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Utilization of Health Care Services at the End of Life

The purpose of the project was to describe the use of health services, and associated costs in the last years of life, and to identify factors that affect consumption at individual and system levels. The conditions for the qualitative good terminal care outside hospitals was also a key research questions in the project.

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About 40,000 people die in Norway every year. About 80 percent of those are over 70 years old, and 60 percent are over 80 years old when they die. In general, the use of health services increases in the last years of life. In the context of changes in age structure over the next decades, with increasing numbers of elderly, this implies challenges for the health services. Knowledge of the consumption of health care in the last years of life, and associated costs, is therefore highly relevant for service providers, health professionals and health authorities, regarding capacity and design of future health care.

Greater emphasis on decentralised services is seen both internationally and in Norway, and this is one of the main goals of the Coordination Reform. To facilitate good services at the end of life is an important part of this. The trend in recent years has been an increasing proportion of people die outside hospitals. What factors contributes to this trend? Are there significant differences in use of services in the last years of life for those who die in hospitals and elsewhere? Are differences in health care consumptions in the last years of life primarily related to the characteristics of the patients, or can observed differences be explained by differences in demand and supply conditions in the health care services? Is care in the final stages of life outside the hospital in keeping with patients' wishes and are the municipalities equipped to provide high quality services? Will shift in responsibilities and tasks from hospital to municipalities help to reduce the overall costs of health care related to the last years of life? A good knowledge base was essential to answer those questions.

The project will contribute to this knowledge through quantitative analyses of data from national health registers, and through qualitative analyses based on data collected through interviews with family members and health care providers in three municipalities, and survey among health professionals in a community sample of municipalities.

Final report, Norwegian Research Council: Utilization of health care services at the end of life


Kalseth J, Halvorsen T. Health and care service utilisation and cost over the life-span: a descriptive analysis of population data. BMC Health Services Research 2020, 20(1):435. 

Kalseth J, Halvorsen T. Relationship of place of death with care capacity and accessibility: a multilevel population study of system effects on place of death in Norway. BMC Health Services Research 2020, 20(1):454. 

Kalseth, J., Anthun, K. S., & Forma, L. Health care and long-term care costs by age and proximity to death in a publicly funded universal system: A descriptive study of population data. Nordic Journal of Health Economics. 2020.

Forma, L., Aaltonen, M., Raitanen, J., Anthun, K. S., & Kalseth, J. Place of death among older people in Finland and Norway. Scandinavian Journal of Public Health, 1403494820944073. 2020.

Reneflot Anne, Kaspersen Silje L, Hauge Lars Johan, Kalseth Jorid. Use of Prescription Medication Prior to Suicide in Norway. BMC Health Serv Res, 2019 Apr 4;19(1):215. 

Paulsen Bård, Johnsen Roar, Hadder Hans. Nurses' experience with relatives of patients receiving end‐of‐life care in nursing homes and at home: A questionnaire‐based cross‐sectional study. Nurs Open. 2018 Jul; 5(3): 431–441. 

Kalseth J, Theisen OM. Trends in place of death: The role of demographic and epidemiological shifts in end-of-life care policy, Palliative Med, 2017: 0269216317691259, European Association for Palliative Care, Februar 2017.


Kalseth, Jorid; Theisen, Ole Magnus. When demography and illness trumps policy: Why Norwegians continue to die in institutions. EAPC Blog, European Association for Palliative Care, Editor's choice from Palliative Medicine, Dec. 15, 2017.


Kalseth, Jorid. Health and care service utilisation and cost in a life cycle perspective: a register data based descriptive analysis. 39th Nordic Health Economists’ Study Group Meeting; 2018-08-22--28.

Kalseth, Jorid; Anthun, Kjartan Sarheim. Health and care cost by age and proximity to death. 24th Nordic Congress of Gerontology; 2018-05-02--05.

Kalseth, Jorid; Anthun, Kjartan Sarheim. Health and care cost by age and proximity to death. The second workshop of the Nordic Network for Health Policy, Health Management, and Health Services Research; 2018-04-17--18.

Kalseth, Jorid; Halvorsen, Thomas. How resource use and institutional accessibility are tied to the place people die. A multilevel analysis of system effects in Norway. Helsetjenesteforskningskonferansen 2018, 13-14.03, Oslo, Norway.

Forma, Leena; Aaltonen, Mari; Raitanen, Jani; Anthun, Kjartan Sarheim; Kalseth, Jorid. The place of death among old people in Finland and in Norway. 38th Nordic Health Economists' Study Group, Helsinki, Finland, 23-25.08.17.

Kalseth, Jorid; Anthun, Kjartan Sarheim. End of life care trajectories – hospital inpatient care in last two years of life. ICIC17 – 17th International Conference on Integrated Care; 2017-05-08--10.

Forma, Leena; Aaltonen, Mari; Raitanen, Jani; Anthun, Kjartan Sarheim; Kalseth, Jorid. The role of primary care hospital as a place of death among old people - a cross-country comparison. Den første nasjonale konferansen i helsetjenesteforskning, 2017-03-14--15.

Kalseth, Jorid; Theisen, Ole Magnus; Anthun, Kjartan Sarheim. Place of care and place of death: the frequency of hospital use prior to death and the increased importance of nursing homes in end of life care in Norway. ICIC16 - 16th International Conference on Integrated Care, Barcelona; 2016-05-23--25.


Key Factors

Project duration

2012 - 2018


Research Council of Norway.


Avd. for sykepleierutdanning, College of Sør-Trøndelag (HIST) (

Dept. of Public Health and General Practice, Norwegian University of Science and Technology (NTNU) (

COCTEL-research group at the Tampere School of Public Health, University of Tampere, Finland

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(The Blog of the European Association for Palliative Care)

When demography and illness trumps policy: Why Norwegians continue to die in institutions