Priceless? The value of health care at the end of life

How many of the medical treatments at the end of life have little benefit? How much should life-prolonging measures be allowed to cost? And what do people in Switzerland think about the cost and value of life-prolonging measures? These are difficult questions that society must face, for up to one-fourth of all health care costs are incurred shortly before death. In addition, it can be expected that medical advances and more intensive treatments will continue to increase the costs in the last phase of life. Due to the aging population, there is a fear that health care expenditures will one day be no longer sustainable and that this could lead to health care rationing, which is a sensitive issue.

This project will conduct an experiment on the preferences of 1,000 randomly selected persons. It will deliver information on whether society is in favour of defining a ceiling on health care expenditures shortly before death and on how high it might be. The participants will be presented with insurance models that differ in, for example, their exclusion of especially expensive medications for serious illnesses. Based on the participants’ decisions, we will derive the willingness to pay for health care expenditures of predefined demographic groups and the Swiss population as a whole. In addition, the research team will examine the costs of over 70,000 deceased persons in their last year of life with regard to typical patterns of dying (such as costs connected with accidents, brief illnesses, chronic diseases) and then determine how the percentages of these patterns of dying have changed over time. This will provide an indication of whether medical care of the dying has increased in recent years or whether elderly people today are in a better state of health shortly before death. For assessing future health care expenditures, both of these findings are important factors.

The results of this study will underpin the debate on the value and benefits of expensive health care measures at the very end of life. They might also be used in compiling guidelines to help the prevention of hidden rationing.

Unbezahlbar? Der Wert des Lebens und die Kosten am Lebensende aus gesellschaftlicher Sicht / Do high health care expenditures at end of life reflect preferences of the Swiss population?