Heterogeneity in end of life health care expenditure trajectory profiles

Panagiotis Kasteridis, Nigel Rice*, Rita Santos

*Corresponding author for this work

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Treatment at the end of life forms a major component of aggregate health care expenditure. Expenditure, however, begins to increase several years before death and varies substantially across individuals. This paper investigates heterogeneity in expenditure profiles across a 36 month period preceding death using group-based trajectory models. A mixture of generalised linear models with four components fits the data best, and identifies decedents in to high cost late rise, medium-high cost late rise, medium-low cost, and low cost late rise expenditure profiles. Approximately 35% of the sample is allocated to the high cost late rise trajectory with average monthly expenditure of £493 36 months prior to death rising linearly for about 28 months before exponential growth to £4,000 in the month preceding death. Health conditions at the beginning of the period increase the risk of being in a higher cost trajectory with cancer having the largest impact. The existence of concurrent morbidities substantially raises the probability of membership to the high-cost late rise profile group. A better understanding of the determinants of expenditure profiles in the run up to death contributes to informing policies aimed at mitigating costs while not compromising quality of care.
Original languageEnglish
Pages (from-to)221-251
Number of pages32
JournalJournal of Economic Behavior and Organization
Early online date27 Oct 2022
Publication statusE-pub ahead of print - 27 Oct 2022

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