Sun Jung Kim1, Kyu-Tae Han2, Tae Hyun Kim3, Eun-Cheol Park4. 1. Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Korea. 2. Department of Public Health, Yonsei University College of Medicine, Seoul, Korea Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea. 3. Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, Korea. 4. Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea ecpark@yuhs.ac.
Abstract
BACKGROUND: Previous studies found that hospice and palliative care reduces healthcare costs for end-of-life cancer patients. AIM: To investigate hospital inpatient charges and length-of-stay differences by availability of hospice care beds within hospitals using nationwide data from end-of-life inpatients with lung cancer. DESIGN: A retrospective cohort study was performed using nationwide lung cancer health insurance claims from 2002 to 2012 in Korea. SETTING AND PARTICIPANTS: Descriptive and multi-level (patient-level and hospital-level) mixed models were used to compare inpatient charges and lengths of stay. Using 673,122 inpatient health insurance claims, we obtained aggregated hospital inpatient charges and lengths of stay from a total of 114,828 inpatients and 866 hospital records. RESULTS: Hospital inpatient charges and length of stay drastically increased as patients approached death; a significant portion of hospital inpatient charges and lengths of stay occurred during the end-of-life period. According to our multi-level analysis, hospitals with hospice care beds tend to have significantly lower end-of-life hospital inpatient charges; however, length of stay did not differ. Hospitals with more hospice care beds were associated with reduction in hospital inpatient charges within 3 months before death. CONCLUSION: Higher end-of-life healthcare hospital charges were found for lung cancer inpatients who were admitted to hospitals without hospice care beds. This study suggests that health policy-makers and the National Health Insurance program need to consider expanding the use of hospice care beds within hospitals and hospice care facilities for end-of-life patients with lung cancer in South Korea, where very limited numbers of resources are currently available.
BACKGROUND: Previous studies found that hospice and palliative care reduces healthcare costs for end-of-life cancerpatients. AIM: To investigate hospital inpatient charges and length-of-stay differences by availability of hospice care beds within hospitals using nationwide data from end-of-life inpatients with lung cancer. DESIGN: A retrospective cohort study was performed using nationwide lung cancer health insurance claims from 2002 to 2012 in Korea. SETTING AND PARTICIPANTS: Descriptive and multi-level (patient-level and hospital-level) mixed models were used to compare inpatient charges and lengths of stay. Using 673,122 inpatient health insurance claims, we obtained aggregated hospital inpatient charges and lengths of stay from a total of 114,828 inpatients and 866 hospital records. RESULTS: Hospital inpatient charges and length of stay drastically increased as patients approached death; a significant portion of hospital inpatient charges and lengths of stay occurred during the end-of-life period. According to our multi-level analysis, hospitals with hospice care beds tend to have significantly lower end-of-life hospital inpatient charges; however, length of stay did not differ. Hospitals with more hospice care beds were associated with reduction in hospital inpatient charges within 3 months before death. CONCLUSION: Higher end-of-life healthcare hospital charges were found for lung cancer inpatients who were admitted to hospitals without hospice care beds. This study suggests that health policy-makers and the National Health Insurance program need to consider expanding the use of hospice care beds within hospitals and hospice care facilities for end-of-life patients with lung cancer in South Korea, where very limited numbers of resources are currently available.