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To the Editor.—Drs Cher and Lenert¹ use Medicare records for California to examine the issue of whether health maintenance organizations (HMOs) provide less potentially ineffective care at the end of life. Unfortunately, the reporting of Medicare inpatient stay data for HMO enrollees is known to be incomplete, which puts into doubt the validity of their findings. Care for HMO enrollees is provided on a capitation basis, rather than fee-for-service (FFS), and, consequently, hospitals do not have a financial incentive to report information to the Health Care Financing Administration (HCFA) on stays of HMO enrollees. Perhaps as many as two thirds of HMO stays are missing from HCFA's inpatient stay files.

HCFA has information on self-reported hospital stays for a sample of beneficiaries through its Medicare Current Beneficiary Survey, an annual in-person survey of over 12000 beneficiaries. In 1994, among 11669 respondents exclusively in FFS, there were 3271 self-reported hospitalizations, . . . [Full Text of this Article]

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Managed Care, Hospice Use, Site of Death, and Medical Expenditures in the Last Year of Life
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