Donald Taylor, Ph.D.

Donald Taylor, Ph.D., is an Assistant Professor of Public Policy in the Terry Sanford Institute of Public Policy, at Duke University, where he works primarily in the Institute's Center for Health Policy, Law and Management. His current research focuses on aging policy.

In October 2003, Dr. Taylor and colleagues from the Duke University Medical Center received a HCFO grant to determine whether hospice saves money for Medicare and whether or not it has any effect on out-of-pocket expenses incurred by families of terminally ill Medicare beneficiaries. The key innovation of this research is the use of longitudinal data and analysis methods that will help them determine whether any cost differences between hospice and regular care are a result of differences in the types of patients who choose hospice (selection effect), or the hospice care itself.

“The ability to observe patient’s health care utilization prior to the onset of their terminal illness is an important benefit of this study,” Taylor says. “It is important to determine whether persons who subsequently choose hospice as they are dying have always been ‘low’ users of care.” Another key component of the study is determining the length of hospice usage required for cost savings to occur. Generally, the first few days and last few days in hospice are the most costly. Given Medicare’s fixed per diem rate, hospices cannot balance less costly days with more costly days if there is a short length of stay. Identifying the length of stay “tipping point” necessary for cost savings to occur is critical, notes Taylor.

Preliminary results suggest that persons who choose hospice are very similar to those who do not in terms of health care utilization two years prior to death—before the terminal illness phase. This implies that selection does not explain preliminary cost reductions observed in the study among hospice users in the last two-to-four months of life, but that hospice does have the effect of reducing the cost to Medicare.

Dr. Taylor will be presenting early results from his HCFO study at the AcademyHealth 2004 Annual Research Meeting, June 6-8 in San Diego. You can find him presenting "Do Selection or Treatment Effects Explain Differences in Medicare End-of-Life Costs Among Hospice and Usual Care Decedents?" on Monday, June 7 from 2:00 to 3:30 p.m. in the Caring for the Elderly Near the End-of-Life: Studies of Hospice Care & Informal Care session or on Tuesday, June 8 from 9:15 to 10:45 a.m. in the Long-Term Care Community Services & Market Factors session.

Other topical areas of interest for Dr. Taylor include the effect of caregiving on caregivers and the cost of informal long term care, the cost of treating Alzheimer's disease and related dementias, and the impact of modifiable health behaviors such as smoking and drinking on the health of the elderly. He is also Principal Investigator of a grant funded by the National Institute on Aging to study the linkage between the perception of risk and health behaviors among the elderly.

Dr. Taylor came to Duke in 1997 after post-doctoral training at the University of North Carolina (UNC) at Chapel Hill and the University of Manchester (U.K.). He received his Ph.D. in Health Policy and Administration from the UNC School of Public Health in 1995.

Selected References

Donald H. Taylor, Jr., John Rattliff, Frank A. Sloan, P. Murali Doraiswamy. Marked Increase in the Diagnosed Prevalence of Alzheimer’s Disease between 1991 and 1999 in the United States. Forthcoming in the Journal of Gerontology: Medical Sciences.

Donald H. Taylor, Jr., Helen Hoenig. The Effect of Equipment Usage and Residual Task Difficulty on Use of Personal Assistance, Days in Bed and Nursing Home Placement. The Journal of the American Geriatrics Society (JAGS) 2004;52(1):72-79.

Truls Østbye, Donald H. Taylor, Jr. The Effect of Smoking on Years of Healthy Life (YHL) Lost Among Middle Aged and Older Americans. Health Services Research 2004;39(3):499-519.

Frank A. Sloan, V. Kerry Smith, Donald H. Taylor, Jr. The Smoking Puzzle: Information, Risk Perception, and Choice. Cambridge: Harvard University Press, 2003.

Donald H. Taylor, Jr., Gerda G. Fillenbaum, Michael E. Ezell. The Accuracy of Medicare Claims Data in Identifying Alzheimer’s Disease. The Journal of Clinical Epidemiology 2002;55:929-937.

Donald H. Taylor, Jr., Vic Hasselblad, S. Jane Henley, Michael J. Thun, Frank A. Sloan. The Benefits of Smoking Cessation for Longevity. American Journal of Public Health 2002; 92(6):990-996.

Donald H. Taylor, Jr., and Frank A. Sloan. How Much Do Person’s with Alzheimer’s Disease Cost Medicare? Journal of the American Geriatrics Society 2000;48:639-646.