The impacts of the scope of benefits expansion on hospice care among adult decedents: a nationwide longitudinal observational study

Abstract

Objectives: Compared to aggressive treatment for patients at the end stage of life, hospice care might be more likely to satisfy such patients' need and benefits and improve their dignity and quality of life. Whether the reimbursement policy expansion affect the use of hospice care among various demographics characteristics and health status was unknown. Therefore, the purpose of this study was to explore the impacts of reimbursement policy expansion on hospice care use, and to investigate the effects on people with various demographics characteristics and health status.

Methods: We used the 2001-2017 Taiwan NHI claims data, Death Registry, and Cancer Registry in this study, and we included people who died between 2002 and 2017. The study period was divided into 4 sub-periods. hospice care use and the initiation time of 1st hospice care use were used as dependent variables; demographic characteristics and health status were also collected.

Results: There were 2,445,781 people who died in Taiwan during the study period. The results show that the trend of hospice care use increased over time, going steeply upward after the scope of benefits expansion, but the initiation time of 1st hospice care use did not increase after the scope of benefits expansion. The results also show that the effects of expansion varied among patients by demographic characteristics.

Conclusion: The scope of benefits expansion might induce people's needs in hospice care, but the effects varied by demographic characteristics. Understanding the reasons for the variations in all populations would be the next step for Taiwan's health authorities.

Keywords: Health Care utilization; Hospice care; Population characteristics.

Fig. 1

The Trend of the hospice care Use: by demographic characteristics and health status. a. The Trend of the hospice care Use: by age of death. b. The Trend of the hospice care Use: by gender. c. The Trend of the hospice care Use: by marital status. d. The Trend of the hospice care Use: by poverty status. e. The Trend of the hospice care Use: by urbanization of residence. f. The Trend of the hospice care Use: by history of severe disease. g. The Trend of the hospice care Use: by experience in receiving CPR

Fig. 2

Initiation time of the 1st hospice care use: by demographic characteristics and health status. a. Initiation time of the 1st hospice care use: by age of death. b. Initiation time of the 1st hospice care use: by gender. c. Initiation time of the 1st hospice care use: by marital status. d. Initiation time of the 1st hospice care use: by poverty status. e. Initiation time of the 1st hospice care use: by urbanization of residence. f. Initiation time of the 1st hospice care use: by history of severe disease. g. Initiation time of the 1st hospice care use: by experience in receiving CPR.