THE AMERICAN MEDICAL system is very well geared to care for people whose ailments or disabilities are curable or, at least, controllable. It is much less well suited to care for those whose illnesses are no longer treatable. A bill before Congress woubreakthrld extend to terminally ill persons covered by Medicare the possibility of seeking "hospice" care, a method of care designed to help dying people remain free of pain and in their homes for as long as possible.
In the past several years, over 400 hospice programs have been started around the country. There is no single model of hospice care, but there are several essential features of it. Hospice care is strictly limited to persons who are no longer receiving curative treatments. While inpatient care may be provided, the aim of the programs is to keep patients comfortable in their homes as long as possible, involve family members in patient care and help families to adjust both before and after the patient's death. Volunteers are used extensively, although doctors and other professionals are on-call around the clock for home visits.
The most important advantage of hospice care is that many patients and families find it a humane and comforting alternative to the high-technology medicine offered by regular hospitals. However, because of its emphasis on in-home care and the use of volunteers, hospice care can be far less expensive than hospital care or nursing home care, the normal alternatives for the terminally ill. The excellent Hospice of Northern Virginia, for example, has found that its cost of providing in-home care is about $68 a day compared with an average cost of $503 a day for final admissions to local hospitals. Even when patients must be moved to the hospice facility, the daily cost is only $270.
Because a very large proportion of Medicare costs are spent on patients in the last year of life, hospice care promises substantial savings for the program. The Health and Human Services Department, however, is concerned that if hospice care coverage is not properly circumscribed, it could be exploited by proprietary firms set up to take advantage of the new authority, and end up costing more than it saves. HHS would prefer to wait for action until the results of a demonstration project have been analyzed. Congress is also being barraged by other types of health-care providers--everything from skilled nursing homes to music therapists--who think they should be covered, too.
The history of government health programs would certainly suggest caution in any extension of coverage. But more than two years are likely to elapse before HHS has completed its study--the results of which are unlikely to be conclusive. In the meantime, hospices currently covered by Medicare as part of the study may have to close down when the project ends next fall, and many other patients will be denied access to a form of care that has shown itself to be humane and efficient. Safeguards are needed to make sure that hospice coverage is not abused, but strictly limited coverage is better than no coverage at all. The bill should be passed.