title: Medicare HMO impact on utilization at the end of life.
abstract: 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.
authors.affiliation: RAND Health Pro gram, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA. fonkych@rand.org
authors.forename: Kateryna
authors.initials: K
authors.lastname: Fonkych
authors.forename: June F
authors.initials: JF
authors.lastname: O'Leary
authors.forename: Glenn A
authors.initials: GA
authors.lastname: Melnick
authors.forename: Emmett B
authors.initials: EB
authors.lastname: Keeler
mesh_terms: 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