Key findings
Nearly all Australians use health services in their last year of life
Among the 1.14 million people who died over the study period, 97% (1.1 million people) used at least one of the 4 health services – hospital admissions, ED presentations, MBS services and prescriptions supplied under the PBS/RPBS – in their last year of life. This proportion was similar for males (97%) and females (98%) but slightly less for people aged 0–64 (91%).
8% of health service costs were spent on people in their last year of life
Overall, $296.1 billion (average of $45.6 billion per year) was spent on the 4 health service types over the study period (1 July 2010 to 31 December 2016). Of this, 8% ($23.6 billion; average of $3.6 billion per year) was spent on services for people in the last year of life.
Note that the expenditure estimates in this report differ from those published in the AIHW’s Health Expenditure Australia reports (AIHW 2021) because of differences in the scope of the services and costs included in the NIHSI AA. For more information see ‘Health services and costs excluded from the analysis’ under Study background.
Average health service costs for people in their last year of life varied by age and sex
On average per year, $24,000 was spent on the 4 types of health services combined for a person in their last year of life.
By age, average costs for people in their last year of life ranged from $16,600 per person aged 20–29 to $37,100 per person aged 60–69. Average costs per person fell after the age of 70, down to $17,000 per person aged 80 and over. This pattern was similar for males and females.
Overall, males in their last year of life had a higher average annual cost than females ($26,300 and $21,600 per person respectively). Among people aged under 70, females had higher average annual costs per person than males. The greatest difference was among people aged 20–29, where costs were 90% higher for females than males ($25,300 compared with $13,200 per person). From age 70, males had higher average annual costs than females.
On average, people in their last year of life used more health services and had higher costs
For all 4 health services, on average people who died used more services in their last year of life than the rest of the population in a single year (that is, people not in their last year). The largest difference was for hospital admissions, with an average of 2.6 admissions per person in their last year of life compared with 0.1 admissions per person per year among those not in the last year of life.
Overall, the average annual health service cost per person for people in their last year of life was 14 times as high as for those not in the last year of life ($24,000 and $1,700 respectively).
The proportion of people not using any health service in their last year of life varied by age and cause of death
- 1.4% of people who died aged 65 and over did not use any of the 4 health services in their last year of life compared with 8.6% of people who died aged 0–64.
- 10% of people who died from suicide did not use any of the 4 health service types in their last year of life. This proportion was much higher than for other leading causes of death (for example, it was 3.1% for people who died from coronary heart disease).
- Among people who died aged under 65, 11% who died from coronary heart disease and 11% who died from accidental falls did not use a health service in their final year.
Health service costs were highest for people dying from cancer
Total health service costs were highest among people who died from cancer, followed by those who died from cardiovascular diseases. These two disease groups had the highest number of deaths over the period.
Among the 20 specific leading causes of death, the average annual cost in the last year of life was highest for people who died from colorectal (bowel) cancer ($40,700 per person), followed by breast cancer ($35,500 per person) and prostate cancer ($34,500 per person). It was lowest for deaths by suicide ($7,600 per person).
When looking at service use, average annual MBS claims in the last year of life were highest for people who died from breast and pancreatic cancers (both just over 100 services per person). It was lowest for deaths by suicide (22 services per person).
How did health service use and costs in the last year of life vary by use of residential aged care services?
Aged care services provide essential care and support to many people in their last year of life, with residential aged care services often providing end-of-life care. The use of aged care services and associated costs by people in their last year of life could not be examined in this study. Instead, the use and costs of 4 health services based on whether or not people used residential aged care services (permanent residential and/or respite care) in their last year of life were examined. This was explored among people aged 85 and over.
Dementia and coronary heart disease were leading causes of death
The leading underlying causes of death among people who used residential aged care in their last year of life were dementia (including Alzheimer’s disease) (19%) and coronary heart disease (16%). For people who did not use residential aged care in their last year, the leading causes of death were coronary heart disease (17%) and cerebrovascular disease (8%).
Among people in their last year of life, people who used residential aged care services had:
- Lower average health service costs. Overall, average health service costs were 27% lower for people who used residential aged care in their last year of life than for those who did not. A similar pattern was found for all 4 health service types. However, it is acknowledged that aged care services provide essential health care and support to people in their last year of life which may not have been captured in this study.
- A higher average number of prescriptions supplied but fewer hospital admissions and MBS claims. The average number of prescriptions supplied under the PBS/RPBS was 27% higher among people who used residential aged care in their last year of life than for those who did not. However, on average hospital admissions and MBS claims were lower for people who used residential aged care in their last year than for those who did not (34% and 16% lower respectively).
- Lower average health service costs for the 10 leading causes of death. Among people who died from one of the leading causes of death, those who used residential aged care in their last year had lower average health service costs than those who did not use such care in their final year.
References
AIHW (Australian Institute of Health and Welfare) (2021) Health Expenditure Australia 2019–20, AIHW, Australian Government, accessed 11 January 2022.