The health and long-term care costs in the last year of life in The Netherlands

Knowing the determinants of rising health and long-term care costs is crucial to support cost containment policies and to predict future expenditures. According to the "red herring" debate, not ageing per se, but proximity to death is the most important determinant of future expenditures. This study aims to update and expand the existing Dutch literature after two major reforms in health and long-term care. Insurance claims data from 2018-2019 of 13,738,193 insured individuals were included. Using negative binomial regression analyses, the association between deceased individuals and survivors on total health and long-term care costs was investigated, as well as per health care sector. Costs rose sharply in the two months prior to death. Regression models showed an association with total health and long-term care costs of 10.8 for deceased individuals compared with survivors (crude model) and 3.3 (adjusted model). Especially including age and chronic diseases decreased the association. The largest differences in costs between deceased individuals and survivors in the adjusted model were found for geriatric rehabilitation care and primary care stays (16.7), home nursing (10,6), and long-term care (9.3). Not just the costs of deceased individuals are important for health care costs, but also age, as measured by being in the highest age category, and chronic diseases. The costs of deceased individuals were heterogeneous across health care sectors.