U.S. hospice benefits.

Area of Science:

• Healthcare Policy
• Geriatric Medicine
• Palliative Care

Background:

• The U.S. palliative care landscape has significantly evolved over 25 years, largely driven by Medicare's hospice benefit expansion.
• Medicare and Medicaid provide crucial health insurance, with hospice benefits being consistent across both programs.
• Over one million elderly Americans utilize hospice benefits annually, with private insurers often aligning with Medicare's offerings.

Purpose of the Study:

• To analyze the growth and utilization of palliative care services in the United States.
• To examine the impact of Medicare and Medicaid hospice benefits on patient access and care delivery.
• To identify trends in patient diagnoses, length of service, and care settings within U.S. hospice care.

Main Methods:

• Analysis of Medicare and Medicaid hospice benefit structures and utilization data.
• Review of trends in patient demographics, diagnoses (including non-cancer), and length of service.
• Examination of care delivery settings, with a focus on home-based hospice care.

Main Results:

• Palliative care has seen remarkable growth, fueled by the Medicare hospice benefit, serving over a million elderly Americans yearly.
• Hospice patients increasingly have non-cancer diagnoses, and while the average length of service increased, the median decreased to 20 days.
• The vast majority of U.S. hospice care (95.6%) is delivered in patients' homes.

Conclusions:

• The hospice benefit has expanded palliative care access for numerous U.S. patients and families.
• Despite its success, the current requirements for utilizing the hospice benefit may be self-limiting, potentially restricting access.
• Further evaluation of hospice benefit criteria is warranted to ensure broader accessibility to palliative care.