Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA.
J Hosp Med. 2022 Jun;17(6):437-444. doi: 10.1002/jhm.12839. Epub 2022 May 8.
Health care costs remain high at the end of life. It is not known if there is a relationship between advance directive (AD) completion and hospital out-of-pocket costs. This analysis investigated whether AD completion was associated with lower hospital out-of-pocket costs at end of life.
We used Health and Retirement Study participants who died between 2000 and 2014 (N = 9228) to examine the association between AD completion status and hospital out-of-pocket spending in the last 2 years of life through the use of a two-part model controlling for socioeconomic status, death-related characteristics and health insurance coverage.
About 44% of decedents had completed ADs. Having an AD was significantly associated with $673 lower hospital out-of-pocket costs, with a higher magnitude of savings among younger decedents. Decedents who completed ADs 3 months or less before death had higher out-of-pocket costs ($1854 on average) than those who completed ADs more than 3 months before death ($1176 on average).
AD completion was significantly associated with lower hospital out-of-pocket costs, with greater out-of-pocket savings among younger decedents. Early AD completers experienced lower costs than decedents who completed ADs closer to death.
在生命末期，医疗保健费用仍然很高。目前尚不清楚是否存在预立医疗指示（advance directive，AD）完成情况与医院自费费用之间的关系。本分析旨在调查 AD 完成情况是否与生命末期的医院自费费用降低有关。
我们使用健康与退休研究（Health and Retirement Study）参与者的数据，这些参与者在 2000 年至 2014 年间死亡（N=9228），通过使用两部分模型来控制社会经济地位、与死亡相关的特征和健康保险覆盖范围，来研究 AD 完成情况与生命最后 2 年的医院自费支出之间的关系。
约 44%的死者完成了 AD。拥有 AD 与医院自费支出降低 673 美元显著相关，在年轻死者中储蓄幅度更大。在死亡前 3 个月或更短时间内完成 AD 的死者的自费支出（平均 1854 美元）高于在死亡前 3 个月以上时间完成 AD 的死者（平均 1176 美元）。
AD 完成情况与医院自费支出降低显著相关，年轻死者的自费储蓄幅度更大。早期完成 AD 的死者的成本低于在接近死亡时完成 AD 的死者。
