Abstract
Objectives: (1) To compare the number of hospital days used by survivors with those by persons in their last, second last, and third last year of life in relation to age; (2) to analyse lifelong hospital utilisation in relation to life expectancy.
Design: Cohort study using a 10% sample (stratified by age and sex) of persons insured by one sickness fund.
Setting: Germany, 1989–1995.
Subjects: 69 847 survivors (with a minimum of three more years to live), 1385 persons in last, 1368 in second last, and 1333 in third last year of life.
Results: The number of days spent in hospital in the last year of life was lowest for the young (24.2 days under age 25) and the old (23.2 days at age 85+) and was greatest at ages 55–64 (40.6 days). The ratio of days to survivors was highest at age 35–44 (31.0) and fell continously thereafter to 4.3 at age 85+. Similar patterns were seen for hospital days in the second and third year before death, except that peaks were at 35–44 years (22.5 and 13.7 days respectively). Calculated lifelong number of hospital days increased with age from 54.8 (death at age 20) to 201.0 (age 90). Numbers of hospital days per year of life, averaged over the entire lifespan, were stable at 2.0–2.2 for deaths between age 50 and 90 (and up to 2.7 at age 20).
Conclusions: Lifelong hospital utilisation for persons who die at 50 or later is directly proportional to the number of years lived. These data contradict results from cross sectional studies that suggest an exponential rise in health care costs as longevity increases. They have important implications for projections of future health care expenditure.
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Selected References
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- Fries J. F. Aging, natural death, and the compression of morbidity. N Engl J Med. 1980 Jul 17;303(3):130–135. doi: 10.1056/NEJM198007173030304. [DOI] [PubMed] [Google Scholar]
- Fuchs V. R. "Though much is taken": reflections on aging, health, and medical care. Milbank Mem Fund Q Health Soc. 1984 Spring;62(2):143–166. [PubMed] [Google Scholar]
- Henderson J., Goldacre M. J., Griffith M. Hospital care for the elderly in the final year of life: a population based study. BMJ. 1990 Jul 7;301(6742):17–19. doi: 10.1136/bmj.301.6742.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Himsworth R. L., Goldacre M. J. Does time spent in hospital in the final 15 years of life increase with age at death? A population based study. BMJ. 1999 Nov 20;319(7221):1338–1339. doi: 10.1136/bmj.319.7221.1338. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Liao Y., McGee D. L., Cao G., Cooper R. S. Quality of the last year of life of older adults: 1986 vs 1993. JAMA. 2000 Jan 26;283(4):512–518. doi: 10.1001/jama.283.4.512. [DOI] [PubMed] [Google Scholar]
- Lubitz J. D., Riley G. F. Trends in Medicare payments in the last year of life. N Engl J Med. 1993 Apr 15;328(15):1092–1096. doi: 10.1056/NEJM199304153281506. [DOI] [PubMed] [Google Scholar]
- Lubitz J., Beebe J., Baker C. Longevity and Medicare expenditures. N Engl J Med. 1995 Apr 13;332(15):999–1003. doi: 10.1056/NEJM199504133321506. [DOI] [PubMed] [Google Scholar]
- Lubitz J., Prihoda R. The use and costs of Medicare services in the last 2 years of life. Health Care Financ Rev. 1984 Spring;5(3):117–131. [PMC free article] [PubMed] [Google Scholar]
- Mcgrail K., Green B., Barer M. L., Evans R. G., Hertzman C., Normand C. Age, costs of acute and long-term care and proximity to death: evidence for 1987-88 and 1994-95 in British Columbia. Age Ageing. 2000 May;29(3):249–253. doi: 10.1093/ageing/29.3.249. [DOI] [PubMed] [Google Scholar]
- Murtaugh C. M., Kemper P., Spillman B. C., Carlson B. L. The amount, distribution, and timing of lifetime nursing home use. Med Care. 1997 Mar;35(3):204–218. doi: 10.1097/00005650-199703000-00003. [DOI] [PubMed] [Google Scholar]
- Roos N. P., Montgomery P., Roos L. L. Health care utilization in the years prior to death. Milbank Q. 1987;65(2):231–254. [PubMed] [Google Scholar]
- Roos N. P., Shapiro E., Tate R. Does a small minority of elderly account for a majority of health care expenditures? A sixteen-year perspective. Milbank Q. 1989;67(3-4):347–369. [PubMed] [Google Scholar]
- Scitovsky A. A. "The high cost of dying" revisited. Milbank Q. 1994;72(4):561–591. [PubMed] [Google Scholar]
- Scitovsky A. A. Medical care in the last twelve months of life: the relation between age, functional status, and medical care expenditures. Milbank Q. 1988;66(4):640–660. [PubMed] [Google Scholar]
- Temkin-Greener H., Meiners M. R., Petty E. A., Szydlowski J. S. The use and cost of health services prior to death: a comparison of the Medicare-only and the Medicare-Medicaid elderly populations. Milbank Q. 1992;70(4):679–701. [PubMed] [Google Scholar]
- Zweifel P., Felder S., Meiers M. Ageing of population and health care expenditure: a red herring? Health Econ. 1999 Sep;8(6):485–496. doi: 10.1002/(sici)1099-1050(199909)8:6<485::aid-hec461>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
- van Vliet R. C., Lamers L. M. The high costs of death: should health plans get higher payments when members die? Med Care. 1998 Oct;36(10):1451–1460. doi: 10.1097/00005650-199810000-00003. [DOI] [PubMed] [Google Scholar]