Abstract
BackgroundRapidly ageing populations means that many people now die in advanced age. This paper investigated public hospital and long-term care home costs in the 12 months before death in Māori and non-Māori of advanced age in New Zealand.MethodsData from an existing longitudinal study (LiLACS NZ) was used, in which 937 older New Zealanders were enrolled in 2010. At the time of this study, 213 Māori and 241 non-Māori in the cohort had died. National Health Index numbers were linked to the hospitalisation National Minimum Dataset to ascertain public hospitalisation and care home costs in the last year of life.ResultsThe average total publicly funded hospital and long-term care home costs in the 12 months prior to death were $16,211 and $17,351 for Māori and non-Māori respectively. Non-Māori tended to have long lengths of stay in their last year of life, and non-Māori men had the highest proportion with high costs and long lengths of stay in care homes. Costs in the last year of life were 8.1 times higher in comparison to costs for individuals who did not die in the same time period.ConclusionDespite New Zealand’s commitment to providing an equitable level of healthcare, this study illustrated that ethnic and gender disparities are still apparent at the end of life. This raises questions as to whether money at the end of life is being spent appropriately, and how it could potentially be more equitably targeted to meet the diverse needs of older people and their families.
Highlights
Ageing populations means that many people die in advanced age
Population and data sources This paper draws on data from an existing longitudinal study in New Zealand (LiLACS NZ), as well as data from matching participants National Health Index (NHI) numbers to the hospitalisation National Minimum Dataset (NMDS) held by the Ministry of Health (MoH)
Within ethnic group comparisons show costs were higher for non-Māori men than non-Māori women, and costs were lower for non-Māori who lived alone
Summary
Ageing populations means that many people die in advanced age. Ageing populations means that many people die in advanced age, and the number of deaths in advanced age is projected to increase substantially over the coming decades in most countries [1]. There is evidence that the inverse care law applies at the end of life, meaning that people most in need of care often miss out [2]. This pattern of care is determined in no small part by social determinants such as cultural and ethnic affiliation, gender, and socioeconomic status [2].
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