The medicare hospice benefit: Ten years of federal policy for the terminally ill

Abstract

The Medicare Hospice Benefit has served terminally ill persons and their families since 1983. The political and social development of this policy combined both humanitarian and cost-saving strategies. Although this federal hospice program has mainstreamed care of the terminally ill and provided multiple services, four major constraints of the benefit package are identified and explored. As the United States draws closer to health care reform, it is important that we analyze this policy before we devise new ways to care for the dying and their families.

Oregon’s assisted suicide law: A different perspective

“…The Medicare hospice benefit, which has paid for hospice care since 1983, paved the way for incorporation of Hospice into mainstream health care. 31 Hospice has become a business, 32 and as Paquette 33 states it is "...no longer on the fringe of health care." Cost-effectiveness and competition are already present.…”

Take Some Time to Look Inside Their Hearts

“…The authors believe that the Death with Dignity Act will forever change hospice care in Oregon as professionals will be forced to look closely at their personal and moral values as well as professional codes of ethics related to this legal choice. The option of a lethal prescription may be the biggest disagreement in hospice care since the passage of the Medicare Hospice Benefit in 1982 when programs disagreed on how to pursue reimbursement for care (Miller & Mike, 1995). Miller,Mesler,and Eggman 55 Three sub-themes emerged that conflict with the hospice philosophy and the role of the social worker: (A) patient directed care; (B) to neither hasten nor postpone death; and (C) non-abandonment of patients.…”

“…After two years of implementation, forty-three people have utilized PAS and thirty-two (76%) of them were enrolled in a hospice program just before death (Sullivan, 2000). Social work is a mandated service under the Medicare Hospice Benefit (Miller & Mike, 1995), and social workers are involved in various roles with patients, families, other team members, and the community.…”

Hospice Psychosocial Service Availability and Utilization in the United States

“…To address this need, hospice services have become a growing source of support for terminally ill patients and their families as indicated by the increase of service utilization since the service became nationally available in the early 1980's (Miller & Mike, 1995).…”

“…Initiated in 1982 under the Tax Equity and Fiscal Responsibility Act (TEFRA), services are covered fiscally by the Hospice Medicare Benefit and regulated by Centers for Medicare and Medicaid Services (Miller & Mike, 1995). This coverage includes the medical care provided during the visits by the interdisciplinary hospice team, patient pharmaceutical needs, durable medical equipment including oxygen, as well as supporting medical supplies (Morefield et al, n.d.).…”