High Technology and Patient Self-Paid Care: the Case of the First Proton Beam Therapy Center in Taiwan

BackgroundHigh technology plays an essential role in the field of health care, because it affects outcome and costs directly. Proton is one of the new and costly treatment for cancer treatment compared to traditional photon therapy. The first proton beam center in Taiwan began in November 2015 at Chang Gung Memorial Hospital. Proton treatment costs are entirely out-of-pocket. A single session costs around NT$2,100and it took about $500,000 to complete the full treatment course. Therefore, taking photon bean therapy could be a considerable burden to patients and families. Studies had shown that patients of higher socioeconomic status, insurance coverage, and unfavorable risk factors were associated with the choice of photon therapy. As the choice of treatment type was influenced by many individual factors, the treatment type was no longer an exogenous variable. Instead, it should be taken as an endogenous variable. If this endogeneity was not considered, the estimate of photon treatment on patient survival was likely to be biased. MethodThis study uses data from Chang Gung Memorial Hospital radiology treatment data between January 2014 to May 2017. We apply propensity score matching to choose comparable patients of liver, lung brain cancers in conventional photon treatment against patients of proton treatment. Stata ivprobit model will be used to estimate the marginal effect of proton treatment on patient survival. In the first stage, the average income and/or education of patient domicile is used as instrumental variable to examine whether patient education, socioeconomic status, gender, age, occupation and IV variables are significantly associated with the choice of proton beam therapy. In the second stage, the predicated choice of treatment and all other variables are used to analyze the survival of patients with probit model. We use Stata ivprobit package for the analyses.Expected outcomeTo examine factors associate the choice proton treatment, to investigate the marginal effect of proton treatment on patient survival, and to provide some policy implications on the use of high technology, high costs self-paid medical care.

Project ID:PF10907-2373
External Project ID:MOST109-2410-H182-005