Medicare Reimbursement for Hospice Care: Ethical and Policy Implications of Cost-Containment Strategies
Journal of Health Politics, Policy and Law. 1985 Fall; 10(3): 565-578.
Fraser discusses the results and implications of a survey conducted by the Department of Health and Human Services to determine the impact on hospices of the Medicare reimbursement program authorized by Congress in 1983. As of July 1985, only about 20% of hospices serving about 10,000 patients had been certified. Failure to participate was attributed to financial and ethical problems arising from federal regulations mandating more complex organizational structures, a $6,500 per patient cap on reimbursement, and a 20% inpatient maximum. In order to remain economically viable, hospices would be forced to screen out certain applicants, control time of admission, and restrict services. Fraser notes widespread concern in the hospice community that regulations governing Medicare reimbursement could be used to limit the options of the terminally ill and foster a presumption against curative treatment for commonly terminal diseases. (KIE abstract)
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