Objective: To examine whether patterns of hospice use by older Medicare ben
eficiaries are consistent with the differing financial incentives in Medica
re managed care (MC) and fee-for-service (FFS) settings. Specifically, are
use patterns consistent with incentives that might encourage hospice use fo
r MC enrollees and discourage hospice use for FFS enrollees?
Study Design: One-year study of hospice use by Medicare beneficiaries dying
in 1996.
Patients and Methods: Medicare enrollment and hospice administrative data w
ere used to examine hospice use before death for all elderly individuals re
siding in 100 US counties with high MC enrollment in 1996. Age-, sex-, and
race-adjusted rate of hospice use and length of stay in hospice are compare
d between FFS and MC enrollees across and within (when possible) the 100 co
unties.
Results: Rates of hospice use were significantly higher for MC enrollees th
an for FFS enrollees (26.6 vs 17.0 per 100 deaths; P < .001). These differe
nces persisted within age, sex, and race groups but were not related to are
a MC enrollment rate or the amount of money paid to managed care organizati
ons. Age-, sex-, and race-adjusted differences were observed in 94 of 100 c
ounties. Length of stay in hospice was marginally longer for MC enrollees t
han for FFS enrollees (median, 24 vs 21 days; P < .0001).
Conclusions: System of care is an important determinant of hospice use in t
he elderly Medicare population.