End-of-life care refers to the range of health and long-term care services people receive in the last phase of life, often defined as the final year before death (OECD, 2023[1]). It involves all the services providing physical, emotional, social and spiritual support to the dying person, including management of pain and mental distress. Emotional support and bereavement care for the dying person’s family are also part of end-of-life care. Due to population ageing and increasing prevalence of chronic conditions across OECD countries, the number of people in need of end-of-life care is growing and is expected to reach 10 million people by 2050, up from 7 million in 2019.
End-of-life care can be delivered in hospitals, hospices, nursing homes and patients’ homes. Although personal characteristics, beliefs and other cultural factors can influence preferences for care at the end of life, existing literature shows that most people would prefer to spend the end of their lives in their homes. A scoping review of end-of-life care studies found a clear preference for deaths at home among patients as well as patient families – up to 89% for patients and up to 84% for patient families (Pinto et al., 2024[2]).
However, fewer than half of those who need end-of-life care are currently receiving it, indicating a lack of adequate access (OECD, 2023[1]). Nearly half of deaths occurred in hospitals across 30 OECD countries in 2023, making hospitals the most common place of death (Figure 10.26). The Netherlands, Norway and Switzerland and accession country Peru record the lowest shares, with only around one‑third of deaths or fewer happening in hospitals. This is linked to the role of nursing homes, hospices or other LTC facilities, which in the Netherlands and Switzerland represent the most prevalent place of death (OECD, 2023[1]). In Hungary, Japan, Iceland, Lithuania, Portugal, and Israel 60% of deaths or more were recorded at hospitals.
The share of deaths occurring in hospitals decreased between 2018 and 2023 in about 70% of the countries, with the largest reductions seen in Estonia (11 p.p.), Japan and Ireland (8 p.p.) and Denmark (7 p.p.). By contrast, it increased in a handful of countries including Latvia and Iceland, as well as accession country Romania. The COVID‑19 pandemic might have contributed to a decline in the share of hospital deaths.
Across 17 OECD countries for which more detailed data on place of death are available, hospitals were the most common place of death, with an average of 47% of deaths taking place in hospitals in contrast to 22% of deaths recorded at home as of 2019‑2020 (Figure 10.27). The Netherlands was the only country where home is the most common place of death. Deaths in LTC facilities and institutions were often observed in Sweden (40%), Switzerland (38%), Iceland (37%), the Netherlands (36%) and New Zealand (32%), whereas hospital death rates were the highest in Japan (75%), Czechia (64%), Estonia (63%), Israel (61%) and Lithuania (60%).
Mainstreaming end-of-life care into health policies and medical education, as well as ensuing access to essential medicines for pain and symptom management, remains a challenge. The Global Atlas of Palliative Care reports that the proportion of medical and nursing schools with mandatory palliative care teaching is 100% in only eight Asian-Pacific and European OECD countries (Austria, Finland, France, Ireland, Lithuania, Luxembourg, Japan and the United Kingdom).
