Patterns of health care use and expenditure during the last 6 months of life in Belgium: differences between age categories in cancer and non-cancer patients

Abstract

Objectives: We analysed end-of-life care in Belgium to examine potential age variation in place of death, transitions between care settings, health care utilisation and public expenditure in the last 6 months of life.

Methods: Administrative data of one sickness fund were used, and analysed through regression analysis and analysis of variance. The study population comprised 40,794 individuals (age>40 years).

Results: Several indicators showed that the end-of-life of older people, especially of those aged >or=90 years, differs from that of younger individuals. Older persons more likely died in a care home, were less transferred between care settings, and stayed less days in hospital. On the other hand, older persons used more home care services, and had more contacts with the general practitioner. Differences between age categories were equally observed for last week's end-of-life care. Opposite to the trend for cancer patients, the odds of having a palliative home care allowance increased with age for non-cancer patients. Public expenditure for the oldest old was lower as compared to the younger decedents, but dependent on place of death.

Conclusion: Several aspects of end-of-life care in Belgium appear to be influenced by age. In view of ageing of the population, these findings can be of interest to decision makers.