Author: Christopher McGowan
McGowan, Christopher, 2016 What Is The Cost Of Public Hospital Care At The End-Of-Life?, Flinders University, School of Health Sciences
This electronic version is made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact firstname.lastname@example.org with the details.
Mr. McGowan established an extensive database of hospital records for decedents across four states and four time periods. The database linked all public hospital records for decedents in 2005 and 2010 for SA, NSW and Qld. and for WA in 1995, 2000, 2005 and 2010. Over 192,000 decedents and 1,000,000 hospital recorded were analysed. These records were examined to establish the percentage of the health budget that is attributable to end-of-life, the difference in the cost of ageing when end-of-life is excluded. Also, examined was the cost of end-of-life differentiated by cause of death and by jurisdiction. Analysis was undertaken to establish if relative and absolute costs of end-of-life was increasing over time. This body of research will assist greatly in better formulating health policy to ensure scare resources are deployed based on evidence. SUMMARY This program of research asked the question: what is the cost of public hospital care associated with end-of-life? The research included a retrospective cohort study to examine Australian public hospital costs associated with end-of-life care and specifically addressed: • the proportion of total public hospital costs comprised of end-of-life care • the proportion of total public hospital costs related to end-of-life care attributable to ageing • Do public healthcare costs changes over time? • factors that impact on hospital costs at the end-of-life • variations in hospital costs at end-of-life among selected States A unique database comprising population-wide health data was created containing all deaths in NSW, Qld, WA and SA for 2005 and 2010, and 1995 and 2000 decedents for WA. Decedents’ public hospital records were linked with births, deaths and marriage records to form a longitudinal public hospital utilisation record for each decedent. These linked, routinely collected administrative health data were examined to establish the proportion of public hospital resources consumed in the last 12 months and last five years of life. The proportion of these resources consumed by older patients, and changes over time, were examined together with factors that might influence public hospital costs of end-of-life care, including age of death, and cause of death. Examination of patterns of hospital utilisation by cause of death and distribution of hospital resources by patient type was also undertaken. Variations among the four jurisdictions were also examined. The findings indicate that the last year of life accounts for 10 percent of total state expenditure on public hospitals; an amount comparable to other research in the Australian context and other developed countries. Further, these costs for end-of-life care were rising significantly faster than inflation. The findings also indicated that while the cost of ageing, excluding the higher proportion of deaths occurring for older people, is substantial, projecting future hospital utilisation demand, after excluding the cost of dying, represents a significant discount to current projections. The research also found that public hospital costs of end-of-life care decrease as decedents’ age, for all causes of death except sudden death. The results indicate that cause of death influences the cost of end-of-life care, ranging from neoplasm related deaths ($26,303) to frailty related deaths ($10,763). Further, the age of death and cause of death remained stable between 2005 and 2010. A comparison of the four jurisdictions found that public hospital utilisation for end-of-life care was largely consistent The pattern of hospital admissions preceding death varied by cause of death, but a higher proportion of resources were consumed by a relatively small number of decedents. Conclusions Costs of end-of-life care in public hospital are rising faster than health inflation and, as such, require attention from policy makers for the future. While to some degree the costs of an ageing population are offset by reduced hospital costs for older decedents, this exchange is not sufficient to mitigate the healthcare costs of an ageing population. Moreover, it was found that a large percentage of end-of-life hospital costs is concentrated on a relatively small percentage of decedents and, as such, might guide policy makers to address healthcare for this group.
Keywords: End-of-life care, health economics, cost of end-of-life,
Subject: Public Health thesis
Thesis type: Doctor of Philosophy
School: School of Health Sciences
Supervisor: Prof Malcolm Battersby