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Supportive Care in Cancer

, Volume 22, Issue 7, pp 1907–1914 | Cite as

Hospice shared-care saved medical expenditure and reduced the likelihood of intensive medical utilization among advanced cancer patients in Taiwan—a nationwide survey

  • Wen-Yuan Lin
  • Tai-Yuan Chiu
  • Chih-Te Ho
  • Lance E. Davidson
  • Hua-Shui Hsu
  • Chiu-Shong Liu
  • Chang-Fang Chiu
  • Ching-Tien Peng
  • Chih-Yi Chen
  • Wen-Yu Hu
  • Ling-Nu Hsu
  • Chia-Ing Li
  • Tsai-Chung Li
  • Chin-Yu Lin
  • Ching-Yu Chen
  • Cheng-Chieh LinEmail author
Original Article

Abstract

Purpose

Hospice shared care (HSC) is a new care model that has been adopted to treat inpatient advanced cancer patients in Taiwan since 2005. Our aim was to assess the effect of HSC on medical expenditure and the likelihood of intensive medical utilization by advanced cancer patients.

Methods

This is a nationwide retrospective study. HSC was defined as using “Hospice palliative care (HPC) teams to provide consultation and service to advanced cancer patients admitted in the nonhospice care ward.” There were 120,481 deaths due to cancer between 2006 and 2008 in Taiwan. Patients receiving HSC were matched by propensity score to patients receiving usual care. Of the 120,481 cancer deaths, 12,137 paired subjects were matched. Medical expenditures for 1 year before death were assessed between groups using a database from the Bureau of National Health Insurance. Paired t and McNemar’s tests were applied for comparing the medical expenditure and intensive medical utilization before death between paired groups.

Results

Compared to the non-HSC group, subjects receiving HSC had a lower average medical expenditure per person (US$3,939 vs. US$4,664; p < 0.001). The HSC group had an adjusted net savings of US$557 (13.3 %; p < 0.001) in inpatient medical expenditure per person compared with the non-HSC group. Subjects that received different types of HPC had 15.4–44.9 % less average medical expenditure per person and significantly lower likelihood of intensive medical utilization than those that did not receive HPC.

Conclusions

HSC is associated with significant medical expenditure savings and reduced likelihood of intensive medical utilization. All types of HPC are associated with medical expenditure savings.

Keywords

Hospice shared care Palliative care Medical expenditure Advanced cancer 

Notes

Acknowledgments

We thank the medical staff in hospice palliative medicine throughout Taiwan for their assistance in completing this study. This study was financially supported by grants from the Bureau of Health Promotion, Department of Health, Executive Yuan, Taiwan (DOH96-HP-1502, DOH97-HP-1503), from China Medical University Hospital (DMR-99-109), and from Taiwan Department of Health, China Medical University Hospital Cancer Research Center of Excellence (DOH102-TD-B-111-004).

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Wen-Yuan Lin
    • 1
    • 2
    • 3
    • 4
  • Tai-Yuan Chiu
    • 5
  • Chih-Te Ho
    • 1
  • Lance E. Davidson
    • 6
  • Hua-Shui Hsu
    • 1
  • Chiu-Shong Liu
    • 1
    • 3
  • Chang-Fang Chiu
    • 7
  • Ching-Tien Peng
    • 5
  • Chih-Yi Chen
    • 8
  • Wen-Yu Hu
    • 9
  • Ling-Nu Hsu
    • 10
  • Chia-Ing Li
    • 11
  • Tsai-Chung Li
    • 12
  • Chin-Yu Lin
    • 10
  • Ching-Yu Chen
    • 2
  • Cheng-Chieh Lin
    • 1
    • 3
    • 4
    • 13
    Email author
  1. 1.Department of Family MedicineChina Medical University HospitalTaichungTaiwan
  2. 2.Department of Family MedicineNational Taiwan University HospitalTaipeiTaiwan
  3. 3.School of MedicineChina Medical UniversityTaichungTaiwan
  4. 4.Graduate Institute of Clinical Medicine ScienceChina Medical UniversityTaichungTaiwan
  5. 5.Department of PediatricsChina Medical University HospitalTaichungTaiwan
  6. 6.Department of Exercise SciencesBrigham Young UniversityProvoUSA
  7. 7.Division of Hematology/Oncology, Department of Internal MedicineChina Medical University HospitalTaichungTaiwan
  8. 8.Department of Surgical MedicineChina Medical University HospitalTaichungTaiwan
  9. 9.Department of NursingNational Taiwan University HospitalTaipeiTaiwan
  10. 10.Department of NursingChina Medical University HospitalTaichungTaiwan
  11. 11.Department of Medical ResearchChina Medical University HospitalTaichungTaiwan
  12. 12.Graduate Institute of BiostatisticsChina Medical UniversityTaichungTaiwan
  13. 13.Institute of Health Care Administration, College of Health ScienceAsia UniversityTaichungTaiwan

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