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Recent studies indicate that approaching death, rather than age, may be the main demographic driver of health care costs. Using a 29-year longitudinal English dataset, this paper uses more robust methods to examine the effects of age and proximity to death on hospital costs. A random effects panel data two-part model shows that approaching death affects costs up to 15 years prior to death. The large tenfold increase in costs from 5 years prior to death to the last year of life overshadows the 30% increase in costs from age 65 to 85. Hence, expenditure projections must consider remaining life expectancy in the populations.

Original publication





J Health Econ

Publication Date





217 - 235


Age Distribution, Aged, Aged, 80 and over, Death, Death Certificates, England, Female, Health Expenditures, Hospital Costs, Humans, Length of Stay, Life Tables, Longitudinal Studies, Male, Models, Econometric, Probability, Terminal Care, Time Factors, Wales