title: Healthcare services funded by Counties Manukau District Health Board for people in the last year of life.
abstract: BACKGROUND
  The last year of life is often associated with a high level of healthcare utilisation and cost. To date, little information is available regarding the healthcare utilisation patterns in the last year of life in New Zealand.
  
  
  OBJECTIVE
  To describe the healthcare utilisation patterns and costs of the residents of Counties Manukau District Health Board (CMDHB) region in the 1-year period prior to death in 2008.
  
  
  METHODS
  CMDHB residents who died in 2008 were identified from the National Mortality Dataset. The health services utilisation patterns and costs in the last year of life were derived from National Minimum Dataset (NMDS), Pharmaceutical Collection, Laboratory Claims Collection, and National Non-Admitted Patient Collection via encrypted NHI linkage.
  
  
  RESULTS
  Forty percent of all deaths in 2008 in CMDHB occurred in a publicly funded hospital. Just over 80% of people had at least one inpatient hospital stay in the last year of life. More than 75% of the healthcare costs funded by CMDHB in the last year of life were related to inpatient hospitalisations. The average cumulative length of inpatient stay over the year in the people who had an inpatient event was 20.6 days. Outpatient, pharmaceutical, and laboratory services were received by 84%, 91%, and 86% of people respectively in their last year of life.
  
  
  CONCLUSIONS
  Consistent with the international literature, this study found that CMDHB residents in the last year of life have a high level of health service utilisation. Decisions about the appropriate use of high cost health services in people towards the end of life can be extremely challenging. These decisions are resource allocation decisions as well as clinical decisions and should be based on clinical factors, cost utilities, and patient, family, and society's expectations.
authors.affiliation: Planning and Funding, CMDHB, Manukau. Private Bag 94052, South Auckland Mail Centre, New Zealand. wingcheuk.chan@cmdhb.org.nz
authors.forename: Wing Cheuk
authors.initials: WC
authors.lastname: Chan
authors.forename: Gary
authors.initials: G
authors.lastname: Jackson
authors.forename: Doone
authors.initials: D
authors.lastname: Winnard
authors.forename: Philippa
authors.initials: P
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000191:economics / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality; D007755:Laboratories, Hospital / Q000191:economics / Q000706:statistics & numerical data; D008107:Liver Diseases / Q000191:economics / Q000401:mortality; D008171:Lung Diseases / Q000191:economics / Q000401:mortality; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics / Q000401:mortality; D009520:New Zealand / Q000453:epidemiology; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D013727:Terminal Care / Q000191:economics*; D055815:Young Adult