| Summary: | 碩士 === 臺北醫學大學 === 醫務管理學系 === 94 === Objective: Cancer has become the leading cause of the death in Taiwan since 1982, and cancer deaths have increased noticeably in recent years. Hospice care provides a support care and high quality of care at the end of life. The purpose of this study is to compare the treatment modules and expenditures between hospice and conventional care for terminal cancer patients.
Methods: The study subjects were terminal cancer patients who deceased during their hospital admission during October 1 2000 to December 31 2004. Data was retrieved from Inpatient Expenditures by Admissions files released by the National Health Research Institutes. The study subjects were divided into two groups in terms of care mode. The study group was patients hospitalized in the hospice care (HC) unit. The control group was patients receiving conventional care (CC). The control group was further separated into two groups according to their setting, one is conventional care in a hospital with hospice care services (CC_H), and the other is conventional care in a hospital without hospice care services (CC_NH). We then trace these patients’ expenditures and treatment modules in all their outpatient, emergency visits and inpatient care up to three months before death. The data sources were from Inpatient Expenditures by Admission file, Ambulatory Care Expenditure by Visits file, Details of Inpatient Orders file, and Details of Ambulatory Care Orders file.
Results: Results of this study showed that there were 34,587 decedents for the male’s and female’s top five leading causes of cancer death. Among these deceased patients, there were 6,694 decedents who chose HC and 27,893 decedents who chose conventional care (include CC_H and CC_NH). Medical expenditures and treatment modules were associated care mode, after controlling for patients demographic characteristics and institutional factors. HC had great savings over conventional care. Patients in HC compare with patients in CC were less likely to receive surgery, chemotherapy and anti-neoplasm drug. Among those patients in conventional group, CC_H patients had higher expenditures and were more likely to undergo surgery, chemotherapy and taking anti-neoplasm drug. HC Patients with colorectal and lung cancer tended to receive radiotherapy compare with CC_H and CC_NH patients.
Conclusion: Hospice care consumed less health care resources and had cost-saving benefit. Related policy should be implemented to promote the acceptance of hospice care among patients/family and medical staff in Taiwan.
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