%0 Journal Article
%T Reducing costs at the end of life through provider incentives for hospice care: A retrospective cohort study
%A Bradley Chen
%A Chin-Chi Kuo
%A Nicole Huang
%A Victoria Y Fan
%J Palliative Medicine
%@ 1477-030X
%D 2018
%R 10.1177/0269216318774899
%X Costs of medical care have been found to be highest at the end of life. To evaluate the effect of provider reimbursement for hospice care on end-of-life costs. The policy expanded access to hospice care for end-stage renal disease patients, a policy previously limited to cancer patients only. This study employed a difference-in-differences analysis using a generalized linear model. The main outcome is inpatient expenditures in the last 30£¿days of life. A cohort of 151,509 patients with chronic kidney disease or cancer, aged 65£¿years or older, who died between 2005 and 2012 in the National Health Insurance Research Database, which contains all enrollment and inpatient claims data for Taiwan. Even as end-of-life costs for cancer are declining over time, expanding hospice care benefits to end-stage renal disease patients is associated with an additional reduction of 7.3% in end-of-life costs per decedent, holding constant patient and provider characteristics. On average, end-of-life costs are also high for end-stage renal disease (1.88 times higher than those for cancer). The cost savings were larger among older patients¡ªamong those who died at 80£¿years of age or higher, the cost reduction was 9.8%. By expanding hospice care benefits through a provider reimbursement policy, significant costs at the end of life were saved
%K Hospice care
%K palliative care
%K physician incentives
%K end-stage renal disease
%U https://journals.sagepub.com/doi/full/10.1177/0269216318774899