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Health Expenditures During The Last Year Of Life

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On Friday, June 2, research developed by the Hospice Institute in conjunction with the Yale School of Public Health was presented to an annual Yale Alumni and Public Health Meeting and Luncheon. Information concerning the utilization of medical resources was analyzed based on national Medicare data during the last 6 and 12 months of life in a variety of health care settings. Hospice care was shown to be clinically effective and less costly than acute inpatient care and nursing home care. Figure 1 from this study displays the proportion of Medicare payments for types of medical service in the last 6 and last 12 months of life. Hospice services accounted for 12.1% of all Medicare reimbursements in the last 6 months of life versus 47.8% for acute inpatient care in the last 6 months of life. Figure 2 shows that in the last 6 months of life most terminal cancer patients (63.5%) received no hospice services. While most cancer patients who used hospice benefits did so only at the very end of life, only 16.1% of patients dying of cancer received hospice services for more than 30 days. This research is currently being prepared for publication. Another interesting piece of research has recently been completed which attempts to assess the impact of physicians' knowledge of and propensity to refer patients for hospice services. The study was conducted by the Hospice Institute and the Yale School of Public Health and was based on a random sample of physicians (n=231) selected from 6 randomly chosen community hospitals in Connecticut. Self-administered surveys ascertained physicians' knowledge, attitudes, and self-reported referral patterns for terminally ill patients. The results showed that approximately 95% of physicians believe that hospice meets the needs of families better than conventional care. They also felt that hospice controls symptoms better than conventional care. Nevertheless, physicians reported referrals of only about half of terminally ill patients for hospice care. Substantial gaps of knowledge were found in physicians' knowledge; 60% believed that patients had to be dying in two months or sooner for inpatient hospice; 20% believed this about home hospice as well. In summary, nearly 30 years after the inception of hospice in the US, physicians' knowledge about hospice remains limited. This limited knowledge may be an essential barrier to the use of care for patients with irreversible illnesses and their families. The Hospice Institute has academic credentials that enable sponsorship of relevant seminars in regard to this issue. This research is currently being prepared for publication.

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