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Fixing Disjointed Chronic Care

The US health care system does many things very well. But one thing it doesn’t do well is coordinate care over time and between sectors. Whenever a patient transitions from hospital to home or from hospital to nursing home or hospice, he or she is likely to end up confused and to encounter care glitches and perverse financial incentives. While the US health care system does a better job coordinating between sectors during illness episodes, better coordination between sectors over time is needed for Americans with lengthy illnesses.

Last year, I saw what many Americans face, when after excellent but ultimately unsuccessful hospital care for cancer, an almost destitute family member decided she’d rather go home to die peacefully than face more (expensive for everyone) treatment.  But frustrating licensing and Medicaid rules made it practically impossible for us, from many miles away, to arrange affordable and effective care for her at home. So she spent her final days, against her wishes and at considerable cost to taxpayers, at an inpatient Medicaid hospice.

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