Zhong Li1,2, Shan Jiang3, Chengzhong Xu4, Fangfang Lu4, Ruibo He1,2, Zijin Pan1,2, Pei Zhang4, Liang Zhang1,2. 1. School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China. 2. Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China. 3. School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China. 4. Yichang Center for Disease Control and Prevention, Yichang, Hubei, China.
Abstract
OBJECTIVE: To determine factors influence place of death (POD) for end-stage cancer patients and investigate how the healthcare utilization mediates on the effect of socioeconomic status (SES) on POD. DESIGN: A population-based, retrospective study from July 2015 to June 2017. SETTING: Yichang, China. PARTICIPANTS: 894 end-stage cancer patients. MAIN OUTCOME MEASURE: POD. RESULTS: Patients of hospital death experience more inpatient hospitalization services (IHS) and emergency department visits. Patients enrolled in the New Rural Cooperative Medical Scheme (OR = 7.60, P < 0.001) and Urban Employee Basic Medical Insurance (OR = 28.0, P < 0.001) have higher rates of hospital death than those in the Urban Resident-based Basic Medical Insurance. Living with spouse (OR = 1.72, P = 0.019) and receiving higher education (OR = 1.92, P = 0.004), increase the likelihood of hospital death by 72% and 92%, respectively. The probability of hospital death will increase by 14% and decrease by 4% per IHS and outpatient services occur, respectively. Outpatient services (Z = -2.28, P < 0.001), and IHS (Z = 2.17, P < 0.001) mediate 1.81% and 1.89%, respectively, of the effect of health insurance on POD. The overall effect of the mediators is non-statistically significant (Z = 0.09, P = 0.825). CONCLUSION: POD is mainly driven by SES. The relationship between health insurance and POD is partly mediated by outpatient services and IHS, respectively. The results corroborated that hospital and home services should be coherently bridged. Furthermore, benefit packages for end-stage cancer patients could be redesigned.
OBJECTIVE: To determine factors influence place of death (POD) for end-stage cancerpatients and investigate how the healthcare utilization mediates on the effect of socioeconomic status (SES) on POD. DESIGN: A population-based, retrospective study from July 2015 to June 2017. SETTING: Yichang, China. PARTICIPANTS: 894 end-stage cancerpatients. MAIN OUTCOME MEASURE: POD. RESULTS:Patients of hospital death experience more inpatient hospitalization services (IHS) and emergency department visits. Patients enrolled in the New Rural Cooperative Medical Scheme (OR = 7.60, P < 0.001) and Urban Employee Basic Medical Insurance (OR = 28.0, P < 0.001) have higher rates of hospital death than those in the Urban Resident-based Basic Medical Insurance. Living with spouse (OR = 1.72, P = 0.019) and receiving higher education (OR = 1.92, P = 0.004), increase the likelihood of hospital death by 72% and 92%, respectively. The probability of hospital death will increase by 14% and decrease by 4% per IHS and outpatient services occur, respectively. Outpatient services (Z = -2.28, P < 0.001), and IHS (Z = 2.17, P < 0.001) mediate 1.81% and 1.89%, respectively, of the effect of health insurance on POD. The overall effect of the mediators is non-statistically significant (Z = 0.09, P = 0.825). CONCLUSION: POD is mainly driven by SES. The relationship between health insurance and POD is partly mediated by outpatient services and IHS, respectively. The results corroborated that hospital and home services should be coherently bridged. Furthermore, benefit packages for end-stage cancerpatients could be redesigned.
Authors: Dai Su; Zhifang Chen; Jingjing Chang; Guangwen Gong; Dandan Guo; Min Tan; Yunfan Zhang; Yanchen Liu; Xinlan Chen; Xinlin Chen; Yingchun Chen Journal: Int J Environ Res Public Health Date: 2020-12-16 Impact factor: 3.390
Authors: Li Weng; Yizhen Hu; Zhijia Sun; Canqing Yu; Yu Guo; Pei Pei; Ling Yang; Yiping Chen; Huaidong Du; Yuanjie Pang; Yan Lu; Junshi Chen; Zhengming Chen; Bin Du; Jun Lv; Liming Li Journal: Lancet Reg Health West Pac Date: 2021-11-09