Comparison of End of Life Costs Between Managed Care and Fee for Service

本研究旨在(1)确定接受管理式照护、按服务收费和医疗保险治疗的病人在生命最后一年的比较成本和资源利用情况；(2)比较死亡地点；(3)比较安宁疗护和医院病床的利用情况；(4)比较65岁以上和65岁以下的病人所获得的照护。从两家管理式医疗保健公司和联邦医疗保险获得了一整套数据。数据集的一些问题是，一个数据集没有完整记录临终关怀的使用情况，而另一个数据集没有完整记录死亡前的住院情况。然而，初步观察表明：(1)管理式护理与死亡地点（即医院与家庭）的服务收费之间没有差异；(2)管理式护理的癌症死亡比例略高于心脏病死亡比例。完整的结果预计将在未来12个月内公布。

This study is designed (1) to determine the comparative costs and resources utilization over the last year of life for patients treated by managed care, fee-for-service, and Medicare, (2) to compare sites of death, (3) to compare utilization of hospice and hospital beds, and (4) to compare care provided to those over 65 and those under 65. A full set of data has been obtained from two managed care companies and from Medicare. Some problems with the data sets are that use of hospice is not fully recorded in one data set and hospitalization prior to death is not fully recorded in another. However, preliminary observations indicate (1) no difference between managed care and fee for service in site of death (i.e., hospital versus home) and (2) managed care has a slightly higher proportion of cancer deaths than deaths from heart disease. Full results are expected within the next 12 months.