Dataset Information

Population-Based Estimates of Health Care Utilization and Expenditures by Adults During the Last 2 Years of Life in Canada's Single-Payer Health System.

ABSTRACT:

Importance

Measuring health care utilization and costs before death has the potential to initiate health care improvement.

Objective

To examine population-level trends in health care utilization and expenditures in the 2 years before death in Canada's single-payer health system.

Design, setting, and participants

This population-based cohort included 966?436 deaths among adult residents of Ontario, Canada, from January 2005 to December 2015, linked to health administrative and census data. Data for deaths from 2005 to 2013 were analyzed from November 1, 2016, through January 31, 2017. Analyses were updated from May 1, 2019, to June 15, 2019, to include deaths from 2014 and 2015.

Exposures

Sociodemographic exposures included age, sex, and neighborhood income quintiles, which were obtained by linking decedents' postal codes to census data. Aggregated Diagnosis Groups were used as a general health service morbidity-resource measure.

Main outcomes and measures

Health care services accessed for the last 2 years of life, including acute hospitalization episodes of care, intensive care unit visits, and emergency department visits. Total health care costs were calculated using a person-centered costing approach. The association of area-level income with high resource use 1 year before death was analyzed with Poisson regression analysis, controlling for age, sex, and Aggregated Diagnosis Groups.

Results

Among 966?436 decedents (483?038 [50.0%] men; mean [SD] age, 76.4 [14.96] years; 231?634 [24.0%] living in the lowest neighborhood income quintile), health care expenditures increased in the last 2 years of life during the study period (CAD$5.12 billion [US $3.83 billion] in 2005 vs CAD$7.84 billion [US $5.86 billion] in 2015). In the year before death, 758?770 decedents (78.5%) had at least 1 hospitalization episode of care, 266?987 (27.6%) had at least 1 intensive care unit admission, and 856?026 (88.6%) had at least 1 emergency department visit. Overall, deaths in hospital decreased from 37?984 (45.6%) in 2005 to 39?474 (41.5%) in 2015. Utilization in the last 2 years, 1 year, 180 days, and 30 days of life varied by resource utilization gradients. For example, the proportion of individuals visiting the emergency department was slightly higher among the top 5% of health care users compared with other utilization groups in the last 2 years of life (top 5%, 45?535 [94.2%]; top 6%-50%, 401?022 [92.2%]; bottom 50%, 409?469 [84.7%]) and 1 year of life (top 5%, 43?007 [89.0%]; top 6%-50%, 381?732 [87.8%]; bottom 50%, 380?859 [78.8%]); however, in the last 30 days of life, more than half of individuals in the top 6% to top 50% (223?262 [51.3%]) and bottom 50% (288?480 [59.7%]) visited an emergency department, compared with approximately one-third of individuals in the top 5% (16?916 [35.0%]). No meaningful associations were observed in high resource use between individuals in the highest income quintile compared with the lowest income quintile (rate ratio, 1.02; 95% CI, 0.99-1.05) after adjusting for relevant covariates.

Conclusions and relevance

In this study, health care use and spending in the last 2 years of life in Ontario were high. These findings highlight a trend in hospital-centered care before death in a single-payer health system.

SUBMITTER: Rosella LC

PROVIDER: S-EPMC7113729 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Population-Based Estimates of Health Care Utilization and Expenditures by Adults During the Last 2 Years of Life in Canada's Single-Payer Health System.

Rosella Laura C LC Kornas Kathy K Bornbaum Catherine C Huang Anjie A Watson Tristan T Shuldiner Jennifer J Wodchis Walter P WP

JAMA network open 20200401 4

<h4>Importance</h4>Measuring health care utilization and costs before death has the potential to initiate health care improvement.<h4>Objective</h4>To examine population-level trends in health care utilization and expenditures in the 2 years before death in Canada's single-payer health system.<h4>Design, setting, and participants</h4>This population-based cohort included 966 436 deaths among adult residents of Ontario, Canada, from January 2005 to December 2015, linked to health administrative a ...[more]

PMID: 32236531

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Dataset Information

Population-Based Estimates of Health Care Utilization and Expenditures by Adults During the Last 2 Years of Life in Canada's Single-Payer Health System.

Importance

Objective

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Conclusions and relevance

Publications

Population-Based Estimates of Health Care Utilization and Expenditures by Adults During the Last 2 Years of Life in Canada's Single-Payer Health System.

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