title: A Longitudinal Analysis of Site of Death: The Effects of Continuous Enrollment in Medicare Advantage Versus Conventional Medicare.
abstract: This study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (M-A) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study ( n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008-2010 (34% died in hospital, and 66% died at home, in long-term senior care, a hospice facility, or other setting). Logistic regression estimated the odds of dying in hospital for those continuously enrolled in M-A from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in M-A contracts may reduce the odds of dying in hospital.
authors.affiliation: 1 Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, MA, USA.
authors.forename: Elizabeth Edmiston
authors.initials: EE
authors.lastname: Chen
authors.affiliation: 1 Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, MA, USA.
authors.forename: Edward Alan
authors.initials: EA
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D018588:Fee-for-Service Plans; D005260:Female; D006291:Health Policy; D006738:Hospices / Q000191:economics / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D020398:Medicare Part C; D013727:Terminal Care / Q000191:economics / Q000706:statistics & numerical data; D014481:United States
keywords: Medicare; end-of-life decisions; good death; health policy; hospice; incentives in health care; payment systems