Comparison Of End-of-life Costs

Clinical Center

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Abstract

This study is designed (1) to determine the comparative costs and resources utilization over the last year of life for patients treated by managed care, fee-for-service, and Medicare, (2) to compare sites of death, (3) to compare utilization of hospice and hospital beds, and (4) to compare care provided to those over 65 and those under 65. A full set of data has been obtained from two managed care companies and from Medicare. Some problems with the data sets are that use of hospice is not fully recorded in one data set and hospitalization prior to death is not fully recorded in another. However, preliminary observations indicate (1) no difference between managed care and fee-for-service in site of death (i.e., hospital versus home) and (2) managed care has a slightly higher proportion of cancer deaths than deaths from heart disease. Full results are expected within the next 12 months. Phase I completed. We are now entering Phase II in which we will pursue an interesting finding that African-Americans receive more end-of-life care than whites. We will investigate the differences in services that are provided, differences in site of death, and causes of death using 2000 data.