Longer Periods Of Hospice Service Associated With Lower End-Of-Life Spending In Regions With High Expenditures

Health Aff (Millwood). 2017 Feb 1;36(2):328-336. doi: 10.1377/hlthaff.2016.0683.

Abstract

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.

Keywords: End-of-Life Care Expenditures; Hospice Enrollment; Regional Variation.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Health Expenditures / statistics & numerical data*
  • Hospice Care / economics
  • Hospice Care / statistics & numerical data*
  • Humans
  • Length of Stay
  • Male
  • Medicare / economics
  • Medicare / statistics & numerical data
  • Neoplasms / economics
  • Neoplasms / mortality
  • SEER Program
  • Terminal Care / economics*
  • United States