Effects of life-sustaining treatment plans on healthcare expenditure and healthcare utilization.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Health Expenditures* ; Delivery of Health Care*; Humans ; Cohort Studies ; Withholding Treatment ; Patient Acceptance of Health Care ; Decision Making

Purpose: To develop an ethical and cultural infrastructure for Life-Sustaining Treatment (LST) plan, it is crucial to carefully analyze its impact and ensure that healthcare utilization is maintained at an appropriate level, avoiding excessive medical interventions. This study aims to investigate the effects of LST decisions on both healthcare expenditure and utilization.
Methods: This cohort study utilized claims data from the National Health Insurance Service, encompassing all medical claims in South Korea. We included individuals who had planned to withdraw or withhold their LST between January and December 2018, identified by claim code IA71, IA72, IA73. We followed a total of 28,295 participants with documented LST plan who were deceased by June 2020. Participants were categorized into LST withdrawal / withholding and LST continuation groups. The dependent variables were healthcare expenditure and utilization. We construct a generalized linear model to analyze the association between these variables.
Results: Out of the 28,295 participants, 24,436 (86.4%) chose to withdraw or withhold LST, while the rest opted for its continuation. Compared to the LST continuation group, those who chose to withdraw or withhold LST had 0.91 times lower odds for total cost. Additionally, they experienced 0.91 times fewer hospitalization days and 0.92 times fewer outpatient visits than those in the LST continuation group.
Conclusion: Healthcare expenditure and utilization deceased among those choosing to withdraw or withhold LST compared to those continuing it. These findings underscore the significance of patients actively participating in decision regarding their treatment to ensure appropriate levels of medical intervention for LST. Furthermore, they emphasize the critical role of proper education and the establishment of a cultural framework for LST plans.
(© 2023. The Author(s).)

Arch Intern Med. 2006 Mar 13;166(5):560-4. (PMID: 16534044)
Cancer. 2008 May 15;112(10):2221-7. (PMID: 18348300)
Health Aff (Millwood). 2003 Nov-Dec;22(6):27-39. (PMID: 14649430)
BMJ Open. 2017 Sep 24;7(9):e016640. (PMID: 28947447)
Neurospine. 2018 Mar;15(1):66-76. (PMID: 29656624)
Psychooncology. 2016 Aug;25(8):919-26. (PMID: 26282448)
Palliat Med. 2014 Sep;28(8):1000-25. (PMID: 24651708)
Int J Environ Res Public Health. 2020 Jun 26;17(12):. (PMID: 32604879)
JAMA. 2000 Nov 15;284(19):2550. (PMID: 11185392)
Gynecol Oncol. 2013 Jul;130(1):156-61. (PMID: 23587882)
Intensive Care Med. 1999 Sep;25(9):949-54. (PMID: 10501750)
Am J Bioeth. 2019 Mar;19(3):10-20. (PMID: 30896350)
JAMA. 2019 Nov 05;322(17):1692-1704. (PMID: 31577037)
BMC Health Serv Res. 2015 Apr 20;15:170. (PMID: 25928166)

2021R1G1A1010954 National Research Foundation

Keywords: Health expenditures; Health utilization; Life support care; Terminal care; Withholding treatment

Date Created: 20231110 Date Completed: 20231113 Latest Revision: 20231122

20231122

PMC10638738

10.1186/s12913-023-10235-x

37950202