• Shiyi Wang, Sylvia H Hsu, Siwan Huang, Pamela R Soulos, and Cary P Gross.
• Shiyi Wang (shiyi.wang@yale.edu) is an assistant professor of epidemiology in the Department of Chronic Disease Epidemiology, Yale University School of Public Health, in New Haven, Connecticut.
• Health Aff (Millwood). 2017 Feb 1; 36 (2): 328-336.

AbstractHospice use is expected to decrease end-of-life expenditures, yet evidence for its financial impact remains inconclusive. One potential explanation is that the use of hospice may produce differential cost-savings effects by region because of geographic variation in end-of-life spending patterns. We examined 103,745 elderly Medicare fee-for-service beneficiaries in the Surveillance, Epidemiology, and End Results Program Medicare database who died from cancer in 2004-11. We created quintiles by the adjusted mean end-of-life expenditures per hospital referral region (HRR), and we examined HRR-level variation in the association between length of hospice service and expenditures across quintiles. Longer periods of hospice service were associated with decreased end-of-life expenditures for patients residing in regions with high average expenditures but not for those in regions with low average expenditures. Hospice use accounted for 8 percent of the expenditure variation between the highest and the lowest spending quintiles, which demonstrates the powers and limitations of hospice use for saving on costs.Project HOPE—The People-to-People Health Foundation, Inc.

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