Rural and urban disparities in healthcare utilization and cost at the end‐of‐life in Quebec

BACKGROUND: The end-of-life (EoL) is a critical period as individuals can face multiple health problems, increasing healthcare utilization and cost. Knowing that regional healthcare availability may contribute to some variations, we aimed to describe rural and urban disparities in healthcare utilization and costs during the last year of life among Quebec residents aged 66 years or older. METHODS: We used a retrospective cohort of individuals who died between April 1, 2014 and March 31, 2018. Data included medical visits, emergency visits, hospitalizations, community care, and long-term care (LTC). Costs were extracted from administrative databases or financial reports and used to estimate total, health-related and social individual costs. Regions of residence were categorized as urban, mid-urban, mid-rural and rural. Generalized linear models were employed to examine variations in service utilization and cost. RESULTS: The cohort comprised 21,117 individuals. Service utilization was generally higher for most health-related than social services. Regional differences in utilization were limited in primary care but variations were observed for LTC and community care. Conversely, average social costs, mostly driven by LTC, nearly doubled health-related costs. Additionally, costs differences between regions were mostly driven by increased utilization rather than higher fees. CONCLUSION: Some urban regions showed higher levels of service use and associated costs. However, this was not uniformly observed across all urban regions, nor were rural regions consistently associated with lower utilization or costs. Factors beyond urbanization level, such as individual healthcare needs, population characteristics or healthcare offer, are critical to understanding EoL service use and costs

Health care · Healthcare service · Population · Retrospective cohort study · Rural area · Service (business) · Urbanization · Geriatric Care and Nursing Homes · Health Systems, Economic Evaluations, Quality of Life · Palliative Care and End-of-Life Issues

• Patterns of Functional Decline at the End of Life

  June R Lunney•JAMA•2003

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