Health service utilization and medical costs for in-hospital death at the end of life.

backgroundDespite comprising < 1% of the population, end-of-life (EOL) patients consume 8%–11.2% of global health expenditures. China’s aging population and limited health service urgently require cost-factor analyses. Data from 3,323 in-hospital deaths (2021–2023) were collected to explore health service utilization and medical costs at the EOL and provide evidence-based recommendations.

methodsBased on a review of medical records from 2021 to 2023 in a tertiary hospital, data from 3,323 in-hospital deaths were compiled and analyzed. Descriptive statistics were applied to summarize demographic characteristics, health service utilization, and medical costs. Multiple linear regression analysis was performed to identify influencing factors of medical costs, including both total medical expenditures and out-of-pocket payments (OOP).

resultsPatients aged ≥ 65 years accounted for 73% of in-hospital deaths and 84.5% of total medical expenditures. A positive correlation was observed between age and total medical expenditures (β = 0.002, P < 0.05), whereas a negative correlation was found with OOP payments (β = − 0.002, P < 0.05). The mean medical expenditure (64,889 yuan) was substantially higher than the 2023 public data (129,000 yuan), driven primarily by spending on pharmaceuticals (32.4%) and laboratory diagnostics (15.3%). Patients covered by urban employee insurance incurred higher total expenses, while urban-rural insurance holders experienced lower OOP burdens. Married patients exhibited greater OOP payments. Comorbidities were significant contributors to elevated total medical expenditures and OOP payments.

conclusionsChina’s rapidly aging population intensifies the challenges of EOL medical and healthcare costs and service utilization. Policymakers should implement both supply- and demand-side reforms, conduct targeted educational initiatives to foster a balanced understanding of life and death, and strengthen patient-centered approaches such as long-term care insurance, home-based palliative care, and a comprehensive management system for comorbidities. In addition, measures within hospital and medical insurance reforms should be refined, supervision and regulation should be strengthened, and the participation of communities and social organizations should be actively promoted in caring for and supporting patients at the EOL. Collectively, these strategies can enhance patients’ quality of life, increase healthcare efficiency, and maintain sustainable control over medical cost growth.