This study compares differences in demographics and Medicare expenditures for beneficiaries in 4 different types of hospice programs: hospital based, skilled nursing facility (SNF) based, home health agency based, and freestanding across the years 1987-1990. Enrollment and expenditures in hospital based hospices is increasing faster than for other types of hospices; at the same time, both hospital and SNF based programs are attracting greater proportions of non-white and female beneficiaries but fewer beneficiaries with non-cancer diagnoses. These results indicate that expansion of the hospice benefit has increased institutionalized use of hospice and that this institutionalized form of hospice may benefit demographic groups that previously underutilized the hospice benefit.