title: Medical care utilization and costs on end-of-life cancer patients: The role of hospice care.
abstract: Although there are 3 hospice care programs for terminal cancer patients in Taiwan, the medical utilization and expenses for these patients by programs have not been well-explored. The aim of this study was to examine the medical utilization and expenses of terminal cancer patients under different programs of hospice care in the last 90, 30, and 14 days of life.This was a retrospective observational study by secondary data analysis. By using the National Health Insurance claim database and Hospice Shared Care Databases. We identified cancer descents from these databases and classified them into nonhospice care and hospice care groups based on different combination of hospice care received. We then analyzed medical utilization including inpatient care, outpatient care, emergency room visits, and medical expenses by patient groups in the last 90, 30, and 14 days of life.Among 118,376 cancer descents, 46.9% ever received hospice care. Patients had ever received hospice care had significantly lower average medical utilization and expenses in their last 90, 30, and 14 days of life (all P < 0.001) compared to nonhospice care group. Each hospice care group had significantly less medical utilization and expenses in the last 90, 30, and 14 days of life (all P < 0.01).Different kinds of hospice care program have different effects on medical care utilization reduction and cost-saving at different stage of the end of life of terminal cancer patients.
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital; School of Medicine and Institute of Public Health and Community Medicine Research Center, National Yang-Ming University Department of Family Medicine, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University Department of Radiology, Taipei Veterans General Hospital; School of Medicine and Institute of Clinical Medicine, National Yang-Ming University Department of Family Medicine, Taipei Veterans General Hospital; School of Medicine and Institute of Hospital and Health Care Administration, National Yang-Ming University National Health Insurance Administration, Ministry of Health and Welfare Department of Family Medicine, College of Medicine and Hospital, National Taiwan University Division of Rheumatology and Immunology, Hualien Tzu Chi Hospital, Hualien, Taiwan.
authors.forename: Hsiao-Ting
authors.initials: HT
authors.lastname: Chang
authors.forename: Ming-Hwai
authors.initials: MH
authors.lastname: Lin
authors.forename: Chun-Ku
authors.initials: CK
authors.lastname: Chen
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Shu-Lin
authors.initials: SL
authors.lastname: Tsai
authors.forename: Shao-Yi
authors.initials: SY
authors.lastname: Cheng
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chiu
authors.forename: Shih-Tzu
authors.initials: ST
authors.lastname: Tsai
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs; D017051:Hospice Care / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics* / Q000706:statistics & numerical data*