Time to death and health expenditure: an improved model for the impact of demographic change on health care costs

Seshamani, Meena

doi:10.1093/ageing/afh187

Cited by 103 publications

(65 citation statements)

References 17 publications

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“…Their finding that medical expenses increased abruptly in the last month of life indicated that PTD is a major factor influencing medical expenditures. Seshamani and Gray (23) found that the impact of aging on health care expenditures might be affected by PTD due to the concentration of morbidities and costs in the last year of life. Another study noted higher general practitioner costs closer to death, while finding that costs were not significantly impacted by age (24).…”

Section: Ptdmentioning

confidence: 99%

“…Another study noted higher general practitioner costs closer to death, while finding that costs were not significantly impacted by age (24). Most studies have concluded that age has less of an impact than PTD (2,23,25,26), while one study that controlled for PTD found that population aging was an important factor influencing the increase in medical expenses (27). Figure 7 shows health care expenditures for people aged 65 or older during the last year of life according to different studies.…”

Section: Ptdmentioning

confidence: 99%

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Tracking hospital costs in the last year of life ― The Shanghai experience

Zhu

Wang

et al. 2018

BST

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Section: Ptdmentioning

confidence: 99%

Section: Ptdmentioning

confidence: 99%

Tracking hospital costs in the last year of life ― The Shanghai experience

Zhu

Wang

et al. 2018

BST

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“…Public spending on prescription medications is a significant commitment, accounting for approximately 18.7% on average of total healthcare spending in OECD countries (12% in New Zealand) [15]. Traditional predictions of future expenditure using prescription drugs have not taken into account the effect of proximity to death (PTD) on individual expenditures [16]. One Danish study has examined medication expenditure and reported that the effect of ageing on future drug expenditures will be overestimated when not accounting for proximity to death [17].…”

Section: Introductionmentioning

confidence: 99%

The Importance of Proximity to Death in Modelling Community Medication Expenditures for Older People: Evidence From New Zealand

Moore

Bennett

Normand

2014

Appl Health Econ Health Policy

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BackgroundConcerns about the long term sustainability of health care expenditures and in particular prescribing expenditures has become an important policy issue in most developed countries. Previous studies suggest that proximity to death (PTD) has a significant effect on total health care expenditures, with its exclusion leading to an overestimation of likely growth. There are limited studies of pharmaceutical expenditures taking PTD into account. ObjectiveThis paper presents an empirical analysis of public medication expenditure on older individuals in New Zealand (NZ). The aim of the study is to examine the individual effects of age and proximity to death (PTD) using individual level data. MethodsThis study uses individual level dispensing data from 2008/2009 covering the whole population of medication users age 70 years or more and resident in New Zealand. A case control methodology is used to examine individual cost and medication use for a 12 month period for decedents (cases) and survivors (controls). A random effects two part model, with a Probit and Generalized Linear Model (GLM) is used to explore the effect of age and proximity to death on expenditures. ResultsThe impact of proximity to death on prescription expenditure is not as dramatic as studies reporting on Acute and/or long term care. The 12 month decedent to survivor mean expenditure ratio was 1.95, 2 2.09 for males and 1.82 for females. The additional cost of dying in terms of prescription drugs decreases with age, with those who die at 90 years of age or older consuming fewer drugs on average and having a lower mean expenditure than those who died in their 70s and 80s. The following variables were found to have a decreasing effect on the mean monthly prescription expenditures, a reduction of 2.2% for each additional year of age, 4.2% being in the Mãori ethnic group and 7.8% for Pacific Islanders. Increases in monthly expenditure were associated with being a decedent 32.1%-62.6% (depending on month), being of Asian origin 16.2% or a male 12.6%. ConclusionsGiven the variance reported between survivors and decedents, to improve accuracy future projections should include PTD in their models. Policies targeted at reducing expenditures should not focus on age but on ensuring appropriate and cost effective prescribing especially towards the end of life. Key points for decision makers: Despite prescription medications being the most common medical intervention there is limited evidence on how proximity to death and ageing affect prescribing expenditures for older people. In terms of expenditure on prescription medications, proximity to death would appear to be a more important driver than ageing and should therefore be considered in any future expenditure projections.

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“…Spending the remaining time to death in the hospital increases hospital cost (Sashamani & Gray, 2004). In this study, LOS increased with age.…”

Section: Discussionmentioning

confidence: 51%

Methods for Analyzing Hospital Length of Stay with Application to Inpatients Dying in Southern Thailand

Lim¹,

Tongkumchum²

2009

GJHS

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This study investigated length of stay (LOS) for patients who died in hospital in Southern Thailand from 2000 to 2003 with respect to principal diagnosis and demographic, geographic and hospital size factors. The computerized data of 40,498 mortality cases were obtained from the Ministry of Public Health from 167 hospitals in 14 provinces of Southern Thailand between October 2000 and September 2003 with information on age, gender, principal diagnosis, province and hospital size. Logistic and linear regression with log-transformed LOS was used to analyze the data. Patients with injuries as principal diagnosis had shortest LOS, whereas cancer patients had the longest LOS. Older patients, particularly females, had higher LOS for all diagnoses. LOS increased with hospital size except in the North and North West. Small hospitals in the South West region had the lowest LOS whereas large hospitals in the North West had the highest. The highest proportion of bed days (11.2%) occurred in males aged less than 60 diagnosed with infectious diseases. Males aged less than 60 diagnosed with injuries and digestive diseases, and aged at least 60 diagnosed with COPD, and aged less than 60 diagnosed with infectious diseases, accounted for more than double those for female patients in the same disease groups. Both logistic regressions with LOS at least 1 week as the outcome and linear regression on appropriately log transformed LOS gave consistent results. Providing suitable palliative care or allowing patients to select the place for spending their final time of life, especially for patients with chronic diseases, which can reduce hospital resource utilization.

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Time to death and health expenditure: an improved model for the impact of demographic change on health care costs

Cited by 103 publications

References 17 publications

Tracking hospital costs in the last year of life ― The Shanghai experience

Tracking hospital costs in the last year of life ― The Shanghai experience

The Importance of Proximity to Death in Modelling Community Medication Expenditures for Older People: Evidence From New Zealand

Methods for Analyzing Hospital Length of Stay with Application to Inpatients Dying in Southern Thailand

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