Hu Guoheng, Zhao Haining, Bian Xiaolong, Li Ying
Yanshan University, Qinhuangdao, Hebei, China.
Front Public Health. 2025 Mar 12;13:1548999. doi: 10.3389/fpubh.2025.1548999. eCollection 2025.
This study aims to investigate end-of-life healthcare expenditures among middle-aged and older patients with cardiovascular and cerebrovascular diseases, with a particular focus on the existence of the "nearing-death effect."
Using inpatient discharge summary data from the Chinese National Medical Insurance Settlement Platform, we identified a cohort of middle-aged and older adults (aged 45 and above) diagnosed with cardiovascular and cerebrovascular diseases in Province H, China, during 2018-2019. Propensity Score Matching (PSM) was employed to examine differences in end-of-life healthcare expenditures between deceased and surviving patients. Robustness checks were performed using Multidimensional Fixed Effects (MDFE) and Difference-in-Differences Machine Learning (DDML).
The findings reveal a substantial increase in end-of-life healthcare expenditures among patients with cardiovascular and cerebrovascular diseases. Specifically, Total Medical Costs, Comprehensive Service Fees, Diagnosis Fees, Treatment Fees, Pharmaceutical Fees, and Nursing Care Fees rose by 34.3, 44.0, 35.7, 62.5, 49.9, and 46.8%, respectively, all statistically significant at the 1% level. These results highlight a pronounced escalation in healthcare expenditures associated with patient mortality.
Among middle-aged and older patients with cardiovascular and cerebrovascular diseases, healthcare expenditures exhibit a distinct "end-of-life effect," characterised by a sharp surge in medical spending during the final stages of life. This phenomenon underscores the intensive utilization of medical resources at the end of life, markedly differing from healthcare expenditure patterns at other stages of life.
本研究旨在调查中老年心血管和脑血管疾病患者的临终医疗费用，特别关注“濒死效应”的存在。
利用中国国家医疗保险结算平台的住院出院总结数据，我们确定了一组在2018 - 2019年期间在中国H省被诊断患有心血管和脑血管疾病的中老年成年人（年龄在45岁及以上）。采用倾向得分匹配法（PSM）来检验已故患者和存活患者在临终医疗费用上的差异。使用多维固定效应（MDFE）和差异-in-差异机器学习（DDML）进行稳健性检验。
研究结果显示，心血管和脑血管疾病患者的临终医疗费用大幅增加。具体而言，总医疗费用、综合服务费、诊断费、治疗费、药费和护理费分别增长了34.3%、44.0%、35.7%、62.5%、49.9%和46.8%，均在1%水平上具有统计学显著性。这些结果突出了与患者死亡率相关的医疗费用的显著上升。
在中老年心血管和脑血管疾病患者中，医疗费用呈现出明显的“临终效应”，其特征是在生命的最后阶段医疗支出急剧飙升。这一现象凸显了生命末期医疗资源的密集利用，与生命其他阶段的医疗费用模式明显不同。
