Hospice

In 1984, hospice care was formally recognized as a benefit under the Medicare program. This was an important turning point for the hospice movement in the United States, demonstrating that hospice care had evolved from being largely a volunteer model to a recognized component of the health care delivery system, and therefore reimbursable. "In 1997, Medicare spent approximately $2 billion of its roughly $200 billion budget on hospice services provided to 382,989 patients who received over 19 million days of hospice care" (NHPCO, p. 1).

With the hospice Medicare benefit came increased regulation and additional restrictions on who was eligible for this benefit. For example, physicians had to give a seriously ill person a prognosis of six months or less to live for that person to be eligible. This admission criterion continues to be problematic, since determining a person's prognosis is not an exact science. In addition, patients (and their families) have to acknowledge that they are likely to die within the next six months. Consequently, patients are often referred to hospice very late in their illness trajectory and, therefore, do not receive the full benefit that the interdisciplinary hospice team is able to offer. In 1999, the average number of days that persons received hospice care prior to their death was forty-eight days; the median length of stay was twenty-nine days. Depending on the health care market, the length of stay in hospice can vary considerably. For example, in 1999 in Oregon the average length of stay was forty-two days and the median was sixteen days.

Figure 1 SOURCE: National Hospice and Palliative Care Organization website (www.nhpco.org)

According to the National Hospice and Palliative Care Organization (NHPCO), Medicaid also covers the cost of hospice care in forty-three states and in the District of Columbia. Health care insurance plans cover "80 percent of employees in medium and large businesses. Eighty-two percent of managed care plans offer hospice benefits, along with most private insurance plans and the federal Civilian Health and Medical Program of the Uniformed Services program" (NHPCO, p. 1).