title: Cash and compassion: profit status and the delivery of hospice services.
abstract: OBJECTIVE
  To evaluate the relationship of hospice profit status to patient selection and service delivery.
  
  
  METHODS
  We analyzed responses to the 1997 California Office of Statewide Health Planning and Development (OSHPD) annual home care and hospice survey. Outcomes included the percentages of patients with noncancer diagnoses, referred from long-term care, and with government payers; average length of stay (LOS); the intensity and skill mix of nursing services; and potential availability of chemotherapy and radiotherapy. Reduced models controlled for facility type, profit status, urbanicity, and patient-days. Complete models additionally controlled for patient gender, age, race/ethnicity, diagnosis, referral source, and primary reimbursement source.
  
  
  METHODS
  All 176 licensed California hospices in 1997.
  
  
  RESULTS
  We report comparisons of for-profit and not-for-profit hospices as the absolute difference in percentage points between outcomes (e.g., a difference of 40% vs. 50% is reported as a 10 percentage point difference). In reduced models, for-profit hospices reported 17 percentage points more discharges with noncancer diagnoses, 15 percentage points more long-term care referrals, and 8 percentage points more patients with government payers. Average LOS did not differ by profit status. In reduced models, for-profit hospices delivered 0.20 more daily nursing visits on average; this difference was attributable to patient characteristics. The ratio of skilled to total nursing visits was 11 percentage points lower for for-profit hospices compared to not-for-profit hospices in reduced models (7 in complete models). Profit status was unrelated to the potential availability of chemotherapy and radiotherapy.
  
  
  CONCLUSIONS
  For-profit hospices compared to not-for profit hospices serve a higher percentage of persons with noncancer diagnoses, residents of long-term care, and persons with government insurance. Differences in patterns of nursing services among hospices were related to patient characteristics. The potential availability of complex palliative services did not differ by profit status.
authors.affiliation: VA Greater Los Angeles Healthcare System, University of California, Los Angeles
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Rosenfeld
authors.forename: David M
authors.initials: DM
authors.lastname: Carlisle
authors.forename: Barbara
authors.initials: B
authors.lastname: Leake
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D005260:Female; D006269:Health Facilities, Proprietary / Q000191:economics / Q000592:standards; D006302:Health Services Research; D006738:Hospices / Q000191:economics / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011787:Quality of Health Care / Q000191:economics / Q000592:standards; D012044:Regression Analysis; D018709:Statistics, Nonparametric