National health insurance expenditure for adult beneficiaries in Taiwan in their last year of life.

BACKGROUND AND PURPOSE: The cost of health care in the last year of life is a major issue of health services research. The purposes of this study were to examine health care use and expenditure under National Health Insurance (NHI) by Taiwanese adults in the last year of life, and to compare their results with those of randomly selected survivors. METHODS: A total of 9,369 adult decedent NHI beneficiaries were selected from NHI enrollee files and the Death Certificate data file for 1999. To compare expenses with those of patients without fatal illness, 10,000 randomly sampled adult beneficiaries of NHI who were alive on December 31, 1999, were selected as a survival group. NHI reimbursement and utilization information for these decedents and survivors were obtained by linking these samples to NHI claims files. RESULTS: The total NHI expenditure in the last year of life for the 9,369 decedents was US$71.6 million. About 54.5% of all medical expenses in the last year of life were incurred in the last 3 months of life. Nephritis and cancer were the most expensive causes of death, with per capita expenses of US$15,220 and US$10,828, respectively. The average expenses for survivors increased with age, while that for decedents increased with age from the 20- to 44-year age group to the 45- to 64-year age group, then decreased for decedents aged 65 and over. The age-dependent pattern of decreasing expenses with increasing age was found in cancer deaths for all age groups and in elderly decedent groups for most causes of death. CONCLUSIONS: This study demonstrated the relatively large amount of health care resources used by Taiwanese NHI participants in their last year of life and suggests the importance of greater awareness of the implications of allocation of medical care resources for terminally ill patients by policymakers and health care providers.