RESEARCH ARTICLE The Health Care Cost of Dying: A Population- Based Retrospective Cohort Study of the Last Year of Life in Ontario, Canada

Background Coordinated and appropriate health care across sectors is an ongoing challenge, especially at the end-of-life. Population-level data on end-of-life health care use and cost, however, are seldom reported across a comprehensive array of sectors. Such data will identify the level of care being provided and areas where care can be optimized. Methods This retrospective cohort study identified all deaths in Ontario from April 1, 2010 to March 31, 2013. Using population-based health administrative databases, we examined health care use and cost in the last year of life. Results Among 264,755 decedents, the average health care cost in the last year of life was $53,661 (Quartile 1-Quartile 3: $19,568-$66,875). The total captured annual cost of $4.7 billion rep-resents approximately 10 % of all government-funded health care. Inpatient care, incurred by 75 % of decedents, contributed 42.9 % of total costs ($30,872 per user). Physician ser