Sage Palliative Medicine & Chronic Care

This episode features Dr Deokhee Yi (Cicely Saunders Institute of Palliative Care, King's College London). Large variation exists in the health service use near the end of life and a 10% of patients are especially high-cost users. A high proportion of care costs in the last year of life occur in the last 3 months. Patients nearing the end of life often prefer to be cared for at home, but habitually spend much time in hospital. Our samples are from older patients with higher risks and more complex needs, having had contacts with specialist palliative care services in three countries where palliative care services are established and integrated into the health care system. In the last 3 months of life, more than 80% of the total health and social costs were attributable to hospital care and the costs of palliative care were only ~10%, despite the fact that all patients had accessed specialist palliative care and reported high satisfaction with these services. Uniquely, the authors were able to compare actual co