title: Regional Variation of Cost of Care in the Last 12 Months of Life in Switzerland: Small-area Analysis Using Insurance Claims Data.
abstract: BACKGROUND
  Health care spending increases sharply at the end of life. Little is known about variation of cost of end of life care between regions and the drivers of such variation. We studied small-area patterns of cost of care in the last year of life in Switzerland.
  
  
  METHODS
  We used mandatory health insurance claims data of individuals who died between 2008 and 2010 to derive cost of care. We used multilevel regression models to estimate differences in costs across 564 regions of place of residence, nested within 71 hospital service areas. We examined to what extent variation was explained by characteristics of individuals and regions, including measures of health care supply.
  
  
  RESULTS
  The study population consisted of 113,277 individuals. The mean cost of care during last year of life was 32.5k (thousand) Swiss Francs per person (SD=33.2k). Cost differed substantially between regions after adjustment for patient age, sex, and cause of death. Variance was reduced by 52%-95% when we added individual and regional characteristics, with a strong effect of language region. Measures of supply of care did not show associations with costs. Remaining between and within hospital service area variations were most pronounced for older females and least for younger individuals.
  
  
  CONCLUSIONS
  In Switzerland, small-area analysis revealed variation of cost of care during the last year of life according to linguistic regions and unexplained regional differences for older women. Cultural factors contribute to the delivery and utilization of health care during the last months of life and should be considered by policy makers.
authors: *Institute of Social and Preventive Medicine, University of Bern †Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern ‡Department of Health Sciences, Helsana Insurance Group §Institute for Epidemiology, Biostatistics & Prevention, University of Zurich, Zurich, Switzerland ∥The Dartmouth Institute of Health Policy & Clinical Practice, Lebanon, NH ¶Section of Geriatrics, Boston University Medical Center, Boston, MA.
authors: Radoslaw
authors: R
authors: Panczak
authors: Xhyljeta
authors: X
authors: Luta
authors: Maud
authors: M
authors: Maessen
authors: Andreas E
authors: AE
authors: Stuck
authors: Claudia
authors: C
authors: Berlin
authors: Kurt
authors: K
authors: Schmidlin
authors: Oliver
authors: O
authors: Reich
authors: Viktor
authors: V
authors: von Wyl
authors: David C
authors: DC
authors: Goodman
authors: Matthias
authors: M
authors: Egger
authors: Marcel
authors: M
authors: Zwahlen
authors: Kerri M
authors: KM
authors: Clough-Gorr
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017062:Small-Area Analysis; D012959:Socioeconomic Factors; D013557:Switzerland; D013727:Terminal Care / Q000191:economics*