NCPA - National Center for Policy Analysis


March 24, 2009

Dying can be expensive; studies show up to a third of all money spent on Medicare patients each year goes toward the 5 percent of elderly and disabled enrollees who die.  Dying well can also be expensive, but usually less so if patients, their families and their doctor have honest conversations about end-of-life care, says the Nashua Telegraph.

Hospice care is the main model of a team-oriented approach to caring for someone with a life-limiting illness through expert medical care, pain management, personally tailored counseling and spiritual support, and related services for the patient's loved ones.  But more than a few hospitals and nursing homes have been borrowing from the hospice model to provide palliative care -- a combination of pain management and spiritual and emotional support -- to patients who are gravely ill, but who may recover, says the Telegraph.

The Medicare hospice program, which pays for more than 80 percent of all formal end-of-life care, has been a particular concern to administrators in recent years:

  • From 2000-2007, costs tripled to more than $10 billion a years, with nearly 4,000 Medicare-certified providers.
  • Initially designed for patients with terminal cancer, now, only 40 percent of Medicare hospice patients have cancer; neurological diseases, heart failure or other conditions make up the majority.
  • More than 1 million people are enrolled in Medicare hospice each year, yet Medicare says only about 40 percent of more than 2 million patients who die each year are in hospice when they pass away.
  • Over the last 10 years, researchers have noted that the average length of stay in Medicare hospice keeps getting longer, leading some reformers to suggest that hospices be paid less for longer stays.

Moreover, it's not clear how many more Medicare patients receive palliative care in a hospital or other setting outside of hospice, however, since many of those services are covered through regular payments, says the Telegraph.

Source: Editorial, "End-of-life care is sometimes needlessly costly," Nashua Telegraph, March 22, 2009.

For text:


Browse more articles on Health Issues