Goal Statement: Financing End-of-Life Care: Challenges for an Aging Population

An Invitational Meeting Sponsored by The Robert Wood Johnson Foundation under its Changes in Health Care Financing and Organization (HCFO) initiative and Last Acts Campaign; Conducted by AcademyHealth and Last Acts Campaign
February 6, 2002 - Loews L'Enfant Plaza, Washington, D.C.

Goal Statement

Each year more than 2 million people die in the United States, yet the delivery and financing mechanisms for end-of-life care are largely patchwork and little understood by most of the population. Whether a person dies in a hospital, a nursing home, or at home, with or without hospice care, is dependent on where the person lives, the health plan, the primary care physician, and the diagnosis. There is no clear pattern as to how these decisions are made or how the care will be financed. The vast majority of people who die each year are age 65 or older and covered by Medicare, which provides 100 percent coverage for hospice services, including skilled nursing, volunteer services, physician visits, skilled therapy, home health aide visits, medical social services, spiritual counseling, nutrition counseling, and bereavement support for the family. Patients choosing the Medicare hospice benefit also receive outpatient prescription drug coverage, which is not currently available under traditional Medicare. Yet, only about 15 percent of deaths each year occur in hospice. Analyses have shown that Medicare is the major payer for hospice services, while private insurance and Medicaid account for a small portion of hospice revenues.

Despite the significant financial burden of end-of-life care on the government, private insurers, and families, there has been relatively little research on ways to improve end-of-life care beyond hospice, or on ways to cost-effectively extend the benefits of hospice to a larger number of patients near death. Moreover, there has been little analysis of palliative care for patients who are not designated as terminally ill, but who can benefit from such care. It is important to carefully assess the impact of various ways of delivering and financing end-of-life care on costs, access, quality and patient and family quality of life.

The purpose of this meeting is to bring together private and public policy makers, researchers, and providers to discuss ways in which to design, deliver and finance end-of-life care. We hope that the meeting discussions will help to identify the role of public policy in dealing with a difficult but important period in everyone's lives, as well as the need for future research on the organization, delivery and financing of end-of-life care.
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