Insurance Type and Quality of End-of-Life Care in Adults < 65 Years with Hematologic Malignancies.

Abstract

Adults with hematologic malignancies are at risk of low-quality end-of-life (EOL) care, with evidence suggesting patients <65 years are especially at high risk. There are sparse data on the association of insurance status with quality of EOL care. We conducted a retrospective population-based analysis comparing the quality of EOL care of adults enrolled in the Merative MarketScan Commercial and Medicaid Research Databases with hematologic malignancies (18-64 years) who died between 2016 and 2021 and were insured by Medicaid or commercial health plans. Among 2,669 patients, 844 had Medicaid and 1,825 commercial insurance. Overall, 58.2% experienced high-intensity healthcare utilization at the EOL and 48.7% died in hospitals. The rate of hospice enrollment and palliative care use was 26.0% and 27.3% respectively. In multivariable analysis, compared to Medicaid, commercial insurance was associated with greater odds of high-intensity healthcare utilization (OR: 1.69, 95%CI, 1.44-1.99), in-hospital death (OR: 2.71, 95%CI, 2.29-3.21), and lower odds of hospice use (OR: 0.70, 95%CI: 0.58-0.83), and palliative care (OR: 0.76, 95%CI: 0.63-0.91). In this large cohort of hematologic malignancy decedents < 65 years, Medicaid beneficiaries were less likely to experience high-intensity healthcare utilization at the EOL, less likely to die in the hospital, and more likely to enroll in hospice and receive palliative care compared to those with commercial insurance. These data suggest potentially higher quality EOL care with Medicaid compared to commercial insurance. Our findings highlight the need for policy solutions focused on insurance to improve EOL care for patients with hematologic malignancies.