title: Differences in out-of-pocket costs of healthcare in the last year of life of older people in 13 European countries.
abstract: Research on the costs of healthcare provision has so far focused on insurer costs rather than out-of-pocket costs. Out-of-pocket costs may be important to patients making medical decisions.
  
  
  
  To investigate the self-reported out-of-pocket costs associated with healthcare in the last year of life of older adults in Europe.
  
  
  
  A post-death survey, part of the Survey of Health, Ageing, and Retirement in Europe, completed by proxy respondents in four waves from 2005 to 2012.
  
  
  
  Proxy respondents for 2501 deceased adults of 55 years or over. Data from 13 European countries and four waves from 2005 to 2012 were used.
  
  
  
  The proportion of people with out-of-pocket costs ranged from 21% to 96% in different European Union countries. Out-of-pocket costs ranged from 2% to 25% of median household income. Secondary and institutional care was most often the largest contributor to out-of-pocket costs, with care received in a care home being the most expensive type of care in 11 of 13 countries. Multilevel analyses showed that limitations in more than two activities of daily living (coefficient = 6.47, 95% confidence interval = 1.81-11.14) and a total hospitalization time of 3-6 months (coefficient = 14.66; 95% confidence interval = 0.97-28.35) or more than 6 months (coefficient = 31.01; 95% confidence interval = 11.98-50.15) were associated with higher out-of-pocket costs. In total, 24% of the variance on a country level remained unexplained.
  
  
  
  Variation in out-of-pocket costs for healthcare in the last year of life between European countries indicates that countries face different challenges in making healthcare in the last year of life affordable for all.
authors.affiliation: 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Yolanda Wh
authors.initials: YW
authors.lastname: Penders
authors.affiliation: 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.|2 Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Rietjens
authors.affiliation: 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Gwenda
authors.initials: G
authors.lastname: Albers
authors.affiliation: 2 Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.|3 The Netherlands Institute for Social Research (SCP), The Hague, The Netherlands.
authors.forename: Simone
authors.initials: S
authors.lastname: Croezen
authors.affiliation: 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D005060:Europe; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012112:Residential Facilities / Q000191:economics; D013727:Terminal Care / Q000191:economics*
keywords: End-of-life; costs; health expenditures; healthcare; international perspectives; out-of-pocket costs