• Caprice A Knapp, Elizabeth A Shenkman, Mircea I Marcu, Vanessa L Madden, and Joseph V Terza.
• Department of Epidemiology, University of Florida, Gainesville, Florida 32604, USA. cak@ichp.ufl.edu
• J Palliat Med. 2009 Mar 1; 12 (3): 223-9.

ObjectiveEach year approximately 50,000 children die. These children could benefit from pediatric palliative care, and hospice is one important provider of palliative care. However, little information exists to understand pediatric hospice care. This study seeks to describe Medicaid pediatric hospice and nonhospice users and to identify factors that affect hospice expenditures.DesignAnalyses of Medicaid administrative data and death certificate data.ParticipantsA total of 1527 children in Florida Medicaid program.ResultsFew children in the sample used hospice services (11%) and the dominant location of death was home for hospice users (55%). Descriptive analyses show that pediatric hospice users had higher inpatient, outpatient, emergency department, and pharmacy expenditures than nonhospice users. Regression results suggest that black non-Hispanic, Hispanic, and children of other races had $730 to $880 fewer hospice expenditures than Whites. Higher hospice expenditures ($970) were associated with longer enrollment spans.ConclusionsDescriptive analyses suggest that there are differences between pediatric hospice and nonhospice users. Minority race/ethnicities, as well as shortened Medicaid enrollment spans, are both associated with decreased hospice expenditures. Information from this study can be used to develop interventions aimed at increasing the prevalence of and reducing inequalities in hospice care.

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