National Policies Fostering Hospice Care Increased Hospice Utilization and Reduced the Invasiveness of End-of-Life Care for Cancer Patients

Abstract

National policies fostering hospice care significantly increased hospice utilization, decreased invasive end-of-life care, and reduced the medical costs of terminal cancer patients.

Choosing and Doing Wisely: Triage Level I Resuscitation a Possible New Field for Starting Palliative Care and Avoiding Low-Value Care-A nationwide matched-pair retrospective cohort study

“…[24] Therefore Taiwan's NHI is designated as offering 'good access, comprehensive and low-cost healthcare system' [35] and highquality palliative care services. [36] Taiwan expanded palliative care policy reimbursed full palliative care services that positively increased cancer [37] and noncancer palliative care access and utilization in Taiwan. [38] Meanwhile, the choice of palliative care designation associated with early palliative care consultation service, [39] provider reimbursement policy, [40] patients' prognostic awareness and advance directives completion, [41] family's diagnostic and prognostic awareness.…”

Differences in medical costs for end-of-life patients receiving traditional care and those receiving hospice care: A retrospective study

“…Next, age, gender, income, occupation, Charlson Comorbidity Index (CCI) score, hospital characteristics (medical region such as north, south, central, or east area, hospital level, number of hospital beds, and number of hospice beds) and hospice bed density were treated as the control variables, and whether to accept hospice palliative care or not was treated as the dependent variable. The propensity score was calculated using logistic regression [7,8]. Data of patients with terminal-stage cancer were first cut in the year of death and then cut for the second time according to the cancer diagnosis.…”

“…Data of patients with terminal-stage cancer were first cut in the year of death and then cut for the second time according to the cancer diagnosis. The matching method required one-to-one matching in the same year of death, cancer diagnosis, and survival days with the nearest neighbor matching technique using the propensity score [7,32,33,38].…”

“…Before 2011, the service of hospice care primarily consisted of inpatient hospice care, and secondly home-based hospice care. However, the utilization rate of hospice care in Taiwan was only about 20% with a slow growth rate [7,8]. The slow growth of hospice care in Taiwan may be explained by differences in cultural customs between different countries [9][10][11] and restrictions on the patient's "right to know" by family members [9][10][11][12][13][14][15][16].…”

“…Few studies have matched patients according to the number of survival days after hospice care or traditional care, except for those that have examined the basic attributes of patients and coexisting diseases. Domestic and foreign studies on medical expenses in hospice care mainly compare differences in medical expenses in a fixed period of time (e.g., one month or one year before death) among patients at the end of their lives who do or do not receive hospice care [7,32,33]. These studies rarely compare the differences in medical expenses between traditional and hospice care using the same number of survival days.…”