The US hospice industry, which provides palliative and supportive care to patients with terminal illness, has undergone substantial changes during the last decade. The magnitude of these changes has not been fully captured in previous studies or reports. In this longitudinal study of hospices active in Medicare during 1999-2009, we analyzed Provider of Services files to understand key shifts in the industry. We found evidence of substantial turbulence. One-fifth of Medicare-certified hospices active in 1999 had closed or withdrawn from the program by 2009, and more than 40 percent had experienced one or more changes in ownership. The most prominent trend was the shift in ownership type from nonprofit to for-profit ownership. Four out of five Medicare-certified hospices that entered the marketplace between 2000 and 2009 were for-profit. Hospices also became larger, as the proportion with 100 or more full-time employees doubled to 5 percent from 1999 to 2009. Although each of the Census regions had more hospices in 2009 than in 1999, the geographic distribution of hospices in the country changed, with proportionally more in the South and West. The impact of all of these changes on cost and quality of hospice care, as well as patient access, remains a critical area for future research.

译文

美国临终关怀行业为绝症患者提供姑息和支持性护理,在过去十年中发生了重大变化。这些变化的幅度在以前的研究或报告中尚未完全捕捉到。在这项对1999-2009年期间活跃于Medicare的临终关怀的纵向研究中,我们分析了服务文件的提供者,以了解该行业的主要变化。我们发现了大幅湍流的证据。五分之一的医疗保险认证的收容所活跃1999年已经关闭或退出该计划2009年,超过40% 的人经历了一次或多次所有权变更。最突出的趋势是所有权类型从非营利性向营利性所有权的转变。进入市场的五分之四的经过医疗保险认证的收容所2000年和2009是营利性的。收容所也变得更大,因为拥有100名或更多全职员工的比例翻了一番,达到5% 名1999年2009年。尽管每个人口普查地区的收容所2009年都比1999年多,但该国收容所的地理分布发生了变化,南部和西部的收容所比例更大。所有这些变化对临终关怀的成本和质量以及患者的访问的影响仍然是未来研究的关键领域。

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