title: Relationship between use of general practice and healthcare costs at the end of life: a data linkage study in New South Wales, Australia.
abstract: OBJECTIVE
  This analysis investigated the relationships between healthcare expenditures in the last 6 months of life and use of general practitioner (GP) services in the preceding 12-month period among older residents of New South Wales, Australia.
  
  
  METHODS
  Questionnaire data (2006-2009) for more than 260,000 people aged 45 years and over were linked to individual hospital and death records and cost data. For 14,819 participants who died during follow-up, generalised linear mixed models were used to explore the relationships between costs of hospital, emergency department (ED) and Medicare-funded outpatient and pharmaceutical services in the last 6 months of life, and quintile of GP use in the 18-7 months before death. Analyses were adjusted for age at death, sex, educational level, language, private health insurance, household income, self-reported health status, functional limitation, psychological distress, number of comorbidities and geographic clustering.
  
  
  RESULTS
  Almost 85% of decedents had at least one hospitalisation in the last 6 months, and the mean (median) of total cost for each person in this period was $A20,453 (14,835). There was no significant difference in the hospital cost, including cost for preventable hospitalisations in the last 6 months of life, across quintiles of GP use in the 18-7 months before death. Participants in the lowest quintile of GP use incurred more ED costs, but ED costs were similar across the other quintiles of GP use. Costs for Medicare-funded outpatient services and pharmaceuticals increased steeply according to quintile of GP use.
  
  
  CONCLUSIONS
  In the Australian setting, there was no association between use of GP services in the 18-7 months before death and hospital costs in the last 6 months, but there was significant association with higher costs for outpatient services and pharmaceuticals. However, there was some indication that limited GP access might be associated with increased ED use at end of life.
authors.affiliation: Centre for Big Data Research in Health, UNSW Australia, Kensington, New South Wales, Australia.
authors.forename: Bich
authors.initials: B
authors.lastname: Tran
authors.affiliation: Centre for Big Data Research in Health, UNSW Australia, Kensington, New South Wales, Australia.
authors.forename: Michael O
authors.identifier: http://orcid.org/0000-0001-6444-7272
authors.initials: MO
authors.lastname: Falster
authors.affiliation: Centre for Health Research, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
authors.forename: Federico
authors.initials: F
authors.lastname: Girosi
authors.affiliation: Centre for Big Data Research in Health, UNSW Australia, Kensington, New South Wales, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Jorm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D003695:Delivery of Health Care / Q000191:economics*; D016527:Drug Costs; D004636:Emergency Service, Hospital; D005260:Female; D058006:General Practice; D017048:Health Care Costs; D005102:Health Expenditures; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009517:New South Wales; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000191:economics / Q000379:methods*; D014481:United States
keywords: PRIMARY CARE