Rural and Urban Disparities in Healthcare Utilization and Cost at the End-of-Life in Quebec: A Retrospective Study

Area of Science:

• Health Services Research
• Gerontology
• Public Health

Background:

• End-of-life (EoL) care involves significant healthcare utilization and costs.
• Regional healthcare availability may influence EoL care disparities.
• Understanding rural vs. urban differences in EoL care is crucial.

Purpose of the Study:

• To describe rural and urban disparities in healthcare utilization.
• To analyze variations in healthcare costs during the last year of life.
• To examine these disparities among older Quebec residents.

Main Methods:

• Retrospective cohort study of individuals aged 66+ who died between 2014-2018.
• Included data on medical visits, emergency care, hospitalizations, community, and long-term care (LTC).
• Analyzed costs (total, health-related, social) and service utilization across urban, mid-urban, mid-rural, and rural regions.

Main Results:

• Service utilization varied, with higher use in LTC and community care across regions.
• Social costs, primarily from LTC, were nearly double health-related costs.
• Cost differences were mainly due to utilization, not higher fees, with limited primary care variations.

Conclusions:

• Urban regions sometimes exhibited higher service use and costs, but this pattern was not universal.
• Rural regions were not consistently associated with lower utilization or costs.
• Factors beyond urbanization, like individual needs and healthcare offer, are key to understanding EoL service use and costs.