Regional Variation of Cost of Care in the Last 12 Months of Life in Switzerland: Small-Area Analysis Using Insurance Claims Data.

Panczak, Radoslaw; Luta, Xhyljeta; Maessen, Maud; Stuck, Andreas E; Berlin, Claudia; Schmidlin, Kurt; Reich, Oliver; von Wyl, Viktor; Goodman, David C; Egger, Matthias; Zwahlen, Marcel; Clough-Gorr, Kerri M (2017). Regional Variation of Cost of Care in the Last 12 Months of Life in Switzerland: Small-Area Analysis Using Insurance Claims Data. Medical Care, 55(2), pp. 155-163. Lippincott Williams & Wilkins 10.1097/MLR.0000000000000634

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Health care spending increases sharply at the end of life. Little is known about variation of cost of end of life care between regions and the drivers of such variation. We studied small-area patterns of cost of care in the last year of life in Switzerland.


We used mandatory health insurance claims data of individuals who died between 2008 and 2010 to derive cost of care. We used multilevel regression models to estimate differences in costs across 564 regions of place of residence, nested within 71 hospital service areas. We examined to what extent variation was explained by characteristics of individuals and regions, including measures of health care supply.


The study population consisted of 113,277 individuals. The mean cost of care during last year of life was 32.5k (thousand) Swiss Francs per person (SD=33.2k). Cost differed substantially between regions after adjustment for patient age, sex, and cause of death. Variance was reduced by 52%-95% when we added individual and regional characteristics, with a strong effect of language region. Measures of supply of care did not show associations with costs. Remaining between and within hospital service area variations were most pronounced for older females and least for younger individuals.


In Switzerland, small-area analysis revealed variation of cost of care during the last year of life according to linguistic regions and unexplained regional differences for older women. Cultural factors contribute to the delivery and utilization of health care during the last months of life and should be considered by policy makers.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Geriatric Clinic > Geriatric Clinic Inselspital
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Panczak, Radoslaw, Luta, Xhyljeta, Maessen, Maud, Stuck, Andreas, Berlin, Claudia, Schmidlin, Kurt, Egger, Matthias, Zwahlen, Marcel, Clough, Kerri


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




Lippincott Williams & Wilkins




Doris Kopp Heim

Date Deposited:

12 Dec 2016 18:34

Last Modified:

05 Dec 2022 15:00

Publisher DOI:


PubMed ID:





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