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

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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.

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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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Authors and Affiliations

  1. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan

    Wen-Yuan Lin, Chih-Te Ho, Hua-Shui Hsu, Chiu-Shong Liu & Cheng-Chieh Lin

  2. Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Wen-Yuan Lin & Ching-Yu Chen

  3. School of Medicine, China Medical University, Taichung, Taiwan

    Wen-Yuan Lin, Chiu-Shong Liu & Cheng-Chieh Lin

  4. Graduate Institute of Clinical Medicine Science, China Medical University, Taichung, Taiwan

    Wen-Yuan Lin & Cheng-Chieh Lin

  5. Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan

    Tai-Yuan Chiu & Ching-Tien Peng

  6. Department of Exercise Sciences, Brigham Young University, Provo, UT, USA

    Lance E. Davidson

  7. Division of Hematology/Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

    Chang-Fang Chiu

  8. Department of Surgical Medicine, China Medical University Hospital, Taichung, Taiwan

    Chih-Yi Chen

  9. Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan

    Wen-Yu Hu

  10. Department of Nursing, China Medical University Hospital, Taichung, Taiwan

    Ling-Nu Hsu & Chin-Yu Lin

  11. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan

    Chia-Ing Li

  12. Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan

    Tsai-Chung Li

  13. Institute of Health Care Administration, College of Health Science, Asia University, Taichung, Taiwan

    Cheng-Chieh Lin

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  1. Wen-Yuan Lin
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  3. Chih-Te Ho
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  4. Lance E. Davidson
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  13. Tsai-Chung Li
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  14. Chin-Yu Lin
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  15. Ching-Yu Chen
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  16. Cheng-Chieh Lin
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Correspondence to Cheng-Chieh Lin.

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Lin, WY., Chiu, TY., Ho, CT. et al. Hospice shared-care saved medical expenditure and reduced the likelihood of intensive medical utilization among advanced cancer patients in Taiwan—a nationwide survey. Support Care Cancer 22, 1907–1914 (2014). https://doi.org/10.1007/s00520-014-2168-5

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  • DOI: https://doi.org/10.1007/s00520-014-2168-5

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