Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2013

Open Access 01-12-2013 | Research article

Place of death and health care utilization for people in the last 6 months of life in Switzerland: a retrospective analysis using administrative data

Authors: Oliver Reich, Andri Signorell, André Busato

Published in: BMC Health Services Research | Issue 1/2013

Login to get access

Abstract

Background

There is a growing interest in examining the current state of care and identifying opportunities for improving care and reducing costs at the end of life. The aim of this study is to examine patterns of health care use at the end of life and place of death and to describe the basic characteristics of the decedents in the last six months of their life.

Methods

The empirical analysis is based on data from 58,732 Swiss residents who died between 2007 and 2011. All decedents had mandatory health insurance with Helsana Group, the largest health insurer in Switzerland. Descriptive statistical techniques were used to provide a general profile of the study population and determinants of the outcome for place of death were analyzed with an econometric approach.

Results

There were substantial and significant differences in health care utilization in the last six months of life between places of death. The mean numbers of consultations with a general practitioner or a specialist physician as well as the number of different medications and the number of hospital days was consistently highest for the decedents who died in a hospital. We found death occurred in Switzerland most frequently in hospitals (38.4% of all cases) followed by nursing homes (35.1%) and dying at home (26.6%). The econometric analysis indicated that the place of death is significantly associated with age, sex, region and multiple chronic conditions.

Conclusions

The importance of nursing homes and patients’ own homes as place of death will continue to grow in the future. Knowing the determinants of place of death and patterns of health care utilization of decedents can help decision makers on the allocation of these needed health care services in Switzerland.
Appendix
Available only for authorised users
Literature
1.
Lubitz JD, Riley GF: Trends in Medicare payments in the last year of life. N Engl J Med. 1993, 328: 1092-1096. 10.1056/NEJM199304153281506.CrossRefPubMed
2.
Madsen J, Serup-Hansen N, Kristiansen IS: Future health care costs—do health care costs during the last year of life matter?. Health Policy. 2002, 62 (2): 161-172. 10.1016/S0168-8510(02)00015-5.CrossRefPubMed
3.
Hoover DR, Crystal S, Kumar R, Sambamoorthi U, Cantor JC: Medical Expenditures during the Last Year of Life: Findings from the 1992–1996 Medicare Current Beneficiary Survey. Health Serv Res. 2002, 37 (6): 1625-1642. 10.1111/1475-6773.01113.CrossRefPubMedPubMedCentral
4.
Felder S, Meier M, Schmitt H: Health care expenditure in the last months of life. J Health Econ. 2000, 9 (5): 679-695.CrossRef
5.
Hogan C, Lunney J, Gabel J, Lynn J: Medicare Beneficiaries’ Costs Of Care In The Last Year Of Life. Health Aff. 2001, 20 (4): 188-195. 10.1377/hlthaff.20.4.188.CrossRef
6.
Polder JJ, Barendregt JJ, van Oers H: Health care cost in the last year of life – The Dutch experience. Soc Sci Med. 2006, 63 (7): 1720-1731. 10.1016/j.socscimed.2006.04.018.CrossRefPubMed
7.
Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL: The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003, 138 (4): 273-287.CrossRefPubMed
8.
Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL: The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003, 138 (4): 288-298.CrossRefPubMed
9.
Fisher ES, Wennberg JE: Health care quality, geographic variations, and the challenge of supply-sensitive care. Perspect Biol Med. 2003, 46: 69-79. 10.1353/pbm.2003.0004.CrossRefPubMed
10.
Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ: Variations in the longitudinal efficiency of academic medical centers. Health Aff. 2004, 10.1377/hlthaff.var.19.
11.
Barnato AE, Herndon MB, Anthony DL, Gallagher PM, Skinner JS, Bynum JP, Fisher ES: Are regional variations in end-of-life care intensity explained by patient preferences? A Study of the US Medicare Population. Med Care. 2007, 45 (5): 386-393. 10.1097/01.mlr.0000255248.79308.41.CrossRefPubMedPubMedCentral
12.
Barnato AE, Chang CC, Farrell MH, Lave JR, Roberts MS, Angus DC: Is survival better at hospitals with higher “end-of-life” treatment intensity?. Med Care. 2010, 48 (2): 125-132. 10.1097/MLR.0b013e3181c161e4.CrossRefPubMedPubMedCentral
13.
Wetizen S, Teno JM, Fennell M, Mor V: Factors associated with site of death: a national study of where people die. Med Care. 2003, 41 (2): 323-335.
14.
Klinkenberg M, Visser G, van Groenou MI, van der Wal G, Deeg DJ, Willems DL: The last 3 months of life: care, transitions and the place of death of older people. Health Soc Care Community. 2005, 13 (5): 420-430. 10.1111/j.1365-2524.2005.00567.x.CrossRefPubMed
15.
Gruneir A, Mor V, Weitzen S, Truchil R, Teno J, Roy J: Where People Die. A Multilevel Approach to Understanding Influences on Site of Death in America. Medical Care Research and Review. 2007, 64 (4): 351-378. 10.1177/1077558707301810.CrossRefPubMed
16.
Houttekier D, Cohen J, Bilsen J, Deboosere P, Verduyckt P, Deliens L: Determinants of the place of death in the Brussels metropolitan region. J Pain Symptom Manage. 2009, 37 (6): 996-1005. 10.1016/j.jpainsymman.2008.05.014.CrossRefPubMed
17.
Houttekier D, Cohen J, Bilsen J, Addington-Hall J, Onwuteaka-Philipsen B, Deliens L: Place of death in metropolitan regions: metropolitan versus non-metropolitan variation in place of death in Belgium, The Netherlands and England. Health Place. 2010, 16 (1): 132-139. 10.1016/j.healthplace.2009.09.005.CrossRefPubMed
18.
Gomes B, Calanzani N, Higginson IJ: Reversal of the British trends in place of death: Time series analysis 2004–2010. Palliat Med. 2012, 26 (2): 102-107. 10.1177/0269216311432329.CrossRefPubMed
19.
Levinsky NG, Yu W, Ash A, Moskowitz M, Gazelle G, Saynina O, Emanuel EJ: Influence of Age on Medical Expenditures and Medical Care in the Last Year of Life. JAMA. 2001, 286 (11): 1349-1355. 10.1001/jama.286.11.1349.CrossRefPubMed
20.
Seshamani M, Gray AM: A longitudinal study of the effects of age and time to death on hospital costs. J Health Econ. 2004, 23 (2): 217-235. 10.1016/j.jhealeco.2003.08.004.CrossRefPubMed
21.
Shang B, Goldman D: Does age or life expectancy better predict health care expenditures. Health Econ. 2008, 17 (4): 487-501. 10.1002/hec.1295.CrossRefPubMed
22.
Palangkaraya A, Yong J: Population ageing and its implications on aggregate health care demand: empirical evidence from 22 OECD countries. Int J Health Care Finance Econ. 2009, 9 (4): 391-402. 10.1007/s10754-009-9057-3.CrossRefPubMed
23.
Shugarman LR, Decker SL, Bercovitz A: Demographic and Social Characteristics and Spending at the End of Life. J Pain Symptom Manage. 2009, 38 (1): 15-26. 10.1016/j.jpainsymman.2009.04.004.CrossRefPubMed
24.
Bech M, Christiansen T, Khoman E, Lauridsen J, Weale M: Ageing and health care expenditure in EU-15. Eur J Health Econ. 2011, 12 (5): 469-478. 10.1007/s10198-010-0260-4.CrossRefPubMed
25.
Zweifel P, Felder S, Meiers M: Ageing of population and health care expenditure: a red herring?. Health Econ. 1999, 8 (6): 485-496. 10.1002/(SICI)1099-1050(199909)8:6<485::AID-HEC461>3.0.CO;2-4.CrossRefPubMed
26.
Werblow A, Felder S, Zweifel P: Population ageing and health care expenditure: a school of ‘red herrings’?. Health Econ. 2007, 16 (10): 1109-1126. 10.1002/hec.1213.CrossRefPubMed
27.
Felder S, Werblow A, Zweifel P: Do red herrings swim in circles? Controlling for the endogeneity of time to death. J Health Econ. 2010, 29: 205-212. 10.1016/j.jhealeco.2009.11.014.CrossRefPubMed
28.
Wong A, van Baal PH, Boshuizen HC, Polder JJ: Exploring the influence of proximity to death on disease-specific hospital expenditures: a carpaccio of red herrings. Health Econ. 2011, 20 (4): 379-400. 10.1002/hec.1597.CrossRefPubMed
29.
Bjorner TB, Amberg S: Terminal costs, improved life expectancy and future public health expenditure. Int J Health Care Fin Econ. 2012, 12 (2): 129-143. 10.1007/s10754-012-9106-1.CrossRef
30.
Goodridge D, Lawson J, Rennie D, Marciniuk D: Rural/urban differences in health care utilization and place of death for persons with respiratory illness in the last year of life. Rural Remote Heal. 2010, 10: 1349.
31.
Kaplan RM: Variation between End-of-Life Health Care Costs in Los Angeles and San Diego: Why Are They So Different?. J Palliat Med. 2011, 14 (2): 215-220. 10.1089/jpm.2010.0285.CrossRefPubMedPubMedCentral
32.
Kelley AS, Ettner SL, Morrison S, Du Q, Wenger NS, Sarkisian CA: Determinants of Medical Expenditures in the Last 6 Months of Life. Ann Intern Med. 2011, 154: 235-242.CrossRefPubMedPubMedCentral
33.
Madden P, Couplan V, Moller H, Davies E: Using maps and funnel plots to explore variation in place of death from cancer within London, 2002–2007. Palliat Med. 2011, 25 (4): 323-332. 10.1177/0269216311398700.CrossRefPubMed
34.
35.
Colombier C, Weber W: Projecting health-care expenditure for Switzerland: further evidence against the ‘red-herring’ hypothesis. Int J Health Plann Manage. 2011, 26 (3): 246-263. 10.1002/hpm.1068.CrossRefPubMed
36.
Fischer S, Bosshard G, Zellweger U, Faisst K: Der Sterbeort: “Wo sterben die Menschen heute in der Schweiz?”. Z Gerontol Geriat. 2004, 37 (6): 467-474. 10.1007/s00391-004-0216-3.CrossRef
37.
Fischer S, Bosshard G, Faisst K, Tschopp A, Fischer J, Bär W, Gutzwiller F: Swiss doctors’ attitudes towards end-of-life decisions and their determinants: a comparison of three language regions. Swiss Med Wkly. 2006, 136 (23–24): 370-376.PubMed
38.
Cohen J, Bilsen J, Fischer S, Löfmark R, Norup M, van der Heide A, Miccinesi G, Deliens L: End-of-life decision-making in Belgium, Denmark, Sweden and Switzerland: does place of death make a difference?. J Epidemiol Community Health. 2007, 61 (12): 1062-1068. 10.1136/jech.2006.056341.CrossRefPubMedPubMedCentral
39.
Lamers LM, Van Vliet RCJA: The Pharmacy-based Cost Group model: validating and adjusting the classification of medications for chronic conditions to the Dutch situation. Health Policy. 2003, 68 (1): 113-121.CrossRef
40.
Beck K: Eine empirische Analyse des Krankheitsrisikos. Risiko Krankenversicherung - Risikomanagement in einem regulierten Krankenversicherungsmarkt. 2011, Bern: Haupt Verlag, 78-79. 2
41.
Higginson IJ, Sen-Gupta GJ: Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med. 2000, 3 (3): 287-300. 10.1089/jpm.2000.3.287.CrossRefPubMed
42.
Gomes B, Higginson IJ, Calanzani N, Cohen J, Deliens L, Daveson BA, Bechinger-English D, Bausewein C, Ferreira PL, Toscani F, Menaca A, Gysels M, Ceulemans L, Simon ST, Pasman HRW, Albers G, Hall S, Murtagh FEM, Haugen DF, Downing J, Koffman J, Pettenati F, Finetti S, Antunes B, Harding R: Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Ann Oncol. 2012, 23 (8): 2006-2015. 10.1093/annonc/mdr602.CrossRefPubMed
43.
Gielen B, Remacle A, Mertens R: Patterns of healthcare use and expenditure during the last 6 months of life in Belgium: Differences between age categories in cancer and non-cancer patients. Health Policy. 2010, 97 (1): 53-61. 10.1016/j.healthpol.2010.03.002.CrossRefPubMed
44.
Broad JB, Gott M, Kim H, Boyd M, Chen H, Connolly MJ: Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health. 2012, 10.1007/s00038-012-0394-5.
Metadata
Title
Place of death and health care utilization for people in the last 6 months of life in Switzerland: a retrospective analysis using administrative data
Authors
Oliver Reich
Andri Signorell
André Busato
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2013
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-13-116

Other articles of this Issue 1/2013

BMC Health Services Research 1/2013 Go to the issue

Research article

What primary health care services should residents of rural and remote Australia be able to access? A systematic review of “core” primary health care services

Research article

Factors associated to referral of tuberculosis suspects by private practitioners to community health centres in Bali Province, Indonesia

Research article

“A manager in the minds of doctors:” a comparison of new modes of control in European hospitals

Research article

The caregiving perspective in heart failure: a population based study

Research article

Diffusion of subsidized ACTs in accredited drug shops in Tanzania: determinants of stocking and characteristics of early and late adopters

Research article

The calculation of quality indicators for long term care facilities in 8 countries (SHELTER project)