title: Does hospital need more hospice beds? Hospital charges and length of stays by lung cancer inpatients at their end of life: A retrospective cohort design of 2002-2012.
abstract: BACKGROUND
  Previous studies found that hospice and palliative care reduces healthcare costs for end-of-life cancer patients.
  
  
  OBJECTIVE
  To investigate hospital inpatient charges and length-of-stay differences by availability of hospice care beds within hospitals using nationwide data from end-of-life inpatients with lung cancer.
  
  
  METHODS
  A retrospective cohort study was performed using nationwide lung cancer health insurance claims from 2002 to 2012 in Korea.
  
  
  METHODS
  Descriptive and multi-level (patient-level and hospital-level) mixed models were used to compare inpatient charges and lengths of stay. Using 673,122 inpatient health insurance claims, we obtained aggregated hospital inpatient charges and lengths of stay from a total of 114,828 inpatients and 866 hospital records.
  
  
  RESULTS
  Hospital inpatient charges and length of stay drastically increased as patients approached death; a significant portion of hospital inpatient charges and lengths of stay occurred during the end-of-life period. According to our multi-level analysis, hospitals with hospice care beds tend to have significantly lower end-of-life hospital inpatient charges; however, length of stay did not differ. Hospitals with more hospice care beds were associated with reduction in hospital inpatient charges within 3 months before death.
  
  
  CONCLUSIONS
  Higher end-of-life healthcare hospital charges were found for lung cancer inpatients who were admitted to hospitals without hospice care beds. This study suggests that health policy-makers and the National Health Insurance program need to consider expanding the use of hospice care beds within hospitals and hospice care facilities for end-of-life patients with lung cancer in South Korea, where very limited numbers of resources are currently available.
authors.affiliation: Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Korea.
authors.forename: Sun Jung
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Public Health, Yonsei University College of Medicine, Seoul, Korea Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyu-Tae
authors.initials: KT
authors.lastname: Han
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, Korea.
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea ecpark@yuhs.ac.
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017051:Hospice Care / Q000191:economics / Q000458:organization & administration*; D006742:Hospital Bed Capacity / Q000191:economics* / Q000706:statistics & numerical data; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008175:Lung Neoplasms / Q000191:economics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics* / Q000458:organization & administration; D056910:Republic of Korea; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics* / Q000458:organization & administration
keywords: Hospice care; fees and charges; length of stay; lung neoplasms