Financing End-of-Life Care
New report examines the role of public policy in organizing,
delivering, and paying for care at the end-of-life

WASHINGTON-More than two million people die each year in the United States. Yet, surprisingly, end-of-life health care delivery and financing mechanisms are largely patchwork and little understood by most Americans. And, with many states and the federal government experiencing budget shortfalls, getting financing for end-of-life care to the top of the legislative agenda is no easy task.

"Financing and delivering high-quality care for those at the end of life pose unique challenges for the government, private insurers, providers, and families," says Anne K. Gauthier, program director for the Changes in Health Care Financing and Organization (HCFO) initiative.

A new report, "Financing End-of-Life Care: Challenges for an Aging Population," explores key end-of-life issues developed at a 2002 conference sponsored by The Robert Wood Johnson Foundation's HCFO initiative and Last Acts® Campaign. The report outlines the current public and private financing systems for end-of-life care and suggests ways that these systems could be updated and improved. For example, it discusses how to build on the success of the 20-year-old Medicare hospice benefit. The report also suggests that the financial incentives for hospitals and physicians be redirected, in the context of end-of-life care, away from aggressive, inpatient medicine and toward rewards for providing palliative care and consultative services outside of the acute-care setting.

"Integrating the major end-of-life funding sources may offer at least one solution for providing comprehensive, cost-efficient, high-quality care," says Bonnie J. Austin, J.D., co-author of the report. "Policy intervention is needed to ensure that limited resources are targeted appropriately."

To download a copy of the report, see www.hcfo.net/pdf/eolcare.pdf. For hard copies, e-mail leanne.defrancesco@academyhealth.org.

HCFO (www.hcfo.net) supports investigator-initiated research and policy analysis, evaluation, and demonstration projects examining major changes in health care financing, and their effects on cost, access, and quality. The program provides policymakers with timely information on health care policy and encourages collaboration between policymakers, providers, and researchers.

AcademyHealth (www.academyhealth.org) is the national program office for HCFO. It is the professional home for health services researchers, policy analysts, and practitioners, and a leading, non-partisan resource for the best in health research and policy.

Last Acts (www.lastacts.org) is a call-to-action campaign reaching health care professionals and the public. Its goal is to bring death-related issues out in the open and help individuals and organizations pursue better ways to care for the dying.

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