1 Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
2 Big Data Center, China Medical University Hospital and China Medical University, Taichung, Taiwan.
Palliat Med. 2018 Sep;32(8):1389-1400. doi: 10.1177/0269216318774899. Epub 2018 May 25.
Costs of medical care have been found to be highest at the end of life.
To evaluate the effect of provider reimbursement for hospice care on end-of-life costs.
The policy expanded access to hospice care for end-stage renal disease patients, a policy previously limited to cancer patients only. This study employed a difference-in-differences analysis using a generalized linear model. The main outcome is inpatient expenditures in the last 30 days of life.
SETTING/PARTICIPANTS: A cohort of 151,509 patients with chronic kidney disease or cancer, aged 65 years or older, who died between 2005 and 2012 in the National Health Insurance Research Database, which contains all enrollment and inpatient claims data for Taiwan.
Even as end-of-life costs for cancer are declining over time, expanding hospice care benefits to end-stage renal disease patients is associated with an additional reduction of 7.3% in end-of-life costs per decedent, holding constant patient and provider characteristics. On average, end-of-life costs are also high for end-stage renal disease (1.88 times higher than those for cancer). The cost savings were larger among older patients-among those who died at 80 years of age or higher, the cost reduction was 9.8%.
By expanding hospice care benefits through a provider reimbursement policy, significant costs at the end of life were saved.
医疗费用在生命末期最高。
评估医疗补助对临终关怀费用的影响。
该政策扩大了终末期肾病患者的临终关怀服务，之前该政策只限于癌症患者。本研究采用广义线性模型的差异分析。主要结果是生命最后 30 天的住院支出。
设置/参与者：2005 年至 2012 年间在国家健康保险研究数据库中死亡的年龄在 65 岁或以上、患有慢性肾脏病或癌症的 151509 名患者，该数据库包含台湾所有的参保和住院理赔数据。
尽管癌症的临终费用随着时间的推移而下降，但将临终关怀福利扩大到终末期肾病患者，与在保持患者和提供者特征不变的情况下，每位死者的临终费用减少 7.3%相关。平均而言，终末期肾病患者的临终费用也很高（比癌症患者高 1.88 倍）。在年龄较大的患者中，成本节约更大——在 80 岁或以上死亡的患者中，成本降低了 9.8%。
通过提供者报销政策扩大临终关怀福利，可以节省生命末期的大量费用。
