Factors Associated with End-Of-Life Health Care Use and Spending in Korea in Comparison with the General Population

This study investigated the factors associated with end-of-life health care use and spending in Korea. Chronically ill decedents, who were hospitalized for one of nine chronic conditions during the year before death, were identified from the National Health Insurance Database in 2017. For comparison, the end-of-life care spending for all decedents and the annual health care spending for the general population were analyzed. The inpatient and outpatient end-of-life care spending for the chronically ill decedents were sixteen and seven times the annual inpatient and outpatient spending for the general population respectively. The regional income level was positively associated with both inpatient and outpatient spending among the decedents with a stronger association in the chronically ill decedents, while a negative association was found in the general population. No significant association was found between the inpatient spending and the number of hospital beds for the chronically ill decedents, whereas the number of beds in small to medium-sized hospitals was positively associated with inpatient spending for the total decedents and the general population. The findings suggest that hospitalization for end-of-life care depends more on the income of the patients, while the inpatient spending for total decedents and the general population are more likely to be affected by the supply of beds.