OBJECTIVES: To examine national variation in use of the Medicare hospice be
nefit by older individuals before their death, and to identify individual c
haracteristics and local market factors associated with hospice use.
DESIGN: Retrospective analysis of Medicare administrative data.
SETTING: Hospice care.
PARTICIPANTS: Older Medicare enrollees who died in 1996.
MEASUREMENTS: Rate of hospice use per 1000 older Medicare beneficiary death
s.
RESULTS: Overall, 155 of every 1000 older Medicare beneficiaries who die us
e hospice before death. This rate is significantly higher among younger old
er persons (P < .001), non-blacks (P < .001), persons living in wealthier a
reas (P < .001), and persons in urban areas (P < .001). Areas with a higher
proportion of non-cancer diagnoses among hospice users have higher rates o
f hospice use for both cancer and non-cancer reasons than areas with a majo
rity of hospice users having cancer diagnoses (P < .001). Hospice use is hi
gher in areas with fewer hospital beds per capita (P < .001), areas with lo
wer in-hospital death rates (P < .001), and areas with higher HMO enrollmen
t (P < .001). Rates of hospice use are also positively related to average r
eimbursements for health care (P < .001) and to physicians per capita (P <
.001). In the largest metropolitan statistical areas (MSAs), rates of hospi
ce use vary more than 11-fold from a low of 35.15 (Portland, ME) to a high
of 397.2 per 1000 deaths (Ft, Lauderdale, FL).
CONCLUSIONS: The wide variation in hospice use suggests that there is great
potential to increase the number of users of the Medicare hospice benefit.