The healthcare cost of dying: a population-based retrospective cohort study of the last year of life in Ontario, Canada

Background — Coordinated and appropriate healthcare across sectors is an ongoing challenge, especially at the end of life. Population-level data on end-of-life healthcare use and cost, however, are seldom reported across a comprehensive array of sectors. Such data will identify the level of care being provided and areas where care can be optimized.

Methods — This retrospective cohort study identified all deaths in Ontario from April 1, 2010 to March 31, 2013. Using population-based health administrative databases, the researchers examined healthcare use and cost in the last year of life.

Results — Among 264,755 decedents, the average healthcare cost in the last year of life was $53,661 (Quartile 1–Quartile 3: $19,568–$66,875). The total captured annual cost of $4.7 billion represents approximately 10% of all government-funded healthcare. Inpatient care, incurred by 75% of decedents, contributed 42.9% of total costs ($30,872 per user). Physician services, medications/devices, laboratories, and emergency rooms combined to less than 20% of total cost. About one-quarter used long-term-care and 60% used home care ($34,381 and $7,347 per user, respectively). Total cost did not vary by sex or neighborhood income quintile, but were less among rural residents. Costs rose sharply in the last 120 days prior to death, predominantly for inpatient care.

Interpretation — This analysis adds new information about the breadth of end-of-life healthcare, which consumes a large proportion of Ontario’s healthcare budget. The cost of inpatient care and long-term care are substantial. Introducing interventions that reduce or delay institutional care will likely reduce costs incurred at the end of life.