The full content of Annals is available to subscribers

Subscribe/Learn More  >
Improving Patient Care |

Medicare Program Expenditures Associated with Hospice Use

Diane E. Campbell, PhD; Joanne Lynn, MD; Tom A. Louis, PhD; and Lisa R. Shugarman, PhD
[+] Article, Author, and Disclosure Information

From Medical Outcomes Research and Evaluation Services, Thetford, Vermont; RAND, Santa Monica, California; The Washington Home Center for Palliative Care Studies, Washington, DC; and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

For author affiliations, see end of text.

Disclaimer: The findings, statements, and views expressed are those of the authors and do not necessarily reflect the opinions and policies of the sponsors.

Grant Support: By the Agency for Healthcare Research and Quality, The National Institute on Aging, The Fan Fox-Leslie Samuels Foundation, and The Washington Home Center for Palliative Care Studies. The work was performed under a cooperative agreement with MedPAC, the Medicare Payment Advisory Commission.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Joanne Lynn, MD, Washington Home Center for Palliative Care Studies and RAND, 4200 Wisconsin Avenue, 4th Floor, Washington, DC 20016; e-mail, jlynn@rand.org.

Current Author Addresses: Dr. Campbell: Medical Outcomes Research and Evaluation Services, PO Box 303, Thetford, VT 05074.

Dr. Lynn: The Washington Home Center for Palliative Care Studies, 4200 Wisconsin Avenue, NW, 4th Floor, Washington, DC 20016.

Dr. Louis: Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205.

Dr. Shugarman: RAND Corporation, 1700 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138.

Ann Intern Med. 2004;140(4):269-277. doi:10.7326/0003-4819-140-4-200402170-00009
Text Size: A A A

The hospice benefit in Medicare aimed to enhance beneficiaries' options for less aggressive end-of-life medical care and for death at home by providing comprehensive services that were not otherwise covered (for example, outpatient drugs, homemaker services, and bereavement counseling) to patients who agree to forgo “curative treatment for their terminal illness” and who have a physician-certified life expectancy of 6 months or less (1). Previous research on patients with cancer who died between 1981 and 1992 (28) indicated, and opinion leaders have often claimed, that hospice enrollment reduces Medicare program costs compared with conventional care during the last month but not the last year of life (24, 910). Earlier evaluations cautioned that changes in pricing, benefit design, and case mix could affect their findings (3).


hospice ; medicare ; cancer

First Page Preview

View Large
First page PDF preview


Grahic Jump Location
Estimated effect of hospice on adjusted mean Medicare program expenditures in the last year of life by type of Medicare expenditure within condition cohort and age stratum.
Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.