Investigation of reimbursement of patients died in palliative care services

The aim of this study is to investigate the reimbursement of patients who died while receiving palliative care service (PCH). The expenditures of the Social Security Institution (SSI) are in an increasing trend every year. PBHs, which started to be given licensed as of 2015, contributed to this increase. The study, which was planned retrospectively, was carried out on patients affiliated with SSI, between 1 July 2013 and 30 June 2018 at the 2nd Stage State Hospital Palliative Care Center in Ankara. Of the 357 patients included in the study, the mean age was 76.33±13.46, 56% (n=200) were male, and the mean hospitalization period was 24.58±32.16 days. It was detected that the most common diagnosis received by the patients was Diabetes Mellitus with 28% (n=99), the most common seen infection was urinary system infection with 29% (n=105), and the most common seen cancer type was gastrointestinal system cancer. Of the patients, 94% (n=334) were not mobilized and 49% (n=17) had pressure sores. In addition, 65% of these patients (n=234) were fed with a total parenteral solution and 42% (n=150) received respiratory support with a nasal cannula. It was observed that there was no statistically significant linear relationship between the ages of the patients and the length of their stays. No significant correlation was found between Social Security Institution reimbursement amounts (SSRs) and patient ages (rS=0.039, p=0.457). While the median SSR in male patients was 4423.3 TRY (ÇAG: 1821.5-10039.4), this value was determined as 5749.7 TRY (ÇAG: 2057.1-11716.8) in female patients. In the regression model established to determine the factors affecting SSRs, when other properties are kept constant, it was detected that SSR's in logarithmic scale; was 0.945 units (95% CI: 0.710-1.179) on average longer for a patient with infection compared to a patient without; that it was 0.522 units (95% CI: 0.258-0.786) on average longer for the patients fed orally compared to those who were not fed likewise; that it was 0.465 units (95% CI: 0.090-0.840) on average longer for those fed with nazaogastric gavage compared to those who were not fed likewise; that it was 0.643 units (95% CI: 0.273-1.014) on average longer for the patients fed with PEG compared to those who were not fed likewise. (F=19.586, p<0.001, R2=0.252). Considering that PCD is gradually gaining importance and that it will have an effect on the increase of SSI's expenditures, it is thought that guidelines should be created for these services, and plans should be made for care rather than treatment in a way to reduce its burden.