Effect of Late Palliative Care Enrollment on Medical Expenditure among Terminal Cancer Patients

• Main Authors: Ting-Yu Lin, 林庭伃
• Other Authors: Nicole Huang
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/85374859689424399514

碩士 === 國立陽明大學 === 醫務管理研究所 === 99 === Background: In recent years, gradually expands "hospice palliative care" of the issue throughout the world. To expect the terminally ill to provide quality and meaningful care before death. Domestic and foreign studies are shown to join hospice care before death can increase the quality of life and reduce medical costs. But there are many terminal cancer patients were too late to join hospice palliative care. Therefore palliative care patients whether get hospice palliative care on time to join while the medical utilization and medical costs have their effect. This is the purpose of this study. Methods: Using the 2004 "National Institutes of Health cancer death file" and the 2003-2004 National Health Insurance database of "outpatient prescription and treatment of detail file", "hospital medical expenses detailed list of files", "institutions of basic medical information file" A total of 35,978 bits study. In this study, "five days" as early as adding and adding hospice late cut-off point of time, a comparative analysis of cancer patients died five days (including 5 days) adding hospice care five days before the accession and non-medical hospice benefits and medical expenses differences, and the use of SAS 9.2 version of the string files for data and analysis. Results: 1. Only in-patient hospice care cancer patient the first time used the day of hospice and death's counting about is 48.28 days, median is 22 days, mode is 1 day; Only out-patient visits of hospice home care cancer patient the first time used the day of hospice and death's counting about is 26.15 days, median is 13 days, mode is 1 day; Both all cancer patient the first time use the day of hospice and death to count about is 77.51 days, median is 50 days, mode is 20 days. 2. After controll other variables, early join hospice patients than later joined hospice patients died the previous year's 0.15 times more than the number of outpatient visits, outpatient medical care costs more than $ 2,411. After controll other variables, early and later join hospice patients the death of patients admitted to hospital the previous year the number no different, the number of days hospitalized more than 8.43 days, average length of stay more than 3.23 days and hospital costs and more $ 13,523, total medical expenses more than $ 5,869. 3. After controll other variables, Patients died of cancer the year before either outpatient or inpatient utilization, male and female not much difference; in outpatient and inpatient health care costs, places men above women. In the outpatient and inpatient health care costs, places men above women. After controll other variables, Patients died of cancer the year before out-patient utilization and costs, the highest in patients 50-74 years of age; in hospitalization costs and total medical costs as if the young patients than older patients health care costs, and there with with increasing age and decreasing trend. After controll other variables, one year before the death of cancer patients in outpatient use, breast cancer no more visits, but the out-patient medical costs are highest, and hospitalization costs were significantly lower than other cancer types. After controll other variables, the year before the death of cancer patients either outpatient or inpatient utilization, total health care costs, there are all the highest transfer of cancer patients. After controll other variables, the year before the death of cancer patients regardless of outpatient, hospital and total medical costs are all higher than the regional medical center hospitals than district hospitals. After controll other variables, one year before the death of cancer patients use and outpatient costs, begin with the Northern Branch of the lowest; in hospital days and charges as if the Kao-Ping Branch of the lowest. 4. Early join hospice female patient total medical costs than later more $ 10,302, early join hospice male patients than later more $ 3,358; early join hospice 0-18 years old patient total medical costs less than later $ 286,962 ,19-49 years old patient less than later $ 12,459, more 85 years old patient less than later $ 23,248, then 50-64, 65-74 and 75-84 years old patients were more than $ 6,791, $ 12,671 and $ 11,635; early join hospice liver cancer patients total medical costs less than later $ 2,454, lung cancer patients less than $ 1,709, colorectal cancer patients less than $ 1,726, and breast cancer, gastric cancer and other cancers were more than $ 2,712, $ 5,713 and $ 16,022; early join hospice care did not transfer disease risk of patient total medical costs than later more $ 7,822, and early join hospice transferred patients than later more $ 5,512. Conclusion: Although the literature has been confirmed to join the end of hospice care of cancer patients can save medical expenses before death. However, the use of five days as a time cut-off point to study, Early than late to join hospice patients a year in medical expenses before death, the benefits do not necessarily have to save money. Finally, early and late join hospice care of cancer patients on the differences in medical costs, because of different age groups or different types of cancer vary.