Longer Periods Of Hospice Service Associated With Lower End-Of-Life Spending In Regions With High Expenditures.
Hospice use is expected to decrease end-of-life expenditures, yet evidence for its financial impact remains inconclusive. One potential explanation is that the use of hospice may produce differential cost-savings effects by region because of geographic variation in end-of-life spending patterns. We examined 103,745 elderly Medicare fee-for-service beneficiaries in the Surveillance, Epidemiology, and End Results Program Medicare database who died from cancer in 2004-11. We created quintiles by the adjusted mean end-of-life expenditures per hospital referral region (HRR), and we examined HRR-level variation in the association between length of hospice service and expenditures across quintiles. Longer periods of hospice service were associated with decreased end-of-life expenditures for patients residing in regions with high average expenditures but not for those in regions with low average expenditures. Hospice use accounted for 8 percent of the expenditure variation between the highest and the lowest spending quintiles, which demonstrates the powers and limitations of hospice use for saving on costs.
Shiyi Wang (shiyi.wang@yale.edu) is an assistant professor of epidemiology in the Department of Chronic Disease Epidemiology, Yale University School of Public Health, in New Haven, Connecticut.
Shiyi
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Wang
Sylvia H. Hsu is an associate professor of accounting at the Schulich School of Business, York University, in Toronto, Ontario, Canada.
Sylvia H
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Hsu
Siwan Huang is a master's graduate in the Department of Biostatistics at the Yale University School of Public Health.
Siwan
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Huang
Pamela R. Soulos is a program manager and data analyst at the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center.
Pamela R
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Soulos
Cary P. Gross is a professor of medicine and epidemiology in the Department of Internal Medicine, Yale University School of Medicine.
Cary P
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Gross
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D009369:Neoplasms / Q000191:economics / Q000401:mortality; D018426:SEER Program; D013727:Terminal Care / Q000191:economics*; D014481:United States
End-of-Life Care Expenditures; Hospice Enrollment; Regional Variation