OBJECTIVES: To examine, in the ‘real-world’ scenario of a Brazilian health care plan, the effect of proximity to death in beneficiaries on health expenditure during the last 5 years of life. METHODS: Retrospective analysis from data stored on the computerised system of the health care plan of 1897 beneficiaries who died between January 2007 and June 2009. The outpatient and hospital health services in the year of death and in the 4 preceding years were examined. The analysis was restricted to total direct costs with medical-hospital care. The variables (demographic, clinical and costs) were subjected to statistical treatment considering a confidence interval of 95%. RESULTS: Out of a total of 1897 deaths analysed, the majority were male (60.4%) and were aged 60 or over (77.0%). The overall mean age of the deceased was 70.6 years (CI95% 69.9-71.4). The cost over the 60 months of the study was US$64,427,852. This total, 66.8% was reimbursed in the year of death and the clinical admissions corresponded to 89.2% of the total. Among the main causes of death, neoplasia and chronic diseases had a heavier influence on expenditure. CONCLUSIONS: The rise in spending on health appears to be directly associated with the effect of increased age together with a second factor considered to be important, the proximity to death. It is estimated that in 2050 Brazil will have a population of 64 million individuals aged 60 or over, representing one of the main challenges to the adequate allocation of resources. This study suggests that the costs in the last year of life should be considered in the projections for spending on health care, in the same way as the ageing factor. One of the alternatives that appears to be important at the end of life is palliative care.