失能老人临终期医疗总费用影响因素研究OA

Objective This study aims to investigate the factors influencing the total end-of-life(EOL)medical expenditure among older adults with disabilities.Methods This study selected older adults with disabilities who were hospitalized and died in Chengdu,Sichuan Province between January 1 and June 30,2024.Hospitalization information within one year prior to death was collected to construct a quantile regression model.This model was utilized to analyze the impact of gender,age,care modality,and disability assessment levels on medical expenditure across various EOL cost levels.Results Institutional care significantly reduced the total EOL medical expenditure for older adults with disabilities.In contrast,seeking care at tertiary medical institutions,participation in the Urban Employee Basic Medical Insurance(UEBMI),and the number of hospitalization days significantly increased these expenditures.As quantile levels increased,the influence of care modality,tertiary institution utilization,and hospitalization days on the total EOL medical expenditure became more pronounced.Conclusions Care modality,hospital level,insurance type,and number of hospitalization days are the main influencing factors of the total medical expenditure among older adults with disabilities at the end of life.Efforts should be made to optimize the Long-term Care Insurance(LTCI)system and transform the care models for older adults with disabilities.It is essential to enhance the consolidation and integration of medical insurance schemes to promote the equitable and rational allocation of EOL medical resources.Furthermore,the hospice and palliative care service network should be improved to alleviate the economic and care burdens on this vulnerable population at the end of life.