Association between Provider Volume and Healthcare Expenditures of Patients with Oral Cancer in Taiwan: A Population-Based Study

Chen, Lifu; Ho, Han‐Chen; Su, Yu‐Chieh; Lee, Moon‐Sing; Hung, Shih‐Kai; Chou, Pesus; Lee, Ching-Chieh J.; Lin, Luke; Lee, Ching‐Chih

doi:10.1371/journal.pone.0065077

Cited by 7 publications

(6 citation statements)

References 23 publications

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“…In the aging Taiwan society, there is also an increasing number of individuals dying of cancer who are covered by the national health insurance (NHI) system. Approximately 29,000 Taiwanese people died from cancer in 1997, and this increased to 40,300 in 2007, which accounted for 13 percent of deaths attributable to cancer [ 2 , 3 ]. There is a growing appreciation of cancer patients’ needs for end-of-life (EOL) care services, especially for those with terminal illnesses.…”

Section: Introductionmentioning

confidence: 99%

Emergency visits among end-of-life cancer patients in Taiwan: a nationwide population-based study

et al. 2015

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BackgroundAn increased number of emergency visits at the end of life may indicate poor-quality cancer care. The study aimed to investigate the prevalence and utilization of emergency visits and to explore the reasons for emergency department (ED) visits among cancer patients at the end of life.MethodsA retrospective cohort study was performed by tracking one year of ambulatory medical service records before death. Data were collected from the cancer dataset of Taiwan’s National Health Insurance Research Database (NHIRD).ResultsA total of 32,772 (19.2%) patients with malignant cancer visited EDs, and 23,883 patients died during the study period. Of these, the prevalence of emergency visits in the mortality group was 81.5%, and their ED utilization was significantly increased monthly to the end of life. The most frequent types of cancer were digestive and peritoneum cancers (34.8%), followed by breast cancer (17.7%) and head and neck cancers (13.3%). Older patients, males, and those diagnosed with metastases, respiratory or digestive cancer were more likely to use ED services at the end of life. Use of an ED service in the nearest community hospital to replace medical centers for dying cancer patients would be more acceptable in emergency situations.ConclusionsOur study provided population-based evidence related to ED utilization. An understanding of the reasons for such visits could be useful in preventing overuse of ED visits to improve the quality of end-of-life care.

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Section: Introductionmentioning

confidence: 99%

Emergency visits among end-of-life cancer patients in Taiwan: a nationwide population-based study

et al. 2015

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“…; Chen et al . 2013a,b). Medical centre physicians with well‐trained staff could perform treatment with a shortened operation period, appropriate antimicrobials and procedures, and well‐designed discharge planning, thereby resulting in fewer complications, shorter hospital stays, lower mortality rates and lower medical expenses (Halm et al .…”

Section: Discussionmentioning

confidence: 99%

“…; Chen et al . 2013a,b). This observation is consistent with a previous study projected that asserts that medical centres could have improved care organisation and best‐practice protocols.…”

Section: Discussionmentioning

confidence: 99%

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Mortality and cost of radiation therapy for oesophageal cancer according to hospital accreditation level: a nationwide population-based study

Liu

Day

et al. 2015

Eur J Cancer Care (Engl)

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This study examined and analysed the relationship between the cost-effectiveness and outcome of radiotherapy for oesophageal cancer among hospitals with varying accreditation levels. We selected 428 oesophageal cancer patients from medical and non-medical centres using the National Health Insurance Research Database, which is maintained by the Taiwanese National Health Research Institutes, and compared their medical expenditure and the outcome of their radiotherapy treatment. In this study cohort of patients with oesophageal cancer, 278 patients were treated in medical centres (mean age: 60.1 years) and 150 patients were treated in non-medical centres (mean age: 62.0 years, P = 0.16). The medical centre group exhibited significantly lower medical expenses, mortality and risk of death compared with the non-medical centre group (adjusted hazard ratio = 1.38, 95% confidence interval = 1.11-1.71). Our study determined that radiotherapy for oesophageal cancer costs significantly less, and medical centres had lower mortality rates than non-medical centres. These findings could provide professional organisations and healthcare policy makers with essential information for allocation of resources.

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“…The goodness of fit between the association of the end-of-life expenditures and explanatory variables by multiple linear regression was assessed with residual analysis, and we found that it was not suitable for implementing multiple linear regression due to unequal variance assumption ( S1 Fig ). Considering the clustering effect of physician compensation, procedures and policy in each hospital ( S2 Fig ), the impact of each variable on medical cost was examined by hierarchical generalized linear model using a hospital-level random-intercept model [ 11 – 13 ]. A two-tailed value of p<0.05 was considered significant.…”

Section: Methodsmentioning

confidence: 99%

Determinants of End-of-Life Expenditures in Patients with Oral Cancer in Taiwan: A Population-Based Study

Lee

Chang

et al. 2015

PLoS ONE

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BackgroundTo investigate the association of basic demographic data, socioeconomic status, medical services, and hospital characteristics with end-of-life expenditure in patients with oral cancer in Taiwan who died between 2009 to 2011.MethodsThis nationwide population-based, retrospective cohort study identified 5,386 patients who died from oral cancer. We evaluated medical cost in the last month of life by universal health insurance. The impact of each variable on the end-of-life expenditure was examined by hierarchical generalized linear model (HGLM) using a hospital-level random-intercept model.ResultsThe mean medical cost in the last six months of life was $2,611±3,329 (U.S. dollars). In HGLM using a random-intercept model, we found that patients younger than 65 years had an additional cost of $819 over those aged ≥65 years. Patients who had a high Charlson Comorbidity Index Score (CCIS) had an additional $616 cost over those with a low CCIS. Those who survived post-diagnosis less than 6 months had an additional $659 in expenses over those who survived more than 24 months. Medical cost was $249 more for patients who had medium to high individual SES, and $319 more for those who were treated by non-oncologists.ConclusionThis study provides useful information for decision makers in understanding end-of-life expenditure in oral cancer. We found significantly increased end-of-life expenditure in patients if they were younger than 65 years or treated by non-oncologists, or had high CCIS, medium to high individual SES, and survival of less than 6 months after diagnosis.

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Association between Provider Volume and Healthcare Expenditures of Patients with Oral Cancer in Taiwan: A Population-Based Study

Cited by 7 publications

References 23 publications

Emergency visits among end-of-life cancer patients in Taiwan: a nationwide population-based study

Emergency visits among end-of-life cancer patients in Taiwan: a nationwide population-based study

Mortality and cost of radiation therapy for oesophageal cancer according to hospital accreditation level: a nationwide population-based study

Determinants of End-of-Life Expenditures in Patients with Oral Cancer in Taiwan: A Population-Based Study

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