Medicare beneficiaries in rural areas are less likely to receive hospice care prior to death than their urban counterparts. Within rural environments, declining rates of hospice use are associated with lower population density and greater distance from urban areas. In contrast, in-hospital death rates for Medicare beneficiaries do not show any urban/rural gradient. Medicare hospice payment policies must be adjusted if the hospice benefit is to be an option for all terminally ill beneficiaries regardless of where they live.
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