Abstract
BackgroundIn contrast to individual preferences, most people in developed countries die in health care institutions, with a considerable impact on health care resource use and costs. However, evidence about determinants of aggregate length of hospital stay in the last year preceding death is scant.MethodsNationwide individual patient data from Swiss hospital discharge statistics were linked with census and mortality records from the Swiss National Cohort. We explored determinants of aggregate length of hospital stay in the last year of life in N = 35,598 inpatients ≥65 years who deceased in 2007 or 2008.ResultsThe average aggregate length of hospital stay in the last year of life was substantially longer in the German speaking region compared to the French (IRR 1.36 [95 % CI 1.32–1.40]) and Italian (IRR 1.22 [95 % CI 1.16–1.29]) speaking region of the country. Increasing age, female sex, multimorbidity, being divorced, foreign nationality, and high educational level prolonged, whereas home ownership shortened the aggregate length of hospital stay. Individuals with complementary private health insurance plans had longer stays than those with compulsory health insurance plans (IRR 1.04 [95 % CI 1.01–1.07]).ConclusionsThe aggregate length of hospital stay during the last year of life was substantially determined by regional and socio-demographic characteristics, and only partially explained by differential health conditions. Therefore, more detailed studies need to evaluate, whether these differences are based on patients’ health care needs and preferences, or whether they are supply-driven.
Highlights
In contrast to individual preferences, most people in developed countries die in health care institutions, with a considerable impact on health care resource use and costs
There was a remarkable difference between the French and the German speaking part regarding those who received intensive care unit (ICU) for >48 h (Appendix Tables 1 and 2): While this group had a significantly longer mean aggregate length of stay in the German speaking part, we found the opposite effect in the French speaking part
We found a significant effect of nursing bed density on the aggregate length of stay: high regional nursing bed density was associated with a shorter aggregate length of hospital stays during the last year of life
Summary
In contrast to individual preferences, most people in developed countries die in health care institutions, with a considerable impact on health care resource use and costs. One of the major concerns relating to demographic aging is the increasing use of health care resources by the growing number of elderly (≥65 years) and oldestold (≥80 years) patients. Previous research related to health care resource use has shown that the average cost of hospital care significantly increased with age. In Switzerland, health insurance has been compulsory since 1996 and covers, in principle, all medical treatments and diagnostics prescribed by doctors. It covers the costs of medical care provided in longterm care institutions [11]. There is, no doubt that hospital inpatient stays are more expensive than any other kind of health care and offer a large potential for cost saving
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