Semeia, Paris, France.
AP-HP Health Economics Research Unit, Hotel Dieu Hospital, Paris, France.
Medicine (Baltimore). 2023 Aug 4;102(31):e34555. doi: 10.1097/MD.0000000000034555.
To inform policy makers on efficient provision of end-of-life care, we estimated the 12-month medical expenditures of French decedents in 2015.
We estimated total medical expenditures by service type and diagnosis category, and analyzed care pathways for breast cancer, dementia, chronic obstructive lung disease.
501,121 individuals died in 2015, 59% of whom were in a hospital at the time of death. The aggregated spending totaled 9% of total health expenditures, a mean of €28,085 per capita, 44% of which was spent during the last 3 months of life. Hospital admissions represented over 70% of total expenditures; 21.3% of the population used hospital palliative care services in their last year of life. Analyses performed on breast cancer, dementia and lung disease found that differences in care pathways markedly influenced spending and were not simply explained by patients characteristics.
Diagnoses and care trajectories, including repeated hospital stays, are the main drivers of the last year of life expenditures. Our data suggests that early identification of patients requiring palliative care and community-based end-of-life service delivery is feasible and could better support patients, families and caregivers with constant or reduced costs.
为了向政策制定者提供有关临终关怀有效提供的信息，我们估计了 2015 年法国死者的 12 个月医疗支出。
我们按服务类型和诊断类别估算了总医疗支出，并分析了乳腺癌、痴呆症、慢性阻塞性肺疾病的护理途径。
2015 年有 501121 人死亡，其中 59%的人在死亡时在医院。总支出占总卫生支出的 9%，人均支出为 28085 欧元，其中 44%在生命的最后 3 个月内支出。住院治疗占总支出的 70%以上；21.3%的人在生命的最后一年使用了医院姑息治疗服务。对乳腺癌、痴呆症和肺部疾病的分析发现，护理途径的差异明显影响了支出，而不仅仅是由患者的特征来解释。
诊断和护理轨迹，包括反复住院，是生命最后一年支出的主要驱动因素。我们的数据表明，早期识别需要姑息治疗的患者，并提供以社区为基础的临终服务是可行的，可以以更低的成本更好地支持患者、家庭和护理人员。
