Home-Based Hospice Care Reduces End-of-Life Expenditure in Taiwan

Inpatient hospice care can reduce futile treatment and medical costs. However, the cost trimming effect of home-based hospice care in hospital has yet not been explored. This study evaluates the impact of home-based hospice care on end-of-life expenditure in hospitals with different spending intensity. This is a population-based retrospective study in Taiwan. Cancer decedents were identified in the National Health Insurance Research Database (NHIRD) from 2009 to 2011. They are categorized by hospital spending intensity. A hierarchical linear regression model with a random-intercept model was used to analyze the relationship between end-of-life expenditure (dependent variable) with and without homebased hospice, and both patient-level and hospital-level characteristics. A total of 78,613 cancer decedents were identified in the NHIRD from 2009 to 2011. Of these decedents, 17,638, 43,286, and 17,689 were categorized by hospital spending intensity as high, moderate, and low, respectively. Decedents with home-based hospice care were associated with US$2452 less in expenditure per patient compared with those without home-based hospice care. The majority of savings occurred in the last 3 months of life. These savings with home-based hospice care were consistent in hospitals with different levels of spending intensity. Home-based hospice reduced one-fifth expenditure at the end of life of cancer decedents treated in hospitals with different spending MD, and Chih-Yuan Huang, MD Abbreviations: CCIS = Charlson Comorbidity Index Score, EOL = end of life, HSI = hospital spending intensity, ICD-9-CM = International Classification of Disease, 9th Revision, Clinical Modification, NHIRD = National Health Insurance Research Database, SD = standard deviation, SES = socioeconomic status. INTRODUCTION E nd-of-life (EOL) care is an issue in terminal decedents with cancer. In the United States, more than 1 quarter of Medicare spending was consumed by EOL care of decedents in their last year of life. Futile treatment has been discussed extensively. And in Canada, decedents with <6 months of life comprised 1.1% of the population but consumed more than one-fifth of healthcare spending. Hospice care is a management to reduce the expenditure and increase quality of life at the EOL. Hospice care can benefit terminally ill patients by increasing family satisfaction, and reduce futile treatment and medical costs. On the other hand, hospice disenrollment is a marker for higher healthcare use and expenditure for care. Many studies have investigated the relationship between inpatients hospice care and EOL treatment and costs. Contrasted with inpatient hospice care, the cost trimming effect of home-based hospice care in hospitals with different spending intensity has yet not been explored. Although it has been mentioned early in 1992. As the telemedicine systems develop, home-based hospice is becoming more feasible and convenient. Rural area previous in lack of hospice may benefit from home-based hospice care. The aim of this study was to increase our understanding about the expenditure-reducing effect of home-based hospice care in hospitals with different levels of spending intensity. We investigated whether home-based hospice care can reduce EOL costs in all kinds of hospitals.