Hospital care expenditures for persons in the last stages of life

Background. Empirical surveys in OECD (The Organisation for Economic Cooperation and Development) countries show greater health expenditures for persons nearing the end of their lives, and the relatively high expenditures for treating persons in the period before death compared with persons surviving treatment. The pattern of health expenditures for persons in the last year of life relative to their age is also characteristic: these expenditures decrease with the person's increasing age. We have calculated the data on expenditures for hospital care of persons in the last years before death for Slovenia and verified whether they have similar characteristics as in the countries where such surveys have already been conducted.Methods. We carried out a retrospective survey of expenditures on in-patient care for the last five years of life of persons who died in 2009. The data processing for 2009 includes expenditures on in-patient care of persons who were still alive on 31 December 2009. The in-patient care includes general and specialised hospitals, which charge all services in acute treatment by diagnosis related groups, psychiatric hospitals and psychiatric wards in general hospitals, the University Rehabilitation Institute Soča and rehabilitation centres in health resorts. Descriptive methods of data processing were used, which estimate the development of health expenditures in the period before death and the relationship (by age, sex, and diagnosis) between health expenditures of people who died and health expenditures of people who survived.Results. Of the EUR 280 million of expenditures for hospitalisation of persons who died in 2009, EUR 172 million (60%) was spent on their treatment in the last five years of their lives. Of the EUR 854 million spent for hospitalisation in 2009, a much larger share (75%) was related to morbidity rather than mortality. Most of the expenditures were intended for hospitalisation of persons who died from neoplasms and blood diseases (41.9%) and due to diseases of the circulatory system (29.9%), totalling to 71.8% of total expenditures. The average expenditure for a person who died before completing 39 years of age was EUR 18,292, while EUR 14,525 for a person who died between 40 and 69 years of age, and EUR 10,483 for a person who died after completing 70 years of age. The average expenditure reduces from EUR 13,969 for a person who died aged 70-74, to EUR 7,652 for a person who died aged 85-89. The average expenditure for a person aged up to 39 years who survived was EUR 2,095 and EUR 3,416 for a person who survived aged 40-75. For persons older than 75, the expenditure curve gradually falls. The ratio between expenditures for persons who died and persons who survived is 4.1 for Slovenia, and is relatively smaller compared to results of foreign surveys.Conclusions. The results of our survey on expenditures for in-patient care show that expenditures increase in the last years of a person's life and that they decrease with a person's age. The same characteristics are shown in results of surveys on these expenditures in other countries. The only exception is the ratio between expenditures for persons who died and persons who survived which for Slovenia is 4.1, and is relatively smaller compared to results from foreign surveys.