International comparison of spending and utilization at the end of life for hip fracture patients

Blankart, Carl Rudolf; Gool, Kees; Papanicolas, Irene; Bernal‐Delgado, Enrique; Bowden, Nicholas; Estupiñán‐Romero, Francisco; Gauld, Robin; Knight, Hannah; Abiona, Olukorede; Riley, Kristen; Schoenfeld, Andrew J.; Shatrov, Kosta; Wodchis, Walter P.; Figueroa, Jose F. (2021). International comparison of spending and utilization at the end of life for hip fracture patients. Health Services Research, 56 Suppl 3, pp. 1370-1382. Wiley 10.1111/1475-6773.13734

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To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries.

Data Sources
Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC).

Study Design
We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age- and sex-specific effects within and across countries. In addition, we analyzed hospital-centricity, that is, the days spent in hospital and site of death.

Data Collection/Extraction Methods
We identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission.

Principal Findings
Resource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs.

Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Faculty Institutions > sitem Center for Translational Medicine and Biomedical Entrepreneurship > Healthcare Regulation and Management
11 Centers of Competence > KPM Center for Public Management

UniBE Contributor:

Blankart, Rudolf and Shatrov, Kosta Donislavov


300 Social sciences, sociology & anthropology > 350 Public administration & military science






[UNSPECIFIED] The Commonwealth Fund, NY, USA ; [UNSPECIFIED] The Health Foundation, UK




Carl Rudolf Berchtold Blankart

Date Deposited:

04 Oct 2021 13:24

Last Modified:

12 Nov 2021 00:13

Publisher DOI:


PubMed ID:





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