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Differences in out-of-pocket costs of healthcare in the last year of life of older people in 13 European countries

(2017) PALLIATIVE MEDICINE. 31(1). p.42-52
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Abstract
Background: Research on the costs of healthcare provision has so far focused on insurer costs rather than out-of-pocket costs. Out-of-pocket costs may be important to patients making medical decisions. Aim: To investigate the self-reported out-of-pocket costs associated with healthcare in the last year of life of older adults in Europe. Design: A post-death survey, part of the Survey of Health, Ageing, and Retirement in Europe, completed by proxy respondents in four waves from 2005 to 2012. Setting/participants: Proxy respondents for 2501 deceased adults of 55years or over. Data from 13 European countries and four waves from 2005 to 2012 were used. Results: The proportion of people with out-of-pocket costs ranged from 21% to 96% in different European Union countries. Out-of-pocket costs ranged from 2% to 25% of median household income. Secondary and institutional care was most often the largest contributor to out-of-pocket costs, with care received in a care home being the most expensive type of care in 11 of 13 countries. Multilevel analyses showed that limitations in more than two activities of daily living (coefficient=6.47, 95% confidence interval=1.81-11.14) and a total hospitalization time of 3-6months (coefficient=14.66; 95% confidence interval=0.97-28.35) or more than 6months (coefficient=31.01; 95% confidence interval=11.98-50.15) were associated with higher out-of-pocket costs. In total, 24% of the variance on a country level remained unexplained. Conclusion: Variation in out-of-pocket costs for healthcare in the last year of life between European countries indicates that countries face different challenges in making healthcare in the last year of life affordable for all.
Keywords
End-of-life, costs, international perspectives, healthcare, out-of-pocket costs, health expenditures, MEDICARE PAYMENTS, END, TRENDS, EXPERIENCE, CANCER, DEATH

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Citation

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Chicago
Penders, Yolanda WH, Judith Rietjens, GWENDA ALBERS, Simone Croezen, and Lieve Van den Block. 2017. “Differences in Out-of-pocket Costs of Healthcare in the Last Year of Life of Older People in 13 European Countries.” Palliative Medicine 31 (1): 42–52.
APA
Penders, Y. W., Rietjens, J., ALBERS, G., Croezen, S., & Van den Block, L. (2017). Differences in out-of-pocket costs of healthcare in the last year of life of older people in 13 European countries. PALLIATIVE MEDICINE, 31(1), 42–52.
Vancouver
1.
Penders YW, Rietjens J, ALBERS G, Croezen S, Van den Block L. Differences in out-of-pocket costs of healthcare in the last year of life of older people in 13 European countries. PALLIATIVE MEDICINE. 2017;31(1):42–52.
MLA
Penders, Yolanda WH, Judith Rietjens, GWENDA ALBERS, et al. “Differences in Out-of-pocket Costs of Healthcare in the Last Year of Life of Older People in 13 European Countries.” PALLIATIVE MEDICINE 31.1 (2017): 42–52. Print.
@article{8513273,
  abstract     = {Background: Research on the costs of healthcare provision has so far focused on insurer costs rather than out-of-pocket costs. Out-of-pocket costs may be important to patients making medical decisions. 
Aim: To investigate the self-reported out-of-pocket costs associated with healthcare in the last year of life of older adults in Europe. 
Design: A post-death survey, part of the Survey of Health, Ageing, and Retirement in Europe, completed by proxy respondents in four waves from 2005 to 2012. 
Setting/participants: Proxy respondents for 2501 deceased adults of 55years or over. Data from 13 European countries and four waves from 2005 to 2012 were used. 
Results: The proportion of people with out-of-pocket costs ranged from 21\% to 96\% in different European Union countries. Out-of-pocket costs ranged from 2\% to 25\% of median household income. Secondary and institutional care was most often the largest contributor to out-of-pocket costs, with care received in a care home being the most expensive type of care in 11 of 13 countries. Multilevel analyses showed that limitations in more than two activities of daily living (coefficient=6.47, 95\% confidence interval=1.81-11.14) and a total hospitalization time of 3-6months (coefficient=14.66; 95\% confidence interval=0.97-28.35) or more than 6months (coefficient=31.01; 95\% confidence interval=11.98-50.15) were associated with higher out-of-pocket costs. In total, 24\% of the variance on a country level remained unexplained. 
Conclusion: Variation in out-of-pocket costs for healthcare in the last year of life between European countries indicates that countries face different challenges in making healthcare in the last year of life affordable for all.},
  author       = {Penders, Yolanda WH and Rietjens, Judith and ALBERS, GWENDA and Croezen, Simone and Van den Block, Lieve},
  issn         = {0269-2163},
  journal      = {PALLIATIVE MEDICINE},
  keyword      = {End-of-life,costs,international perspectives,healthcare,out-of-pocket costs,health expenditures,MEDICARE PAYMENTS,END,TRENDS,EXPERIENCE,CANCER,DEATH},
  language     = {eng},
  number       = {1},
  pages        = {42--52},
  title        = {Differences in out-of-pocket costs of healthcare in the last year of life of older people in 13 European countries},
  url          = {http://dx.doi.org/10.1177/0269216316647206},
  volume       = {31},
  year         = {2017},
}

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