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The Impact of Withdrawing or Withholding of Life-Sustaining Treatment: A Nationwide Case-Control Study Based on

Claire Junga Kim1, Do-Kyong Kim1, Sookyeong Mun2

  • 1Department of Medical Humanities, Dong-A University College of Medicine, Busan, Korea.

Journal of Korean Medical Science
|February 20, 2024
PubMed

Insights

The Decisions on Life-Sustaining Treatment Act did not reduce medical costs. Patients who chose to forgo life-sustaining treatment incurred higher healthcare expenses, contrary to expectations.

Area of Science:

  • Medical Economics
  • Healthcare Policy
  • End-of-Life Care

Background:

  • The Decisions on Life-Sustaining Treatment Act aimed to respect patient autonomy in end-of-life care.
  • Previous assumptions suggested that withholding or withdrawing life-sustaining treatment might reduce medical costs.

Purpose of the Study:

  • To analyze the impact of the Decisions on Life-Sustaining Treatment Act on medical costs.
  • To investigate whether patients undergoing decisions on life-sustaining treatment incur fewer healthcare expenses.

Main Methods:

  • Analysis of medical cost data from the National Health Insurance Service-National Sample Cohort.
  • Identification of patients who died in 2018-2019.
  • Propensity score matching to create case (implemented life-sustaining treatment) and control groups.

Main Results:

  • The case group (with life-sustaining treatment) exhibited higher medical costs across all periods before death.
  • Significant cost differences were observed in consultation, admission, injection, laboratory tests, imaging and radiation therapy, nursing hospital bundled payments, and special equipment.

Conclusions:

  • This study is the first cost analysis examining the impact of the Decisions on Life-Sustaining Treatment Act.
  • The findings challenge the common expectation that decisions to withhold or withdraw life-sustaining treatment lead to reduced medical costs.

Keywords:
End-of-LifeLife-Sustaining TreatmentNational Health Insurance ServiceThe Act on Determination of Life-Sustaining Treatment

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