title: Hospice use in Medicare managed care and fee-for-service systems.
abstract: OBJECTIVE
  To examine whether patterns of hospice use by older Medicare beneficiaries are consistent with the differing financial incentives in Medicare managed care (MC) and fee-for-service (FFS) settings. Specifically, are use patterns consistent with incentives that might encourage hospice use for MC enrollees and discourage hospice use for FFS enrollees?
  
  
  METHODS
  One-year study of hospice use by Medicare beneficiaries dying in 1996.
  
  
  METHODS
  Medicare enrollment and hospice administrative data were used to examine hospice use before death for all elderly individuals residing 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 compared between FFS and MC enrollees across and within (when possible) the 100 counties.
  
  
  RESULTS
  Rates of hospice use were significantly higher for MC enrollees than for FFS enrollees (26.6 vs 17.0 per 100 deaths; P < .001). These differences persisted within age, sex, and race groups but were not related to area MC enrollment rate or the amount of money paid to managed care organizations. Age-, sex-, and race-adjusted differences were observed in 94 of 100 counties. Length of stay in hospice was marginally longer for MC enrollees than for FFS enrollees (median, 24 vs 21 days; P < .0001).
  
  
  CONCLUSIONS
  System of care is an important determinant of hospice use in the elderly Medicare population.
authors.affiliation: Division of Health Services Research and Policy, University of Minnesota School of Public Health, 420 Delaware Street SE, MMC 729, Minneapolis, MN 55455, USA. virni001@tc.umn.edu
authors.forename: B A
authors.initials: BA
authors.lastname: Virnig
authors.forename: E S
authors.initials: ES
authors.lastname: Fisher
authors.forename: A M
authors.initials: AM
authors.lastname: McBean
authors.forename: S
authors.initials: S
authors.lastname: Kind
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D012052:Reimbursement, Incentive; D014481:United States