Abstract

Background 

People who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain.

Objectives 

To describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life.

Methods 

Retrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274 048).

Results 

Secondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last 3 months. The mean cost was £10 000. Cause of death was associated with differing patterns of healthcare use: dying of cancer was preceded by the greatest number of hospital admissions and dementia the least. Greater age was associated with lower admission rates and cost. There was higher resource use in the urban areas. No difference was observed by deprivation.

Conclusions 

Hospitalisation near the end of life was least frequent for older people and those living rurally, although length of stay for both groups, when they were admitted, was longer. Research is required to understand if variation in hospitalisation is due to variation in the quantity or quality of end-of-life care available, varying community support, patient preferences or an inevitable consequence of disease-specific needs.

Citation

Diernberger K, Luta X, Bowden J, et al, Healthcare use and costs in the last year of life: a national population data linkage study, BMJ Supportive & Palliative Care, 2021.

You might also like...

Blog

If not now, when?

Blog

Despite government promising to 'fix the crisis in social care once and for all', no plan to reform...

Chart

Longer waits, missing patients and catching up

Chart

Six charts looking at the impact of the COVID-19 pandemic on consultant-led elective care.

Kjell-bubble-diagramArtboard 101 copy

Get social

There are big unanswered questions about the government's health and care reform agenda, after a cursory mention of… https://t.co/mjDB6v1TLD

Follow us on Twitter
Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more