title: The health care cost of dying: a population-based retrospective cohort study of the last year of life in Ontario, Canada.
abstract: BACKGROUND
  Coordinated and appropriate health care across sectors is an ongoing challenge, especially at the end-of-life. Population-level data on end-of-life health care use and cost, however, are seldom reported across a comprehensive array of sectors. Such data will identify the level of care being provided and areas where care can be optimized.
  
  
  METHODS
  This retrospective cohort study identified all deaths in Ontario from April 1, 2010 to March 31, 2013. Using population-based health administrative databases, we examined health care use and cost in the last year of life.
  
  
  RESULTS
  Among 264,755 decedents, the average health care cost in the last year of life was $53,661 (Quartile 1-Quartile 3: $19,568-$66,875). The total captured annual cost of $4.7 billion represents approximately 10% of all government-funded health care. Inpatient care, incurred by 75% of decedents, contributed 42.9% of total costs ($30,872 per user). Physician services, medications/devices, laboratories, and emergency rooms combined to less than 20% of total cost. About one-quarter used long-term-care and 60% used home care ($34,381 and $7,347 per user, respectively). Total cost did not vary by sex or neighborhood income quintile, but were less among rural residents. Costs rose sharply in the last 120 days prior to death, predominantly for inpatient care.
  
  
  CONCLUSIONS
  This analysis adds new information about the breadth of end-of-life health care, which consumes a large proportion of Ontario's health care budget. The cost of inpatient care and long-term care are substantial. Introducing interventions that reduce or delay institutional care will likely reduce costs incurred at the end of life.
authors: Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario; Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.
authors: Peter
authors: P
authors: Tanuseputro
authors: Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada; Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
authors: Walter P
authors: WP
authors: Wodchis
authors: Department of Medicine and Department of Critical Care Medicine, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Ontario.
authors: Rob
authors: R
authors: Fowler
authors: Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada.
authors: Peter
authors: P
authors: Walker
authors: Institute for Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada.
authors: Yu Qing
authors: YQ
authors: Bai
authors: Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada.
authors: Sue E
authors: SE
authors: Bronskill
authors: Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario; Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors: Douglas
authors: D
authors: Manuel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011159:Population Surveillance; D012042:Registries; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics*