A DETAILED PROFILE OF THE END-OF-LIFE CARE IN MEDICARE

这项拟议研究的目标是：1.详细记录五大类(癌症、痴呆症、充血性心力衰竭、慢性阻塞性肺病、所有其他死亡)的医疗保险受益人的临终护理费用和模式。2.审查这些类别内的费用和护理模式的地理差异，并确定与这些疾病的费用和护理模式的差异有关的因素。3.演示用于前瞻性地确定可能即将寿终正寝的受益人群体的方法，并计算这些群体的预期收入率。这项工作的总体目标是获得重塑临终关怀医疗保险支付政策所需的基础研究。医疗保险支离破碎的服务费支付阻碍了对终末期疾病的综合治疗，并鼓励急性过度姑息治疗。综合支付方法(按日支付、按人头支付或其他方式)具有更大的潜力，可以鼓励提供适当和富有同情心的临终关怀。调整联邦医疗保险政策以实现更全面的支付，需要确定可能从特殊临终关怀中受益的个人，确定综合支付所涵盖的服务和提供者，计算这些服务的平均成本，并分析围绕平均成本的变化。拟议的研究将提供必要的详细数据，以讨论重组临终关怀医疗保险支付的选项。我们提出了描述性分析和假设检验相结合的方法。首先，由于可获得的详细信息如此之少，我们建议创建一个关于联邦医疗保险临终关怀的数据薄，全面介绍费用和使用情况。描述性分析将由临终关怀专家国家咨询委员会指导，目的是制定一份关于医疗保险资助的临终关怀的有用参考。其次，我们将检验有关成本和使用的具体假设。

The objectives of this proposed study are: 1. To document in detail the cost and patterns of end-of-life care for Medicare beneficiaries within five broad categories (cancers, dementia, congestive heart failure, chronic obstructive pulmonary disease, all other deaths). 2. To examine the geographic variations in cost and patterns of care within these categories, and determine the factors associated with variation in cost and patterns of care for these diseases. 3. To demonstrate methods for prospectively identifying cohorts of beneficiaries likely to be nearing end of life, and to calculate prospective capitation rates for these cohorts. The overall goal of this work is to obtain basic research needed to reshape Medicare payment policy for end-of-life care. Medicare's fractured fee-for-service payment discourages integrated management of end stage disease and encourages acute over palliative treatment. Integrated payment approaches (per diem, capitation, or other) have greater potential to encourage delivery of appropriate and compassionate end-of-life care. Restructuring Medicare policy toward more integrated payment requires identifying individuals likely to benefit from special end-of-life care, determining services and providers to be covered under an integrated payment, calculating Medicare's average cost for those services, and analyzing variation around that average cost. The proposed research will provide detailed data needed to discuss options for restructuring Medicare payment for end-of-life care. We propose a combination of descriptive analysis and hypothesis testing. First, because so little detailed information is available, we propose to create a databook on Medicare end-of- life care, a comprehensive profile of cost and use. Descriptive analyses will be guided by a National Advisory Board of experts in end-of-life care, with a goal of developing a useful reference on Medicare-financed end-of-life care. Second, we will test specific hypotheses regarding cost and use.