Decomposition of Medical Cost for End-of-Life Head and Neck Cancer Patients

BACKGROUND: The purpose of this study is to investigate if hospice care has lower medical expenses without compromising quality than other care settings for end-of-life head and neck cancer (ELHNC) patients.METHODS: From Aug. 2000 to Dec. 2010, a retrospective review was conducted in 564 ELHNC patients who died in our hospital system or died within three days after discharge. These patients were hospitalized in four care settings including hospice, intensive care unit (ICU), general ward (GW), and nursing ward (NW). The medical expenses included four main parts: bed, medical personnel, pharmaceutical, and procedure fee.RESULTS: A total of 564 patients were enrolled in our study, 514 male and 50 female respectively. 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.CONCLUSIONS: Compared with the nonhospice 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 the health insurance system of Taiwan for ELHNC patients.