Abstract
BackgroundAn accurate understanding of the current state of end-of-life care is important for healthcare planning. The objectives of this study were to examine the trajectories of end-of-life medical and long-term care expenditures and associated factors.MethodsThis was a retrospective longitudinal study using a large-scale linked database of medical and long-term care claims—National Health Insurance, Advanced Elderly Medical Insurance, and long-term care insurance—covering Prefecture A in Japan. Patients aged ≥70 years who died between April 1, 2016, and March 31, 2017, were included (N = 16,084 patients; mean age = 85.1 ± 7.5 years; 7804 men (48.5%) and 8280 women (51.5%)). The outcome measures were medical expenditures (inpatient, outpatient, and prescription), long-term care expenditures, and total healthcare expenditures (the sum of medical and long-term care expenditures) during the 60 months before the date of death. We calculated each patient’s monthly medical and long-term care expenditures for 60 months before the date of death and applied group-based trajectory modeling to identify distinct trajectories. Factors associated with spending trajectories were examined via multinomial logistic regression analyses. Explanatory variables included age, sex, diseases, and the medical services used.ResultsWe identified six distinct spending trajectories for the total healthcare expenditures: high persistent (45.6%), medium-to-high persistent (26.1%), early rise then high persistent (9.8%), late rise (6.4%), low persistent then very late rise (i.e., when spending starts increasing later than “late rise”; 6.4%), and progressive increase (5.7%). Factors associated with the high-persistent trajectory were chronic illnesses, various organ failures, neurodegenerative diseases, fractures, and tube feeding. The trajectory pattern of medical expenditures was similar to that of total healthcare expenditures; however, a different pattern was seen for long-term care expenditures.ConclusionsRegarding combined medical and long-term care spending of the last 5 years, most patients belonged to a pattern in which the healthcare expenditures remained high, and a combination of multiple factors contributed to these patterns. This finding can offer healthcare providers a longer-term perspective on end-of-life care.
Highlights
An accurate understanding of the current state of end-of-life care is important for healthcare planning
Regarding combined medical and long-term care spending of the last 5 years, most patients belonged to a pattern in which the healthcare expenditures remained high, and a combination of multiple factors contributed to these patterns
Patients with high-persistent spending trajectories in medical expenditures belonged to high spending trajectories and low spending trajectories in long-term care expenditures almost
Summary
An accurate understanding of the current state of end-of-life care is important for healthcare planning. Because Japan has the highest rate of aging in the world and is the fastest aging country, the size of its end-of-life population is increasing This increase is being recognized as a social issue, termed the arrival of the “frequent death society.” [1] the number of deaths per year in Japan is estimated to peak around 2040, with an estimated increase of 360,000 deaths between 2015 and 2040. In 2018, 75.8% of deaths occurred in individuals ≥75 years of age and 47.6% in individuals ≥85 years of age [2] These demographic changes are placing pressure on Japan’s end-of-life care, and responses to these pressures are needed in various sectors, especially healthcare [1]. To ensure future system sustainability, the allocation of resources to end-of-life care and the management of quality are recognized as urgent social issues for insurers and healthcare providers [3]
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