Health care services utilization and cost in the last year of life in Colombia: a retrospective study

Abstract

Introduction: Health care costs at the end of life cause a high expenditure on health care resources. The implementation of integrated palliative care programs has proven to be cost-efficient. The study aimed to analyze the consumption and cost of health care resources during the last year of life of patients who are not part of a palliative care program. Methods: A descriptive, longitudinal and retrospective study was conducted in patients of a Colombian health insurance company who died in 2013 due to pathologies that were susceptible and non-susceptible to palliative care. Causes of death were obtained from official death certificates. McNamara et al. strategy of classification was applied and adapted to assess services received during the last year of life. Analysis of costs was conducted by pathologies at different levels of care. Results: 3,392 deaths in 2013 (70% susceptible to palliative care and 30% non-susceptible to palliative care). Total health care cost: USD 47,550,155. Patients susceptible to palliative care were responsible for 84% of the year’s expenditure (the annual expenditure) (USD 40 million). There were significant differences between the average costs for susceptible and non-susceptible palliative care patients (USD 16,878 versus USD 7,433 per year, p < 0.001). The average cost per patient for the last three months of life represented 52% of the expenditure during the last year of life (USD 8,754). The last month of life was 25.6% of the expenditure during the last year of life (USD 4,324). Conclusions: Cost of care for the last three months of life of susceptible palliative care patients generates a huge health care expenditure, mainly attributable to hospital care cost. The implementation of a palliative care program could decrease these assistance costs.