Promoting access to Medicare hospice benefit could save taxpayers, benefit underserved communities

Health care disparities are widely documented for minority groups in the U.S., and access to quality hospice care is no exception. Additionally, the disconnect between connecting minority populations with hospice care costs taxpayers millions.

It is known that 25 percent of individual Medicare expenditures take place during the last year of life, mainly because patients with chronic illnesses tend to experience more frequent and severe complications as they get closer to death, and health care costs associated with curative treatments become more significant. We wanted to understand better why Medicare spends about 20 percent more on the last year of life for black and Hispanic people than white people. 

The answer is clear. Racial and ethnic minority patients with terminal illnesses are much less likely to enter hospice care than their white counterparts—even when controlling for socioeconomic factors such as age, education, income and area population. There is also evidence that addressing this issue will save the Medicare program millions of dollars. In our recent paper published in Gerontology and Geriatric Medicine, we found that increasing minorities’ access to hospice care could save over $2,100 per enrollee—equal to about $270 million in annual Medicare savings. The data from the study also supports a positive association between racial/ethnic minority Medicare hospice utilization and the prevalence of for-profit hospices.

Our findings build on a growing body of academic literature related to potential hospice taxpayer savings. Dobson DaVanzo & Associates, an economic research firm, recently conducted a comprehensive research review and analysis for the National Hospice and Palliative Care Organization (NHPCO), the largest membership association working on behalf of hospice. They reported that taxpayer savings for higher hospice utilization in general by Medicare beneficiaries could generate savings between $2,309 to $17,903 per hospice user. Additionally, the researchers note that “if 80 percent, as opposed to the current 50 percent, of decedent Medicare beneficiaries used hospice for 24 months, nearly $2 billion could be saved by the Medicare program annually.”

In addition to disparities in education and access, differences in knowledge, cultural beliefs, and treatment preferences all contribute as a barrier to hospice care for minority populations. In one study, only 16 percent of Hispanics said they have ever even heard of hospice. While knowledge about the benefits of hospice and palliative care are not widespread throughout minority and underserved communities, the same study found that 95 percent of Hispanics and 94 percent of Chinese speakers want to learn more—identifying a clear opportunity to close the gap.

The data also shows that minorities tend to be more willing to invest substantial financial resources into life-sustaining treatments, but simply changing this mindset and increasing hospice enrollment will not eliminate racial disparities observed within hospice care. Equity in providing quality hospice care needs to be prioritized, and addressing these disparities is paramount to improving the quality of life of minority populations.

The benefits of improved access to hospice care for minority and underserved populations are clear. The question for public health researchers and policymakers now is how to close the gap and ensure equity in access to – and utilization of - this person-centered end-of-life care.

First, further research on outreach programs that successfully reduce the racial and ethnic minority hospice enrollment gap is paramount. Knowledge about the option to enter hospice care is the first step towards boosting utilization.

Second, we need a policy architecture that better supports access goals. For example, the bipartisan Rural Access to Hospice Act (S. 1190/H.R. 2594) – recently introduced federal legislation that would allow patients served by Federally Qualified Health Centers (FQHCs) to keep their physician of choice when electing hospice care – would remove a significant access barrier among underserved patient populations. Research shows that FQHCs serve a higher proportion of patients in minority racial groups and at higher rates than white patient populations. This kind of policy solution – which would address hospice enrollment challenges at a structural level – is critical to increase utilization rates among minority populations and close the current hospice access gap.

It’s a win-win scenario: Simple changes like these would go a long way to providing underserved communities with access to quality hospice care that they deserve and improving end-of-life care access for all terminally-ill Americans would ensure taxpayer dollars are used more efficiently.

Dr. M. Courtney Hughes is an associate professor of Health Studies in the College of Health and Human Sciences at Northern Illinois University and Dr. Erin Vernon is an assistant professor of Economics in the Albers School of Business and Economics at Seattle University.