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January 19, 2016

A Policy Prescription for Hospice Care

Author Affiliations
  • 1Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
JAMA. 2016;315(3):257-258. doi:10.1001/jama.2015.18424

Since the founding of the inaugural hospice in the United States in 1974, there has been substantial growth of the hospice movement, with an estimated 1.6 million patients receiving hospice care in 2014.1 Hospice aims to meet the needs of patients with life-limiting illnesses through expert symptom management, provision of home-based care, and facilitation of caregiver support. An important contributor to the expansion of hospice was the Medicare Hospice Benefit, created by Congress in 1982, which enabled older US adults to receive hospice care. Paradoxically, some of the requirements of the benefit also created barriers to enrollment. To limit Medicare costs during the enactment of the hospice benefit, eligibility was restricted to individuals with an estimated life expectancy of 6 months or less, and individuals had to be willing to forgo all treatment directed at their underlying disease. As science and clinical care have advanced over time, what is appropriate for end-of-life care in 2016 is very different from 1982. These enrollment requirements result in underuse of hospice and instead contribute to excess use of hospital care and intensive care at the end of life.

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