title: Hospice shared-care saved medical expenditure and reduced the likelihood of intensive medical utilization among advanced cancer patients in Taiwan--a nationwide survey.
abstract: OBJECTIVE
  Hospice shared care (HSC) is a new care model that has been adopted to treat inpatient advanced cancer patients in Taiwan since 2005. Our aim was to assess the effect of HSC on medical expenditure and the likelihood of intensive medical utilization by advanced cancer patients.
  
  
  METHODS
  This is a nationwide retrospective study. HSC was defined as using "Hospice palliative care (HPC) teams to provide consultation and service to advanced cancer patients admitted in the nonhospice care ward." There were 120,481 deaths due to cancer between 2006 and 2008 in Taiwan. Patients receiving HSC were matched by propensity score to patients receiving usual care. Of the 120,481 cancer deaths, 12,137 paired subjects were matched. Medical expenditures for 1 year before death were assessed between groups using a database from the Bureau of National Health Insurance. Paired t and McNemar's tests were applied for comparing the medical expenditure and intensive medical utilization before death between paired groups.
  
  
  RESULTS
  Compared to the non-HSC group, subjects receiving HSC had a lower average medical expenditure per person (US$3,939 vs. US$4,664; p<0.001). The HSC group had an adjusted net savings of US$557 (13.3%; p<0.001) in inpatient medical expenditure per person compared with the non-HSC group. Subjects that received different types of HPC had 15.4-44.9% less average medical expenditure per person and significantly lower likelihood of intensive medical utilization than those that did not receive HPC.
  
  
  CONCLUSIONS
  HSC is associated with significant medical expenditure savings and reduced likelihood of intensive medical utilization. All types of HPC are associated with medical expenditure savings.
authors.affiliation: Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Lin
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chiu
authors.forename: Chih-Te
authors.initials: CT
authors.lastname: Ho
authors.forename: Lance E
authors.initials: LE
authors.lastname: Davidson
authors.forename: Hua-Shui
authors.initials: HS
authors.lastname: Hsu
authors.forename: Chiu-Shong
authors.initials: CS
authors.lastname: Liu
authors.forename: Chang-Fang
authors.initials: CF
authors.lastname: Chiu
authors.forename: Ching-Tien
authors.initials: CT
authors.lastname: Peng
authors.forename: Chih-Yi
authors.initials: CY
authors.lastname: Chen
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Hu
authors.forename: Ling-Nu
authors.initials: LN
authors.lastname: Hsu
authors.forename: Chia-Ing
authors.initials: CI
authors.lastname: Li
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
authors.forename: Chin-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Lin
mesh_terms: D005102:Health Expenditures / Q000706:statistics & numerical data; D017051:Hospice Care / Q000191:economics* / Q000379:methods*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D010166:Palliative Care / Q000191:economics / Q000379:methods; D057216:Propensity Score; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies; D013624:Taiwan