Medicare Rule, Finances Likely Affect Blacks' Use Of End-Of-Life Hospice Services, Study Finds

Main Category: Palliative Care / Hospice Care
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 24 Dec 2008 - 3:00 PST

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Blacks might be less likely than whites to seek end-of-life hospice care because of financial barriers and a Medicare rule that requires hospice patients to forgo additional curative treatments, according to a study published in the journal Cancer, Reuters Health reports. For the study, lead researcher Jessica Fishman of the University of Pennsylvania and colleagues interviewed 283 people who were diagnosed with cancer and had an estimated six months or less to live about their end-of-life treatment preferences (Reuters Health, 12/22).

Researchers focused specifically on the responses from blacks because they are known to be less likely to seek hospice care (Edelson, HealthDay/U.S. News & World Report, 12/22). When compared with whites, blacks were more likely to want to continue aggressive treatment and expressed a greater perceived need for additional services (Reuters Health, 12/22). Hospice care focuses on quality-of-life issues, such as pain relief, rather than curing a disease. Under current Medicare rules, beneficiaries must have a prognosis of six months or less of life and must agree to forgo any additional treatment to qualify for coverage of hospice care, according to U.S. News & World Report.

Study co-author David Casarett, an associate professor of medicine at the university, said that lack of finances also deterred blacks from seeking hospice care. "We looked at household finances, how much money was left at the end of the month," and blacks "generally had less money at the end of the month," he said, adding, "Money affects people's perceived need for hospice services. People with greater financial resources have other ways of getting the services that hospices provide."

Researchers concluded that the "hospice eligibility criteria of Medicare and other insurers requiring patients to give up cancer treatment contribute to racial disparities in hospice use," and "these criteria do not select those patients with the greatest needs for hospice services." They recommend that "eligibility for hospice care should not depend on treatment" but "should be determined by people's needs for hospice services" (HealthDay/U.S. News & World Report, 12/22).

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