Trajectories at the end of life: A controlled investigation of longitudinal Health Services Consumption data.
BACKGROUND
Knowledge of individual-level trajectories of Health Services Consumption (HSC) at End-of-Life (EoL) is scarce. Such research is needed for understanding and planning health expenditures.


OBJECTIVE
To explore individual-level EoL trajectories in the Israeli population. This approach differs from past studies which aggregated across populations or disease groups.


METHODS
We used HMO (Health Maintenance Organization) longitudinal data for HSC of persons ages 65-90 who died during 2010-2011 (n=35,887) and of an age by sex matched sample of persons who were alive by mid-2012 (n=48,560).


METHODS
HSC per quarter was calculated for each individual. Trajectory-types of HSC were described through k-means cluster analysis.


METHODS
Data were extracted from computerized HMO files. HSC was computed as a standardized function of HMO costs for each individual.


RESULTS
In both samples, low HSC trajectories were the most common. However, among the deceased, all trajectories had higher HSC than those who were alive; the low HSC trajectory cluster represented a smaller percentage of the sample; and all relevant trajectories included a HSC peak. In contrast, the most common trajectory among the living was a flat low HSC. Clusters differed significantly by sex, disease status, and age.


CONCLUSIONS
This methodology shows the utility of individual-level analysis of HSC at end-of-life and should inform future research and current debates concerning EoL care and resource distribution.
Minerva Center for the Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel; The Herczeg Institute on Aging, Tel-Aviv University, Tel Aviv, Israel; Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. Electronic address: Jiska@post.tau.ac.il.
Jiska
J
Cohen-Mansfield
Beit Rivka Medical Center, Petah Tikva, Israel; Minerva Center for the Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel. Electronic address: shaybr@clalit.org.il.
Shai
S
Brill
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005102:Health Expenditures; D006291:Health Policy; D006296:Health Services / Q000191:economics*; D006801:Humans; D007557:Israel; D008137:Longitudinal Studies; D008297:Male; D012737:Sex Factors; D013727:Terminal Care / Q000706:statistics & numerical data*
End of life care; Health care costs; Health policy; Health services; International health