2946482ba402ae376b444
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    Article provided by Elsevier in its journal Health Policy.

    Volume (Year): 97 (2010)
    Issue (Month): 1 (September)
    Pages: 53-61

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    Handle: RePEc:eee:hepoli:v:97:y:2010:i:1:p:53-61
    Contact details of provider: Web page: http://www.elsevier.com/locate/healthpol

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    1. Thomas, C & Morris, S.M & Clark, D, 2004. "Place of death: preferences among cancer patients and their carers," Social Science & Medicine, Elsevier, vol. 58(12), pages 2431-2444, June.
    2. Baoping Shang & Dana Goldman, 2008. "Does age or life expectancy better predict health care expenditures?," Health Economics, John Wiley & Sons, Ltd., vol. 17(4), pages 487-501.
    3. Batljan, Ilija & Lagergren, Mårten, 2004. "Inpatient/outpatient health care costs and remaining years of life--effect of decreasing mortality on future acute health care demand," Social Science & Medicine, Elsevier, vol. 59(12), pages 2459-2466, December.
    4. Cohen, Joachim & Bilsen, Johan & Hooft, Peter & Deboosere, Patrick & Wal, Gerrit van der & Deliens, Luc, 2006. "Dying at home or in an institution: Using death certificates to explore the factors associated with place of death," Health Policy, Elsevier, vol. 78(2-3), pages 319-329, October.
    5. Brockmann, Hilke, 2002. "Why is less money spent on health care for the elderly than for the rest of the population? Health care rationing in German hospitals," Social Science & Medicine, Elsevier, vol. 55(4), pages 593-608, August.
    6. Jakobsson, Eva & Bergh, Ingrid & Ohlen, Joakim & Oden, Anders & Gaston-Johansson, Fannie, 2007. "Utilization of health-care services at the end-of-life," Health Policy, Elsevier, vol. 82(3), pages 276-287, August.
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