Association Between Hospice Enrollment and Total Health Care Costs for Insurers and Families, 2002-2018.

Aldridge, Melissa D; Moreno, Jaison; McKendrick, Karen; Li, Lihua; Brody, Ab; May, Peter

dc.contributor.author	Aldridge, Melissa D
dc.contributor.author	Moreno, Jaison
dc.contributor.author	McKendrick, Karen
dc.contributor.author	Li, Lihua
dc.contributor.author	Brody, Ab
dc.contributor.author	May, Peter
dc.date.accessioned	2024-06-04T13:32:43Z
dc.date.available	2024-06-04T13:32:43Z
dc.date.issued	2022-02-11
dc.identifier.pmid	35977281
dc.identifier.doi	10.1001/jamahealthforum.2021.5104
dc.identifier.uri	http://hdl.handle.net/10147/641737
dc.description	Importance: Use of hospice has been demonstrated to be cost saving to the Medicare program and yet the extent to which hospice saves money across all payers, including whether it shifts costs to families, is unknown. Objective: To estimate the association between hospice use and total health care costs including family out-of-pocket health care spending. Design setting and participants: This retrospective cohort study of health care spending in the last 6 months of life used data from the nationally representative Medicare Current Beneficiary Survey (MCBS) between the years 2002 and 2018. Participants were MCBS participants who resided in the community and died between 2002 and 2018. Exposures: Covariate balancing propensity scores were used to compare participants who used hospice (n = 2113) and those who did not (n = 3351), stratified by duration of hospice use. Main outcomes and measures: Total health care expenditures were measured across payers (family out-of-pocket, Medicare, Medicare Advantage, Medicaid, private insurance, private health maintenance organizations, Veteran's Administration, and other) and by expenditure type (inpatient care, outpatient care, medical visits, skilled nursing, home health, hospice, durable medical equipment, and prescription drugs). Results: The study population included 5464 decedents (mean age 78.7 years; 48% female) and 38% enrolled with hospice. Total health care expenditures were lower for those who used hospice compared with propensity score weighted non-hospice control participants for the last 3 days of life ($2813 lower; 95% CI, $2396-$3230); last week of life ($6806 lower; 95% CI, $6261-$7350); last 2 weeks of life ($8785 lower; 95% CI, $7971-$9600); last month of life ($11 747 lower; 95% CI, $10 072-$13 422); and last 3 months of life ($10 908 lower; 95% CI, $7283-$14 533). Family out-of-pocket expenditures were lower for hospice enrollees in the last 3 days of life ($71; 95% CI, $43-$100); last week of life ($216; 95% CI, $175-$256); last 2 weeks of life ($265; 95% CI, $149-$382); and last month of life ($670; 95% CI, $530-$811) compared with those who did not use hospice. Health care savings were associated with reductions in inpatient care. Conclusions and relevance: In this population-based cohort study of community-dwelling Medicare beneficiaries, hospice enrollment was associated with lower total health care costs for the last 3 days to 3 months of life. Importantly, we found no evidence of cost shifting from Medicare to families related to hospice enrollment. The magnitude of lower out-of-pocket spending to families who enrolled with hospice is meaningful to many Americans, particularly those with lower socioeconomic status.	en_US
dc.language.iso	en	en_US
dc.rights	Copyright 2022 Aldridge MD et al. JAMA Health Forum.
dc.rights	Attribution 4.0 International	*
dc.rights.uri	http://creativecommons.org/licenses/by/4.0/	*
dc.subject	HOSPICE	en_US
dc.subject	DEATH AND DYING	en_US
dc.subject	HEALTH ECONOMICS	en_US
dc.title	Association Between Hospice Enrollment and Total Health Care Costs for Insurers and Families, 2002-2018.	en_US
dc.type	Article	en_US
dc.identifier.eissn	2689-0186
dc.identifier.journal	JAMA health forum	en_US
dc.source.journaltitle	JAMA health forum
dc.source.volume	3
dc.source.issue	2
dc.source.beginpage	e215104
dc.source.endpage
refterms.dateFOA	2024-06-04T13:32:44Z
dc.source.country	United States
dc.source.country	United States
dc.source.country	United States