Cost of shifting from healthcare to long-term care in later life across major diseases: analysis of end-of-life care during the last 24 months of life.

Aim: To evaluate the costs associated with healthcare and long-term care during the last 24 months before death according to major disease groups. Methods: Individual data regarding healthcare and long-term care costs according to public insurance schemes during the last 24 months before death among all decedents older than 75 years reported in a city in Japan between April 1, 2010 and March 31, 2014 were identified; the data for nine major diseases were then analyzed. Results: For the 2149 decedents studied, the average healthcare costs per capita in the last 24 months of life for moderately-old (75 to 84 years) and extremely-old (85 years and older) decedents was 4,135,467 JPY and 2,493,001 JPY, respectively, while the average long-term care costs per capita for 24 months was 1,300,710 JPY and 2,723,239 JPY, respectively. The total costs (healthcare and long-term care combined) ranged from 9,169,547 JPY for chronic kidney disease to 5,023,762 JPY for ischemic heart disease. In all the diseases studied, the moderately-old decedents incurred higher healthcare costs while the extremely-old decedents incurred higher long-term care costs. However, for the care costs of chronic lower respiratory diseases, this pattern was not observed. Conclusion: A shift in expenditure from healthcare to long-term care as the decedents' age increased was observed in major diseases, with some exceptions.