HOSPICE VERSUS HOSPITAL CARE? A COST AND SURVIVAL BENEFIT ANALYSIS

Introduction and Objective: Do no harm seems essential for approaching terminal cancer patients but is frequently challenged by the expectation of curative intent from family members. Therefore, decision making toward terminal illness becomes a dilemma for patients, families, and health care providers. Accordingly many health policies develop guidelines to deal with end of life. The purpose of this study is to investigate if hospice care has lower medical expenses without compromising quality than other care settings. Method: From Aug. 2000 to Dec. 2010, a retrospective review was conducted in 564 head and neck patients who died in hospital system. These patients were hospitalized in four care settings including hospice, ICU, general ward(GW), and nursing ward(NW). The medical expenses included four main parts: bed, medical personnel, pharmaceutical, and procedure fee. Results and Conclusions: The highest total and daily expense of care setting was ICU, followed by GW, NW, and hospice. Besides, ICU care also had the highest bed fee, pharmaceutical, medical personnel, and procedure fee, and hospice care had the lowest pharmaceutical and bed fee. Besides, the percentage of pharmaceutical fee was the highest part at GW and NW. There was no significant statistical difference in patient or family satisfaction among these four groups. Compared with the non-hospice service, hospice care needs the lowest total and daily medical expenses because of its lower pharmaceutical and bed fee. Hence, hospice care is the best way to reduce medical expense and to prevent wasting of medical resources in a health insurance system.