安寧療護使用天數對末期病人醫療資源耗用之影響

The impact of length of hospice stay on cost

目標：以健保資料庫探討安寧天數對末期病患醫療資源耗用的影響，期以研究結果推動安寧療護觀念以減少無效醫療。方法：此為實驗對照研究，選取2013年死亡時67歲以上接受安寧之病患，依據性別、年齡、死前366天至730天醫療點數、特定疾病等變項與非安寧者進行1:1隨機配對，兩組各有7,890人。結果：兩組皆離死亡愈近資源耗用愈高，其中安寧組死前7天內之每人醫療點數較非安寧組為低，且其差值愈接近死亡愈明顯，從65點至2,325點。而安寧使用天數與死前0~10天及0~15天之每人費用成反比，安寧天數每多一天，費用減少523及598點；再與非安寧組比較，安寧天數越多點數節省越多，惟該現象於天數達9天及17天以上才顯現。結論：安寧療護可以節省資源，但安寧天數需相當或大於每人費用觀察期間的天數，才能觀察到其資源節省的效益。另精算，安寧組7,890人相較於非安寧組於死前7天內減少約6,056萬之醫療點數。

Objectives: To explore the impact of the length of hospice stay on the medical expenditure for terminally-ill patients by analysis of the database of National Health Insurance (NHI). Methods: This case-controlled study compared decedents over 67 years of age who were hospice users with non hospice decedents in 2013. After one-to-one random matching, there were 7,890 persons in each group. The variables used to create matches were age, gender, specific disease and the medical expenditure between the 366th and 730th days before the date of death. Results: Both hospice users and non hospice users had increased medical expenditure while approaching the date of death. In the 7 days before death, the medical expenditure per hospice users was 65 NT$ lower than that of non hospice users; the saving increased to more than 2,325 NT$ on the final day before death. The medical expenditure of within 10 days before death showed per hospice day reductions of 523 NT$. Conclusions: The longer the hospice stay, the greater the saving in medical expenditure.