The costs of health care at the end of life are a major issue of health services research. The purpose of this study is to examine the factors related to expenditure of NHI in the last three months of life by adult people who died in 1999 in Taiwan. Methods: Ten thousand individuals aged 20 and over who died in 1999 were randomly selected from the Death Certificate data file. To obtain a complete record of the National Health Insurance reimbursement and utilization experience for these deceased individuals, we linked the sample to the inpatient claims and the outpatient claims files provided by the Bureau of the National Health Insurance. Of this sample, 8,124 of the deceased were matched. The logged sum of an individual's last three months expenses was modeled using intensive care utilization variables and variables specified in the behavioral model of health services utilization developed by Andersen. The behavioral model views the use of health services as a function of the predisposing, enabling, and need characteristics of an individual. Multiple regressions were employed for data analysis. Results: The health care expenditure of the last three months was related to predisposing, need, enabling characteristics, and intensive care utilization variables. The multivariable regression model explained 75.20% of teristics related to the expenditure of NHI by adult beneficiaries in their last three months of life in Taiwan. We suggest that the appropriateness of care for terminal patients, and the relationship between dying cost and age, marital status, regional health care resource deserve further study.
台灣公共衛生雜誌 / Taiwan Journal of Public Health,20(6),451-462.