AUTHOR=Hu Guoheng , Zhao Haining , Bian Xiaolong , Li Ying 

TITLE=Dying to pay: end-of-life medical costs for middle-aged and older adult patients with cardiovascular and cerebrovascular diseases

JOURNAL=Frontiers in Public Health

VOLUME=Volume 13 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1548999

DOI=10.3389/fpubh.2025.1548999

ISSN=2296-2565

ABSTRACT=ObjectiveThis study aims to investigate end-of-life healthcare expenditures among middle-aged and older patients with cardiovascular and cerebrovascular diseases, with a particular focus on the existence of the “nearing-death effect.”MethodsUsing inpatient discharge summary data from the Chinese National Medical Insurance Settlement Platform, we identified a cohort of middle-aged and older adults (aged 45 and above) diagnosed with cardiovascular and cerebrovascular diseases in Province H, China, during 2018–2019. Propensity Score Matching (PSM) was employed to examine differences in end-of-life healthcare expenditures between deceased and surviving patients. Robustness checks were performed using Multidimensional Fixed Effects (MDFE) and Difference-in-Differences Machine Learning (DDML).ResultsThe findings reveal a substantial increase in end-of-life healthcare expenditures among patients with cardiovascular and cerebrovascular diseases. Specifically, Total Medical Costs, Comprehensive Service Fees, Diagnosis Fees, Treatment Fees, Pharmaceutical Fees, and Nursing Care Fees rose by 34.3, 44.0, 35.7, 62.5, 49.9, and 46.8%, respectively, all statistically significant at the 1% level. These results highlight a pronounced escalation in healthcare expenditures associated with patient mortality.ConclusionAmong middle-aged and older patients with cardiovascular and cerebrovascular diseases, healthcare expenditures exhibit a distinct “end-of-life effect,” characterised by a sharp surge in medical spending during the final stages of life. This phenomenon underscores the intensive utilization of medical resources at the end of life, markedly differing from healthcare expenditure patterns at other stages of life.