Quantity over Quality? Perception of Designating Long-Term Care Hospitals as Providers of Hospice and Palliative Care

Abstract

Amendment to the Act on Decisions on Life-sustaining Treatment was recently enacted to designate long-term care hospitals as providers of hospice and palliative care. Despite its benefit of providing improved accessibility to end-of-life care, the amendment has raised concerns about its effect on quality of service. This study aimed to use information obtained from an expert group interview and previous studies to compare how cancer patients, family caregivers, physicians, and the general Korean population perceive the potential benefits and risks of this amendment. Methods: We conducted a multicenter crosssectional study from July to October 2016. The included participants answered a structured questionnaire regarding the extent to which they agree or disagree with the questionnaire items indicating the potential benefits and risks of the amendment. Chi-square tests and univariate and multivariate logistic regression analyses were performed. Results: Compared with the general population, physicians agreed more that long-term care hospitals are currently not adequately equipped to provide quality hospice and palliative care. Family caregivers found improved access to long-term care hospitals more favorable but were more likely to agree that these hospitals might prioritize profits, thereby threatening the philosophy of hospice care, and that families might cease to fulfill filial responsibilities. Compared with the general population, cancer patients were more concerned about the potentially decreased service quality in this setting. Conclusion: Although potential service beneficiaries and providers expected improved accessibility of hospice and palliative care services, they were also concerned whether the system can provide adequate quality of end-of-life care.

Disparities of health expenditure associated with the experience of admission in long-term care hospital among patients with colorectal cancer in South Korea: A generalized estimating equation

“…Given the projected increase in healthcare utilization and expenditure for older adults, LTCHs play an important role in meeting the demand for services while promoting efficient healthcare spending [ 20 ]. However, concerns have been raised owing to the rapid increase in the number of LTCHs and the marketization of services.5 This competitive environment has led to excessive competition among LTCHs, resulting in unnecessary healthcare spending and increased health expenses [ 21 , 22 ]. Considering the significant burden posed by cancer and the unnecessary healthcare spending pattern observed in LTCHs, the utilization of LTCHs among patients with cancer may have led to substantial medical expenses [ 23 , 24 ].…”

Disparities in healthcare expenditures according to economic status in cancer patients undergoing end-of-life care

“…In this study, a higher proportion of patients in the ‘high’ economic status received treatment in general hospitals while a greater proportion of individuals is the ‘low’ economic status patients received treatment in long-term care hospitals at end-of-life. Long-term care hospitals focus on providing medical care and functional rehabilitation to a wide range of patients, including patients with geriatric or chronic diseases or undergoing recovery [ 29 , 30 ]. Contrastingly, general hospitals tend to provide more innovative or high-cost services.…”