Abstract
BackgroundThis study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants.MethodAt the Pusan National University Hospital hospice center, between January 2015 and April 2016, 276 patients were hospitalized with several diagnosed types of terminal stage cancer. This study separated patients into two groups, “old” and “new,” by admission date, considering the new system has been applied from July 15, 2015. The study subsequently compared LoS, total cost, and out-of-pocket expenses for the two groups.ResultsOverall, 142 patients applied to the new medical insurance payment system group, while the old medical insurance payment system included 134 patients. The results do not show a significantly negative difference in LoS for the new system group (p = 0.054). Total cost is higher within the new group (p < 0.001); however, the new system registers lower patient out-of-pocket expenses (p < 0.001).ConclusionThe novelty of this study is proving that the new medical insurance payment system is not inferior to the classic one in terms of LoS. The total cost of the new system increased due to a multidisciplinary approach toward palliative care. However, out-of-pocket expenses for patients overall decreased, easing their financial burden.
Highlights
This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants
Overall, 142 patients applied to the new medical insurance payment system group, while the old medical insurance payment system included 134 patients
134 patients belong to the old payment system group and 142 to the new payment system group
Summary
This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants. When the cancer cannot be controlled anymore, a healthcare team determines whether to stop medical testing and treatment [2] For such patients, medical facilities can provide palliative care, which includes medical treatment to alleviate pain and symptoms, and psychological, social, and spiritual therapies [2, 3]. The existing Korean national medical insurance system is a fee-for-service system that covers only medical treatment, making it impossible for patients and their families to obtain any psychological, social, or spiritual support via the national insurance system [9]. It does not cover admission room and individual nursing fees [9]. There are several studies that evaluated the effect of the DRG system in surgical groups [12, 13] or other countries [14,15,16], but
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