癌症與非癌生命末期病人使用安寧療護對照護利用及費用的影響

Effect of hospice care use on the utilization and expenses of care for end-of-life patients with and without cancer

我國人口快速高齡化，安寧療護需求持續增加，自2009年將八大非癌末期患者納入安寧療護給付範圍後，安寧療護的照護層面更為全面，過往安寧療護影響之研究未包含非癌末期患者，因此，本研究目的係探討癌症與八大非癌患者使用安寧療護對照護利用及費用的影響。方法：本研究採用百萬承保抽樣歸人檔，研究對象為2012年死亡之罹患癌症與八大非癌末期成年患者共5,062人，使用多元邏輯斯迴歸和線性迴歸分析，探討安寧療護使用對於生命末期積極照護利用及整體醫療費用之影響。結果：生命末期病人使用安寧療護可使死亡前30天接受較少侵入性治療，包含加護病房的使用、插管的使用、呼吸器的使用、心肺復甦術的使用，以及死亡時是在醫院。在醫療費用上，使用安寧療護可以減少死亡前1個月的總醫療費用。結論：生命末期病人使用安寧療護，在死亡前積極照護率呈現下降，顯示有使用安寧療護的末期患者，在照護品質上較佳、醫療利用較少且在死亡前一個月的醫療總費用較低。

The demand for hospice care is increasing because of the rapidly aging population in Taiwan. Since 2009, health insurance payments have been expanded to cover eight categories of noncancer terminal diseases, thus making hospice care accessible to more people. Previous discussions on hospice care have focused only on patients with end-of-life cancer, to the neglect of other patients. This study fills this gap by exploring the effect of hospice care expenses and utilization on patients with cancer and patients with noncancer terminal diseases. Methods: Data were obtained from the Million People File - a study of 5,062 adult patients with either cancer or diseases in one of the eight categories of noncancer terminal diseases who died in 2012. Multivariate logistic regression and linear regression were used to verify the use of hospice care for end-of-life aggressive care utilization and overall medical expenses. Results: End-of-life patients receiving hospice care used fewer aggressive treatments 30 days prior to death, including use of intensive care units, intubations, mechanical ventilation, and cardiopulmonary resuscitation, and were less likely to die in a hospital. The use of hospice care reduced the total cost of medical care in the final months before death. Conclusions: In general, for end-of-life patients receiving hospice care, the use of aggressive care before death has been declining. End-of-life patients treated with hospice care had better care quality and less medical utilization. The total medical expenses for hospice care decreased during the final month prior to death.