Patients who die in a hospital will undergo more billable tests and procedures than those who die at home or in hospice care, racking up costs in their final month of life up to seven times as much as patients dying at home, according to a new analysis from Arcadia Healthcare Solutions.

The analysis uses claims data from a unnamed private Medicaid company from an unspecified Western state. In the available patient data, 42 percent died at home, with their final month of care costing an average of $4,760. For the 40 percent who died at a hospital, the average costs shot up to $32,379.

Following hospital deaths, the analysis said a nursing facility was the second most expensive in a patient’s final month (7 percent of patients in the study died there, with an average of $21,221), followed by hospice care (7 percent, $17,845) and the emergency room (5 percent, $7,969).

“In the end, everyone died. They all died," Arcadia’s chief medical officer, Richard Parker, MD, said to National Public Radio. "If we look at this retroactively, retrospectively—and we could go back and ask people—I bet most of them would say I'd rather be home with my family."

He added that hospital deaths of patients covered by Medicare or private insurance are likely even more expensive due to differing reimbursement rates.

Parker and Arcadia put the blame for more expensive hospital deaths on an internal culture among physicians of “keep treating patients regardless of the quality of life.”

Lachlan Forrow, MD, a professor of medical ethics at Harvard University, told NPR it’s more complicated, saying it’s common for patients to move back and forth between several locations in their final month, and some may be admitted to hospitals because their pain and symptoms couldn’t be adequately managed in a home setting.