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

本研究的目的是：1。详细记录医疗保险受益人在五大类（癌症、痴呆、充血性心力衰竭、慢性阻塞性肺病和所有其他死亡）中的临终关怀费用和模式。 2.检查这些类别中的成本和护理模式的地理差异，并确定与这些疾病的成本和护理模式差异相关的因素。 3.演示前瞻性地确定可能接近生命终点的受益人群体的方法，并计算这些群体的预期人均费率。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。医疗保险的破碎收费服务支付不鼓励综合管理的终末期疾病，并鼓励急性姑息治疗。 综合支付方法（按日、按人头或其他）在鼓励提供适当和富有同情心的临终关怀方面具有更大的潜力。调整医疗保险政策以实现更综合的支付，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，计算医疗保险对这些服务的平均成本，并分析平均成本的变化。 拟议中的研究将提供详细的数据，以讨论重组医疗保险支付临终关怀的选择。我们提出了描述性分析和假设检验相结合。 首先，由于可获得的详细信息很少，我们建议创建一个关于医疗保险临终关怀的数据手册，一个全面的成本和使用概况。 描述性分析将由国家临终关怀专家咨询委员会指导，目的是为医疗保险资助的临终关怀提供有用的参考。 其次，我们将测试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.