Health and social care near the end of life: Can policies reduce costs and improve outcomes?

Abstract

Background A key concern related to population ageing is how it will impact on health and social care use and expenditure trends. The belief that older people are more costly for health and social care systems than younger people is pervasive, and so the logic goes that having a larger share of the population at older ages may unsustainably accelerate growth in public health spending. In reality, the evidence suggests that the effects of ageing on health care costs will be modest and growth will be slow, but there will naturally be some additional care needs. Health and social care costs can nevertheless be particularly high for people near the end of life. In fact, the costs associated with end of life care largely explain why health and social care expenditures per person, on average, are higher for older people than for younger people, since most people die at older ages. Methods Literature review of patterns of service use and costs of care at the end of life; how needs for end of life care are likely to change with population ageing; and effects of end of life care interventions on patterns and costs of care. Results The evidence suggests that costs near the end of life vary greatly, and high overall costs are driven by service use by a small proportion of decedents. Conclusions Although the numbers of people with needs for palliative and end of life care will rise with population ageing, a review of the literature indicates that it is possible to reduce use of services and costs, and to improve patient experiences with well-designed palliative and end of life care interventions.