Heterogeneity in end of life health care expenditure trajectory profiles

Panagiotis Kasteridis, Nigel Rice and Rita Santos

Journal of Economic Behavior & Organization, 2022, vol. 204, issue C, 221-251

Abstract: Treatment at the end of life forms a major component of aggregate health care expenditure. Expenditure, however, begins to increase several years before death and varies substantially across individuals. This paper investigates heterogeneity in expenditure profiles across a 36 month period preceding death using group-based trajectory models. A mixture of generalised linear models with four components fits the data best, and identifies decedents in to high cost late rise, medium-high cost late rise, medium-low cost, and low cost late rise expenditure profiles. Approximately 35% of the sample is allocated to the high cost late rise trajectory with average monthly expenditure of £493 36 months prior to death rising linearly for about 28 months before exponential growth to £4000 in the month preceding death. Health conditions at the beginning of the period increase the risk of being in a higher cost trajectory with cancer having the largest impact. The existence of concurrent morbidities substantially raises the probability of membership to the high-cost late rise profile group. A better understanding of the determinants of expenditure profiles in the run up to death contributes to informing policies aimed at mitigating costs while not compromising quality of care.

Keywords: End of life; Health care expenditure; Group-based trajectory models; Panel data; Mixture models (search for similar items in EconPapers)
JEL-codes: C33 C38 C46 I12 J14 J24 (search for similar items in EconPapers)
Date: 2022
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Persistent link: https://EconPapers.repec.org/RePEc:eee:jeborg:v:204:y:2022:i:c:p:221-251

DOI: 10.1016/j.jebo.2022.10.017

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