Nearly three-quarters of all Americans die in hospitals and nursing homes, yet few of those institutions are prepared to offer patients the kind of care they most need at the end of life. Instead, doctors routinely use strong medications and costly interventions such as defibrillators and respirators to keep the terminally ill hanging on, often in pain and discomfort. Grants from The Robert Wood Johnson Foundation, the Soros Foundation, and the United Hospital Fund are helping to establish palliative care programs in communities across the country. But the term has come to be associated with restrictive conditions defined by Medicare and insurance companies. Currently, in order for a patient to receive hospice care, at least one doctor must certify that the patient has six months or less to live and has agreed to forgo life-prolonging treatments such as dialysis, chemotheraphy and radiation.
Palliative care begins earlier in the process and allows dialysis, etc., for the sake of comfort.
Although palliative care potentially translates into a huge cost savings for the healthcare system, it may be more expensive for consumers than high-tech interventions. Currently, insurance companies do not cover nonhospice palliative care. That's likely to change soon as the programs become more widespread and insurers realize the economies. The field is also likely to come under closer scrutiny as healthcare institutions rush to meet consumer demand. At present, there are few safeguards to help the public evaluate palliative care programs.