Geographic variation in hospice use prior to death

Beth A. Virnig, Sara Kind, Marshall Mcbean, Elliott Fisher

Research output: Contribution to journalArticlepeer-review

119 Scopus citations


OBJECTIVES: To examine national variation in use of the Medicare hospice benefit by older individuals before their death, and to identify individual characteristics and local market factors associated with hospice use. DESIGN: Retrospective analysis of Medicare administrative data. SETTING: Hospice care. PARTICIPANTS: Older Medicare enrollees who died in 1996. MEASUREMENTS: Rate of hospice use per 1000 older Medicare beneficiary deaths. RESULTS: Overall, 155 of every 1000 older Medicare beneficiaries who die use hospice before death. This rate is significantly higher among younger older persons (P < .001), non-blacks (P < .001), persons living in wealthier areas (P < .001), and persons in urban areas (P < .001). Areas with a higher proportion of non-cancer diagnoses among hospice users have higher rates of hospice use for both cancer and non-cancer reasons than areas with a majority of hospice users having cancer diagnoses (P < .001). Hospice use is higher in areas with fewer hospital beds per capita (P < .001), areas with lower in-hospital death rates (P < .001), and areas with higher HMO enrollment (P < .001). Rates of hospice use are also positively related to average reimbursements for health care (P < .001) and to physicians per capita (P < .001). In the largest metropolitan statistical areas (MSAs), rates of hospice use vary more than 11-fold from a low of 35.15 (Portland, ME) to a high of 397.2 per 1000 deaths (Ft. Lauderdale, FL). CONCLUSIONS: The wide variation in hospice use suggests that there is great potential to increase the number of users of the Medicare hospice benefit.

Original languageEnglish (US)
Pages (from-to)1117-1125
Number of pages9
JournalJournal of the American Geriatrics Society
Issue number9
StatePublished - 2000


  • Health care resources
  • Hospice
  • Medicare


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