Background: A study by Melberg et al (2013) on hospital expenditure in Norway in 2010 finds that the average costs of decedents decreased by 24 % and 33 % for males and females respectively between the ages of 70 and 80. Similar results are observed in other European countries and in the United States. The forces behind this inverse relation are not well understood.
Objective: To determine whether the decline in resource use on decedents with age is due to disease prevalence across age groups, i.e. case mix, the treatment intensity across age groups or a combination of factors.
Method: The study will employ both descriptive graphical presentation and regression analysis to determine the effect of type of disease and treatment intensity on resource use with age. Data is collected from the Norwegian Patient Registry.
Results: Initial findings indicate that the most common disease group amongst decedents is circulatory diseases. This is also the relatively cheapest disease group in terms of both average cost and number of days spent in hospital per patient independent of age. The AC declines for every yearly increase in age by NOK 2080, NOK 1693 and NOK 1017 for neoplasms, respiratory and circulatory diseases respectively. The inverse relation between resources consumed and age is less pronounced amongst circulatory diseases. Similar results are present for the average number of days as well, although the decline in number of days for circulatory diseases is not significant with age in the regression results. The average number of days decline for every yearly increase in age by 0.3 and 0.25 days for neoplasms and respiratory diseases respectively, while it increases for every yearly increase in age by 0.007 days for circulatory diseases.
Conclusion: Even though circulatory is the most common and the cheapest disease of the three disease types investigated in this study, the disease prevalence does not entirely explain the decline in average costs since there is a significant decline in average costs for all diseases. This finding suggests a decline in aggressiveness of care received in the oldest age groups. In addition, observing the relationship between age and resource use by number of days in hospital as well as expenditure indicates that the consumption of resources in hospitals differs depending on how the resources are measured and on type of disease. The relation between days and age implies a more conservative decline in resources used and for circulatory diseases the relationship is insignificant