Healthcare reform has generated tremendous controversy over rationing of care to reduce healthcare costs. Opinions vary widely, especially on how to approach end-of-life care for the terminally ill. Known as palliative or hospice care, end-of-life treatment focuses on making the dying patient’s last days as comfortable and pain-free as possible without the intrusive use of excessive medical treatment. Hospice care is administered within specialized settings of healthcare institutions, nursing homes or in the patient’s home. Besides making the patient as comfortable as possible, hospice care usually provides support services for the patient’s loved ones as they go through this stressful period of bereavement.

The use of hospice care varies greatly across the United States. For instance, the New York Times reports that in the state of New York, less than 20 percent of dying patients receive hospice care for only about a week or less, compared to an average of 32 percent who receive an average of about 11 days nationwide. There are several reasons cited for the disparities for moving a patient into hospice are, either within a designated institution or at home. For one thing, doctors, patients, and their families are often reluctant to discuss end-of-life treatment and to admit to giving up hope. Another factor is that palliative care is less profitable for hospitals and doctors than administering aggressive treatment. Doctors who specialize in palliative care often work on a fixed salary, and these medical services do not drive up healthcare costs and additional revenues as do aggressive interventions. A family’s financial situation plays a large factor in the hospice care decision. The healthcare costs of aggressive treatment right up to end of life are mostly covered by public insurance programs like Medicare; but hospice care often is only partially covered. For instance, reimbursement covers only for a few hours of care per day in the home setting rather than the round-the-clock care received in an institution. For a patient to qualify for Medicare hospice coverage, the diagnosis must be terminal, with a life expectancy of less than six months. The patient must agree to the withholding of further treatments. Research indicates that patient who do participate in end-of-life conversations with their doctors did forgo aggressive care earlier. These patients regain more personal healthcare control, which resulted in reduced healthcare costs and a more dignified and peaceful death. Much of the reduced costs can be attributed to fewer admissions to Intensive Care Units.

References: The New York Times, http://www. nytimes. com/2009/08/20/health/20doctors. html 8/20/09Centers for Disease Control and Prevention, 2008,  http://www. cdc. gov/aging/EOL. htm, retrieved August 22, 2009Reuters, 2009, http://www. reuters. com/article/pressRelease/idUS194058+19-Mar-2009+PRN20090319, retrieved August 22, 2009