Case studies—how service use and costs may vary in the last year of life
These fictional case studies provide examples of how health services used by people in the last year of life vary under different circumstances:
- Grace, a grandmother in her 80s
- Matt, a father diagnosed with bowel cancer
- James, a young landscape gardener
- Carrie, a first-time mother.
These are not actual people, nor do they necessarily represent the circumstances of other Australians of the same age with the same health conditions. The case studies are designed to give readers a greater understanding of the diversity of health services used by people in their last year of life.
At 80, Grace, who was always on the ball, started forgetting little things, like where she left her keys or what she was supposed to get at the grocery store. Initially, she shrugged it off, joking that she must just be getting old. However, her forgetfulness got worse, and she even missed her grandson’s birthday party. Her daughter, Sophie, recognised that this behaviour was unusual, so she took Grace to her GP. After follow-up tests, Grace was diagnosed with dementia.
Sophie organised a home-care provider to come to Grace’s house a few days a week to help with household chores and home maintenance. As Grace’s dementia progressed, Sophie became her full-time carer, and helped her with daily tasks such as bathing, household chores, transport and meal preparation. A few years after Grace’s initial diagnosis, Sophie decided to move Grace into a residential aged care facility as she was no longer able to give Grace the care she needed.
After 18 months at the facility, Grace died after falling ill with a chronic urinary tract infection and influenza. She was 85.
Grace visited her GP regularly after receiving her dementia diagnosis. In her last year of life, she claimed 36 MBS services, which included GP visits and pathology tests. She also saw a geriatrician twice. Grace also claimed 66 prescription medications under the PBS. The total cost of health services used in her last year of life was $7,600, far below the overall average of $21,600 per person for females in their final year of life. Grace’s out-of-pocket expenses were $470. These costs are only for Grace’s use of specific health services (MBS services and prescriptions supplied under the PBS). Grace would likely have received other health care while living in residential aged care, so her total health-care costs are likely to have been higher if all services were included.
When Matt received a bowel cancer screening kit in the mail, he did not pay much attention. He did not do the test and thought nothing more about it. Two years later, he received another kit. His daughter, Amy, saw it on the dining room table and urged him to do the test. She said that someone at her work had taken part in the screening program and their test was positive. Matt was reluctant but agreed. A couple of weeks later he got a letter. His result was positive.
The next few months were a whirlwind of appointments, including a colonoscopy, scans, and pathology tests. Matt had never been keen on doctors, and now was being referred to a surgeon and oncologist. He just kept thinking, ‘But I felt fine.’
Matt had surgery, chemotherapy and radiation treatment. Amy was a great support. With her encouragement, Matt made some big life changes. He stopped smoking, was eating less takeaway, and was going for regular walks. As they sat in the waiting room for his 6-monthly check-up, Matt could see that Amy was worried. Eleven months later, Matt died. He was 66.
In his last year of life, Matt was admitted to hospital 7 times, including 2 trips to the ED. His hospital costs amounted to $25,000 over his last 12 months. Before the cancer diagnosis, Matt had rarely used other medical services. In his last year, he claimed 123 health services on the MBS, one-third of which were for pathology. Matt also had 78 medications dispensed under the PBS. Matt’s MBS and PBS services cost $19,000. All of Matt’s health-care costs in his last year were above the national average. The costs of his health services ($47,700) were higher than the average for his 60–69 age group ($36,300). Matt paid $2,500 in out-of-pocket costs for the MBS services and PBS prescriptions used in his last year.
James was a healthy and happy 22-year-old. After graduating from Year 12, he thought about applying for university, but James loved working outdoors so was not sure that another 3 to 4 years studying was right for him. James soon found the perfect job as a landscape gardener.
James and his long-term girlfriend, Suzie, had camped along the East coast every Easter long weekend since they began dating. They had been eagerly counting the days until their next trip, but about a week before they were due to leave James felt he was getting sick. He went to see his GP who suggested that James take a couple of days off work and rest.
James and Suzie set off on their holiday a few days later. About an hour into their drive James started to feel tired. As they rounded a corner, James noticed a few kangaroos near the road but did not see the one right in front of him. He swerved and hit a tree. James and Suzie died on impact.
In his last year of life, James used one health service – a GP consultation claimed on the MBS. The cost for his health services over the 12 months before his death was $88, well below the average cost per person of $24,000.
Carrie was 42 when she discovered she was pregnant. She and her partner, Paul, were delighted. They had delayed having children until they were financially secure, but what was supposed to be a couple of years turned into 5, and then 10. They were aware of the risks of having a baby later in life. They knew that first-time mothers aged 40 and over were more likely to experience complications during pregnancy and birth than younger mothers. But Carrie also knew that maternal deaths in Australia were rare. In 2019, there were 17 maternal deaths in Australia (AIHW 2021). Also, Carrie knew she was fit and healthy. She did not smoke or drink. She was not overweight and felt great.
The first trimester was tough. Carrie was at the doctor for something new every week. Paul took her to the hospital ED twice because he was so worried. By the 26th week of the pregnancy, Carrie had developed gestational diabetes, which meant more visits to her obstetrician and doctor, as well as to a dietician.
Carrie and Paul’s baby boy was born at 38 weeks after a prolonged labour that ended with Carrie having a caesarean section. Carrie started to feel unwell a couple of days after she had been discharged from hospital. By that night, she was back in hospital with sepsis. She died the next day.
The cost of health services used in Carrie’s last year of life was $37,000, higher than the average cost per person for females ($21,600). Nearly 90% of her costs were for 2 hospital admissions ($33,000). The remaining costs were $3,450 for 48 services claimed under the MBS (including GP visits, pathology tests and ultrasounds) and $350 for prescription medication supplied under the PBS. Carrie paid $1,150 in out-of-pocket costs for services supplied under the MBS and PBS for the year.
AIHW (Australian Institute of Health and Welfare) (2021) Australia's mothers and babies: Maternal deaths, AIHW, Australian Government, accessed 28 April 2022.