Charity for the dying: who receives unreimbursed hospice care?
OBJECTIVE
Many deaths occur among persons without insurance coverage for hospice care. We examined the patient and agency characteristics associated with receiving unreimbursed hospice care in a national survey.


RESULTS
We examined the receipt of unreimbursed care using the 1998 National Home and Hospice Care Survey (NHHCS) discharge dataset. Overall, only 3% of hospice patients received unreimbursed care. Because 98% of older adults are eligible for Medicare, we stratified multivariate analysis on age greater or less than 65 years. Among persons less than 65 years of age, younger, nonwhite persons were more likely to receive unreimbursed care, as were persons with cancer. Agencies providing unreimbursed care to persons over the age of 65 years were more likely to be not-for-profit and freestanding.


CONCLUSIONS
Recipients of unreimbursed hospice care are demographically similar to the uninsured, and whether uninsured persons receive unreimbursed hospice care depends on clinical and agency organizational factors related to the motivation to provide unreimbursed care.
D017677:Age Distribution; D000368:Aged; D003625:Data Collection; D005260:Female; D017051:Hospice Care / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms; D017664:Uncompensated Care / Q000706:statistics & numerical data*; D014481:United States