In 2020, 161,300 people died in Australia (AIHW 2022a). The types and number of health services people use in the year before death, as well as how much is spent on these services, are of key interest to health-care professionals and policy makers.
Australians use various health services in their final year of life. The frequency and type of services used can be affected by demographic and clinical factors. For example, some people have no contact with the health system in the 12 months before their death. These tend to be healthy young people and people who die suddenly from causes such as injury. Other people have high levels of health service use. These tend to be people aged 65 and over, people with multiple comorbidities (Legler et al. 2011; Luta et al. 2020) and people who die from specific causes, such as cancer.
Some international research and research for specific states and territories in Australia have explored patterns of health service use and costs in the period before death. This study is the first large-scale analysis for a range of health services and causes of death in Australia. It provides new insights, including:
- estimates of the total health expenditure in the last year of life for 4 health services
- detailed cost estimates of these services by whether people used residential aged care (that is, permanent residential and/or respite care) in their final year
- characteristics of people who used, and did not use, health services in their final year.
The findings help fill a major evidence gap in an area with growing policy relevance in Australia. This is particularly so in the context of population growth, ageing, increased longevity, a growing economy and increased spending on health.
This study uses linked administrative data from the AIHW’s National Integrated Health Services Information Analysis Asset to examine health service use and costs for 4 main service types:
- public hospital emergency department (ED) presentations
- public (and some private) hospital admitted patient hospitalisations
- Medicare services covered by the Medicare Benefits Schedule (MBS), such as general practitioner (GP), specialist, pathology and diagnostic imaging services
- prescriptions supplied under the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS).
The average number of services used and associated costs for people in their last year of life were estimated by age, sex, service type, cause of death and use of residential aged care services. Findings were compared to the average number of services used and associated costs in a single year for people not in their last year of life. The study period was between 1 July 2010 and 31 December 2017 for people in their last year of life and between 1 July 2010 and 31 December 2016 for people not in their last year of life. See Study background for more information on the NIHSI AA and the study methods.
Residential aged care services and associated costs are not included in this analysis. Rather, health service use and costs for people who used residential aged care services (permanent residential and/or respite care) at any point in their last year of life are compared with those who did not use such care in their last year. However, it is acknowledged that aged care services provide essential care and support to many people in their last year of life. In 2020–21, the Australian Government and state and territory governments spent over $23.6 billion on aged care, with the largest proportion (60%) spent on residential aged care (AIHW 2022b). Further work is needed to examine what proportion of aged care costs are for people in their last year of life.
AIHW (Australian Institute of Health and Welfare) (2022a) Deaths in Australia, AIHW, Australian Government, accessed 9 June 2022.
AIHW (2022b) GEN Aged Care Data: Spending on aged care, AIHW, Australian Government, accessed 18 May 2022.
Legler A, Bradley EH and Carlson MDA (2011) ‘The effect of comorbidity burden on health care utilization for patients with cancer using hospice’, Journal of Palliative Medicine, 14(6): 751–756, doi: 10.1089/jpm.2010.0504.
Luta X, Diernberger K, Bowden J, Droney J, Howden D, Schmidlin K, Rodwin V, Hall P and Marti J (2020) ‘Healthcare trajectories and costs in the last year of life: a retrospective primary care and hospital analysis’, BMJ Supportive & Palliative Care, 0:1–9, doi: 10.1136/ bmjspcare-2020-002630.