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Bradley, Carlson and Gallo Report Findings About Impact of Ownership Status on Hospice Care

A paper in the May issue of Medical Care explores the question of whether there is a difference in the care provided to terminally ill patients by nonprofit and for-profit hospices. The issue of whether profit motive affects patient care is becoming increasingly important in all sectors of the healthcare industry as for-profit providers become more common, but is especially important in the context of hospice because the number of for-profit hospices increased more than six times as fast as the number of nonprofit hospices over the last ten years. “The change in this industry is quite dramatic when you consider the entire hospice movement in the U.S. is only 30 years old,” says Elizabeth Bradley, Ph.D., Associate Professor of Public Health in the Division of Health Policy and Administration, Director of the Health Management Program, and senior author on the study.

Bradley, along with lead author Melissa Carlson, M.B.A., M.P.H. and Research Associate, and co-author William Gallo, Ph.D., Associate Research Scientist, analyzed data from the 1998 National Home and Hospice Care Survey, conducted by the National Center for Health Statistics, from more than 2,000 patients receiving care from over 400 home and inpatient hospices nationwide in order to determine whether for-profit and nonprofit hospices provided a similar pattern of care to their patients.

After controlling for various patient and hospice characteristics, the authors found that patients of for-profit hospices received a significantly narrower range of services than did patients of nonprofit hospices. Because hospice typically includes a broad range of diverse services, which address not just medical but also social, emotional, and spiritual needs of patients and their families, the finding is troubling and suggests care may be qualitatively different in for-profit compared to nonprofit hospices.

While the study does not provide an explanation for the differences in care provided by nonprofit and for-profit hospices, and does not assess the overall quality of care, it does provide a starting point from which to monitor whether the differences in care provided by the two types of entities persist as for-profit ownership continues to grow. Carlson’s thesis work will build on this paper by analyzing differences between for-profit and nonprofit hospices in care processes, such as length-of-stay in hospice, and access to hospice care over a ten-year period.

As for-profit hospices make up an increasingly large proportion of hospice providers, the authors argue that it is important for health care professionals to understand how system-based factors such as profit motive affect patient care.

The research was conducted with support from the Nathan Cummings Foundation, the Patrick and Catherine Weldon Donaghue Medical Research Foundation, and the Claude D. Pepper Older Americans Independence Center at the Yale School of Medicine.

- Story by Christy Gordon, based on interview with Elizabeth Bradley, April 19, 2004 and Carlson, M.D.A., Gallo, W.T. and Bradley, E.H. Ownership Status and Patterns of Care in Hospice: Results from the National Home and Hospice Care Survey, Medical Care 42(5): 432-438, May 2004.