Medicare HMO impact on utilization at the end of life.
OBJECTIVE
To estimate the effect of independent practice association (IPA) model HMOs and the Kaiser Foundation Health Plan's group model on inpatient utilization of Medicare beneficiaries in the last 2 years of life, compared with traditional fee-for-service (FFS) coverage.


METHODS
Data from the Centers for Medicare & Medicaid Services were linked to inpatient discharge data from the California Office of Statewide Health Planning and Development for 1991-2001. A sample of aged Medicare beneficiaries who died between January 1998 and June 2001 and were continuously enrolled during the 2 years before death in (1) FFS (n = 234,498), (2) an IPA (n = 109,577), or (3) Kaiser (n = 29,434) were selected.


METHODS
The probability of at least 1 hospitalization, number of inpatient days given at least 1 hospitalization, and total inpatient days per year in the last 2 years of life were estimated for each subgroup. A 2-part regression model, which adjusted for age, sex, Medicaid status, race, ethnicity, and chronic condition associated with the last hospitalization, was applied to determine the HMO-FFS difference in inpatient utilization during the last 2 years of life.


RESULTS
During their last 2 years of life, decedents in IPAs and Kaiser used approximately 34% and 51% fewer inpatient days, respectively, than decedents in FFS.


CONCLUSIONS
Medicare beneficiaries who died while enrolled in an HMO, particularly Kaiser, had many fewer hospital days during the 2 years before death than beneficiaries who died with FFS coverage.
Fonkych
Kateryna
K
RAND Health Pro gram, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA. fonkych@rand.org
O'Leary
June F
JF
Melnick
Glenn A
GA
Keeler
Emmett B
EB
D000208:Acute Disease / Q000191:economics; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002204:Capitation Fee; D002908:Chronic Disease / Q000191:economics; D005006:Ethnicity; D018588:Fee-for-Service Plans; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007193:Independent Practice Associations / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D017146:Models, Organizational; D013727:Terminal Care / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review