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The magnitude, share and determinants of unpaid care costs for home‐based palliative care service provision in T oronto, C anada
Author(s) -
Chai Huamin,
Guerriere Denise N.,
Zagorski Brandon,
Coyte Peter C.
Publication year - 2014
Publication title -
health and social care in the community
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.984
H-Index - 68
eISSN - 1365-2524
pISSN - 0966-0410
DOI - 10.1111/hsc.12058
Subject(s) - palliative care , service (business) , business , nursing , gerontology , demographic economics , medicine , economics , marketing
With increasing emphasis on the provision of home‐based palliative care in C anada, economic evaluation is warranted, given its tremendous demands on family caregivers. Despite this, very little is known about the economic outcomes associated with home‐based unpaid care‐giving at the end of life. The aims of this study were to (i) assess the magnitude and share of unpaid care costs in total healthcare costs for home‐based palliative care patients, from a societal perspective and (ii) examine the sociodemographic and clinical factors that account for variations in this share. One hundred and sixty‐nine caregivers of patients with a malignant neoplasm were interviewed from time of referral to a home‐based palliative care programme provided by the T emmy L atner C entre for P alliative C are at M ount S inai H ospital, T oronto, C anada, until death. Information regarding palliative care resource utilisation and costs, time devoted to care‐giving and sociodemographic and clinical characteristics was collected between J uly 2005 and S eptember 2007. Over the last 12 months of life, the average monthly cost was $14 924 (2011 CDN$) per patient. Unpaid care‐giving costs were the largest component – $11 334, accounting for 77% of total palliative care expenses, followed by public costs ($3211; 21%) and out‐of‐pocket expenditures ($379; 2%). In all cost categories, monthly costs increased exponentially with proximity to death. Seemingly unrelated regression estimation suggested that the share of unpaid care costs of total costs was driven by patients' and caregivers' sociodemographic characteristics. Results suggest that overwhelming the proportion of palliative care costs is unpaid care‐giving. This share of costs requires urgent attention to identify interventions aimed at alleviating the heavy financial burden and to ultimately ensure the viability of home‐based palliative care in future.