Regulations vs. ideals: a case history of a hospice closure

The cost of health care and health insurance and the increasing number of Americans without access to basic health services has become a primary issue in today's society. Leading politicians, economists, planners, and private individuals recognize the essential need to re-design the system and provide coverage to all Americans. However, the history of programs strangling in the red tape created by inflexible regulatory efforts to set standards, monitor performance, and control costs, thereby denying access to individuals they were specifically designed to serve, points to the need for an equally new approach to planning such a system. The authors have attempted to illustrate, through the case history of the closure of a hospice serving a poor socioeconomic area of New York City, the need for government regulators, program planners, and caregivers to recognize and define common goals and develop flexible and cooperative working relationships.