The health care cost of dying: a population-based retrospective cohort study of the last year of life in Ontario, Canada

PLoS One. 2015 Mar 26;10(3):e0121759. doi: 10.1371/journal.pone.0121759. eCollection 2015.


Background: Coordinated and appropriate health care across sectors is an ongoing challenge, especially at the end-of-life. Population-level data on end-of-life health care use and cost, however, are seldom reported across a comprehensive array of sectors. Such data will identify the level of care being provided and areas where care can be optimized.

Methods: This retrospective cohort study identified all deaths in Ontario from April 1, 2010 to March 31, 2013. Using population-based health administrative databases, we examined health care use and cost in the last year of life.

Results: Among 264,755 decedents, the average health care cost in the last year of life was $53,661 (Quartile 1-Quartile 3: $19,568-$66,875). The total captured annual cost of $4.7 billion represents approximately 10% of all government-funded health care. Inpatient care, incurred by 75% of decedents, contributed 42.9% of total costs ($30,872 per user). Physician services, medications/devices, laboratories, and emergency rooms combined to less than 20% of total cost. About one-quarter used long-term-care and 60% used home care ($34,381 and $7,347 per user, respectively). Total cost did not vary by sex or neighborhood income quintile, but were less among rural residents. Costs rose sharply in the last 120 days prior to death, predominantly for inpatient care.

Interpretation: This analysis adds new information about the breadth of end-of-life health care, which consumes a large proportion of Ontario's health care budget. The cost of inpatient care and long-term care are substantial. Introducing interventions that reduce or delay institutional care will likely reduce costs incurred at the end of life.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Health Care Costs*
  • Humans
  • Male
  • Ontario / epidemiology
  • Patient Acceptance of Health Care
  • Population Surveillance*
  • Registries
  • Retrospective Studies
  • Terminal Care / economics*

Grants and funding

The project was funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC), Health System Performance Research Network Grant. This study was also supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the MOHLTC. The views expressed in this paper are the views of the authors and do not necessarily reflect those of the funders. PT is supported through the Bruyère Center for Learning, Research and Innovation in Long-term care, and through a fellowship with the Population Health Intervention Research Network. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.