Out-of-pocket expenditure at end-of-life among decedents from cardiovascular disease

BACKGROUND: Most people who develop chronic diseases, including cardiovascular disease (CVD), live in their homes in the community in their last year of life. Since cost-sharing is common in most countries, including those with universal health insurance, these people incur out-of-pocket expenditures (OOPE). The study aims to identify the prevalence and measure the size of OOPE among CVD decedents at end-of-life (EOL) explore differences among countries in OOPE, and examine whether the decedents’ characteristics or their countries’ health policy affects OOPE more. METHODS: SHARE data among people aged 50+ from seven European countries (including Israel) who died from CVD are analyzed. Decedents’ family members are interviewed to learn about OOPE on their relatives’ accounts. RESULTS: We identified 1,335 individuals who had died from CVD (average age 80.8 years, 54% men). More than half of CVD-decedent people spend OOPE on community services at EOL and their expenditure varies widely among countries. About one-third of people in France and Spain had OOPE, rising to around two-thirds in Israel and Italy and almost all in Greece. The average OOPE is € 369.3, with wide variance across countries. Significant odds of OOPE exist in the country variable only, and significant differences exist in the amount of OOPE among countries and ages. CONCLUSIONS: Since improving CVD care efficiency and effectiveness are key aims, healthcare policymakers should consider expanding public funding for community services in order to mitigate OOPE, alleviate the economic burden on households, mitigate forgoing of community services due to price, and reduce rehospitalization. The expansion of public funding of CVD community care may lower their OOP expenditure, mitigate the non-use of community services due to cost, and reduce hospital readmissions. This is important in all countries included in the study and especially so in those where OOP expenditure is highest. KEY MESSAGES: • More than half of CVD decedents spent out of pocket on community services in their last year of life. • The expansion of public funding of CVD community care may reduce hospital readmissions.