Assessing the value of hospice care: is documentation of cost savings necessary.

Hospice care is one end-of-life option that since its inception has been the subject of numerous cost comparisons. Early hospice care emerged as a social movement in the United Kingdom. This movement began outside the medical services establishment and sought to improve care for the terminally ill through palliative and supportive services, provided in the patient's own home (1). Hospice care was viewed as a dramatic shift away from the dominant medical paradigm that favored aggressive and technologically intensive treatment of advanced disease in an institutional setting. While many public and health policy analysts have attributed the high cost of dying to the use of aggressive and intensive treatments, the cost-savings of hospice is still an issue for debate. The results of the National Hospice study, which documented medical cost savings during the last six months of life for hospice patients as compared to conventional care patients, was seen as the impetus for Medicare reimbursement for hospice services (2,3). Against this backdrop, the Medicare Hospice Benefit was enacted in 1982 with the goal of providing humane, compassionate and cost-effective care for Medicare beneficiaries with incurable advanced disease. Ever increasing concerns about rising health care costs and the economics of dying have fueled numerous studies trying to quantify the cost savings at the end of life that may result from hospice versus conventional care.