Association Between Hospice Length of Stay, Health Care Utilization, and Medicare Costs at the End of Life Among Patients Who Received Maintenance Hemodialysis

Wachterman, Melissa; Hailpern, Susan M.; Keating, Nancy L.; Tamura, Manjula Kurella; O’Hare, Ann M.

doi:10.1001/jamainternmed.2018.0256

Cited by 79 publications

(86 citation statements)

References 51 publications

(94 reference statements)

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“…This was based on the presence of a claim secondary to pancreatic malignancy in the Hospice SAFs. To characterize hospice use at end of life, hospice utilization was categorized into three groups based on hospice admission date relative to date of death . Specifically, “early hospice utilization” was defined as a hospice admission date at least 28 days before death.…”

Section: Methodsmentioning

confidence: 99%

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Paredes

Hyer

Tsilimigras

et al. 2019

Journal of Surgical Oncology

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Background: Use of hospice services among patients with pancreatic cancer following pancreatic resection remains unknown. Methods: Patients with pancreatic cancer who underwent resection were identified in the Medicare Standard Analytic Files. Outcomes included overall hospice use, early hospice enrollment (≥4 weeks before death), late hospice enrollment (initiation within 3 days of death), and Medicare expenditures. Results: Among the 4369 deceased individuals, three-fourths of patients (n = 3252, 74.4%) used hospice at the time of death. Patients who did not use hospice were more likely to be male, have a complication on index admission and receive life sustaining treatments on subsequent admissions (P < .05). Only one-third (32.2%) of patients initiated hospice services early. Medicare expenditure during the last month of life was $10 000 lower among patients who initialized hospice services at least 1 month before death versus within 3 days of death (late: $10 581 [$5454-$17 200], early: $221 [$46-$733]; P < .001) Conclusion: While three-fourths of patients utilized hospice services after pancreatic resection, only one-third of patients initiated hospice services at least one-month before death. Late hospice use was associated with higher Medicare expenditures during the last month of life. Further research is needed to understand barriers to early hospice utilization.

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Section: Methodsmentioning

confidence: 99%

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Paredes

Hyer

Tsilimigras

et al. 2019

Journal of Surgical Oncology

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“…Thus, subjects with a serious disease like ESRD with the NHI faced a much greater economic burden than those with MA. Subjects with high OOP expenditure are more likely to face the risk of CHI [25][26][27][28]. CHE was compared between subjects with MA (n=68) and…”

Section: Discussionmentioning

confidence: 99%

Comparison of Healthcare Utilization and Out-of-pocket Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

Shin¹

2020

Preprint

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Background: Korea's health security system named National Health Insurance and Medical Aid has revolutionized the nation's mandatory health insurance and continues to reduce excessive copayments. However, few have been studied on healthcare utilization and expenditure according to the health security system in case of severe disease. This study looked at reverse discrimination within End-Stage Renal Disease between National Health Insurance and Medical Aid. Methods: Subjects were a total of 305 diagnosed with End-Stage Renal Disease in Korea Health Panel from 2008 to 2013. Chi-square, t-test, and ANCOVA were conducted to identify healthcare utilization rate, out-of-pocket expenditure, and catastrophic expenditure rate. Fixed effect panel analysis was used to evaluate total out-of-pocket expenditure over a 6-year trend by National Health Insurance and Medical Aid. Results: There were no significant differences in healthcare utilization rate in emergency-room visits, admission, or out-patient department visits between National Health Insurance and Medical Aid because healthcare service was essential for a serious disease such as End-Stage Renal Disease. Meanwhile, each out-of-pocket expenditure for admission and out-patient department in National Health Insurance was 2.6 and 3.1 times higher than Medical Aid (P<0.05). A total of out-of-pocket expenditure including emergency-room visits, admission, out-patient department visits, and prescribed drug expenditure was 2.9 times higher in National Health Insurance than those of Medical Aid (P<0.001). Over a 6-year trend for a total of out-of-pocket expenditure, subjects with National Health Insurance spent more than those of Medical Aid (P<0.01). If annual household gross income was less than the median and subjects were covered by National Health Insurance, the catastrophic health expenditure rate was 85.9%, but 47.1% in Medical Aid (P<0.001). Conclusion: Serious disease such as End-Stage Renal Disease can result in reverse discrimination depending on the type of health security system. It is necessary to consider those who belong to National Health Insurance but are still poor. Key words: National Health Insurance, Medical Aid, Healthcare utilization, Out-of-pocket expenditure, End-stage Renal Disease, Catastrophic health expenditure

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“…Thus, subjects with a serious disease like ESRD with the NHI faced a much greater economic burden than those with MA. Furthermore, subjects with high OOP expenditure are more likely to face the risk of CHE [25][26][27][28]. CHE was compared between subjects with NHI under the median of household income decile and with MA.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Out-of-Pocket Expenditure and Catastrophic Health Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

Shin

Lee²

2020

Preprint

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Background: Korea's health security system named National Health Insurance and Medical Aid has revolutionized the nation's mandatory health insurance and continues to reduce excessive copayments. However, few have been studied on healthcare utilization and expenditure according to the health security system in case of severe disease. This study looked at reverse discrimination within end-stage renal disease between National Health Insurance and Medical Aid. Methods: Subjects were a total of 305 diagnosed with end-stage renal disease in Korea Health Panel from 2008 to 2013. Chi-square, t-test, and ANCOVA were conducted to identify healthcare utilization rate, out-of-pocket expenditure, and prevalence of catastrophic expenditure. Mixed effect panel analysis was used to evaluate total out-of-pocket expenditure over a 6-year trend by National Health Insurance and Medical Aid. Results: There were no significant differences in healthcare utilization rate in emergency-room visits, admission, or out-patient department visits between National Health Insurance and Medical Aid because healthcare service was essential for a serious disease such as End-stage Renal Disease.Meanwhile, each out-of-pocket expenditure for admission and out-patient department in National Health Insurance was 2.6 and 3.1 times higher than Medical Aid (P<0.05). A total of out-of-pocket expenditure including emergency-room visits, admission, out-patient department visits, and prescribed drug expenditure was 2.9 times higher in National Health Insurance than those of Medical Aid (P<0.001). Over a 6-year trend for a total of out-of-pocket expenditure, subjects with National Health Insurance spent more than those of Medical Aid (P<0.01). If total household income decile was less than the median and subjects were covered by National Health Insurance, the catastrophic health expenditure rate was 92.2%, but 58.8% in Medical Aid (P<0.001). Conclusion: Serious disease such as end-stage renal disease can result in reverse discrimination depending on the type of health security system. It is necessary to consider those who belong to National Health Insurance but are still poor.

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Association Between Hospice Length of Stay, Health Care Utilization, and Medicare Costs at the End of Life Among Patients Who Received Maintenance Hemodialysis

Cited by 79 publications

References 51 publications

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Comparison of Healthcare Utilization and Out-of-pocket Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

Comparison of Out-of-Pocket Expenditure and Catastrophic Health Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

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