尽管为了改善晚期癌症患者及其护理人员的生活质量而将临终关怀纳入健康保险范围，但很少有研究评估该政策涵盖家庭临终关怀服务的效果。在韩国引入保险覆盖的家庭临终关怀服务后，癌症患者的死亡地点发生了变化。这项队列研究使用了2018年2月1日至2021年12月31日的数据，数据来自死亡原因统计韩国统计局每年发布的数据库，其中包含该国所有死亡的信息。死于癌症（一种符合临终关怀资格的代表性疾病）的个体被分配到病例组，而死于痴呆（一种不符合临终关怀资格的疾病）的个体被分配到对照组。研究人群共有 218,522 人。由于韩国健康保险院于 2020 年 9 月 1 日开始承保家庭临终关怀服务，最后随访日期为 2021 年 12 月 31 日，因此随访期干预前和干预后分别为31个月和16个月（干预前：2018年2月1日至2020年8月31日；干预后：2020年9月1日至2021年12月31日）。根据是否是该人自己的家而定的二进制变量。应用分段回归的比较中断时间序列模型来分析时间趋势及其结果变化。在符合分析条件的 218522 例死亡中（平均 [SD] 死亡年龄，78.6 [8.8] 岁；130435 名男性 [ 59.7%]），207459 例因癌症，11063 例因痴呆症。引入家庭临终关怀后，癌症患者的家庭死亡率比痴呆患者高 24.5%（估计为 1.245 [95% CI，1.030-1.504]；P = .02）。干预后，生活在农村地区的癌症死亡和痴呆死亡之间的水平变化差异更为明显（估计为 1.320 [95% CI，1.118-1.558]；P = .001）。此外，较高的教育水平与家庭临终关怀带来的即时效应大小差异较大相关（低教育水平：估计，1.205 [95% CI，1.025-1.416]；P = .02；中等教育水平水平：估计，1.307 [95% CI，0.987-1.730]，P = .06；高教育水平：估计，1.716 [95% CI，0.932-3.159]；P = .08)。在韩国保险强制要求以家庭为基础的临终关怀之后，癌症患者的死亡地点在干预后癌症患者在家中死亡的可能性增加了。这一发现表明需要扩大家庭临终关怀的范围，以尊重绝症患者的自主权并提高他们的死亡质量。

Although hospice care has been covered by health insurance for the purpose of improving the quality of life of patients with terminal cancer as well as their caregivers, few studies have evaluated the outcomes of the policy to cover home-based hospice care services.To investigate the changes in the place of death of patients with cancer after the introduction of insurance-covered, home-based hospice care services in Korea.This cohort study used data from February 1, 2018, to December 31, 2021, from the Causes of Death Statistics database, released annually by Statistics Korea, which contains information on all deaths in the country. Individuals who died of cancer, a representative hospice-eligible disease, were assigned to the case group, and those who died of dementia, a non-hospice-eligible disease, were assigned to the control group. A total of 218 522 individuals constituted the study population.Because the Korean Health Insurance Service had begun covering home-based hospice care services on September 1, 2020, and the last follow-up date was December 31, 2021, the follow-up periods for before and after intervention were 31 months and 16 months, respectively (preintervention period: February 1, 2018, to August 31, 2020; postintervention period: September 1, 2020 to December 31, 2021).The place of death was categorized as a binary variable according to whether it was the person's own home or not. Comparative interrupted time-series models with segmented regression were applied to analyze the time trend and its change in outcomes.Of the 218 522 deaths eligible for the analysis (mean [SD] age at death, 78.6 [8.8] years; 130 435 men [59.7%]), 207 459 were due to cancer, and 11 063 were due to dementia. Immediately after the introduction of home-based hospice care, the rate of home deaths was 24.5% higher for patients with cancer than for those with dementia (estimate, 1.245 [95% CI, 1.030-1.504]; P = .02). The difference in the level change between cancer deaths and dementia deaths, on intervention, was more pronounced for those living in rural areas (estimate, 1.320 [95% CI, 1.118-1.558]; P = .001). In addition, a higher educational level was associated with a larger difference in the immediate effect size due to home-based hospice care (low educational level: estimate, 1.205 [95% CI, 1.025-1.416]; P = .02; middle educational level: estimate, 1.307 [95% CI, 0.987-1.730], P = .06; high educational level: estimate, 1.716 [95% CI, 0.932-3.159]; P = .08).In this cohort study exploring the changes in the place of death for patients with cancer after the insurance mandates for home-based hospice care in Korea, the probability of patients with cancer dying in their own homes increased after the intervention. This finding suggests the need to broaden the extent of home-based hospice care to honor the autonomy of individuals with terminal illness and improve their quality of death.