Lessons learned from hospice in the United States of America

Hospice care in the USA is both envied and criticized. It is an experiment that continues to evolve. What began as a version of inpatient hospice care transplanted from the St Christopher’s Hospice model in the United Kingdom is now a large health care system that greatly emphasizes home care rather than inpatient care. Although the establishment of the federal Medicare Hospice Benefit in 1982 was followed by enormous growth, the benefit has been a two-edged sword for hospice. It is an economic engine, and at the same time, a self-limiting mechanism.

This chapter explores the history of...

Hospice care in the USA is both envied and criticized. It is an experiment that continues to evolve. What began as a version of inpatient hospice care transplanted from the St Christopher’s Hospice model in the United Kingdom is now a large health care system that greatly emphasizes home care rather than inpatient care. Although the establishment of the federal Medicare Hospice Benefit in 1982 was followed by enormous growth, the benefit has been a two-edged sword for hospice. It is an economic engine, and at the same time, a self-limiting mechanism.

This chapter explores the history of hospice in the USA within the broader context of palliative care. It describes the growth and development of hospice as a health care system, provides details about its regulation and economics, and presents its major challenges, both present and future.