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Hospice: Philosophy of care and appropriate utilization in the United States

Diane E Meier, MD, FACP
Elizabeth McCormick, MD
Ruth L Lagman, MD, MPH, FACP, FAAHPM
Section Editor
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD


Hospice care is a model and philosophy of care that focuses on palliating terminally ill patient’s pain and other symptoms, and attending to their and their family’s emotional and spiritual needs.

The concept of hospice started during the middle ages when hospices were set up as places of rest for pilgrims and other travelers. At the end of the 19th century, hospices were designated specifically to care for the dying, first in Ireland and later in England. St. Christopher’s Hospice in London opened in 1967 under the direction of Dr. Cicely Saunders. A nurse, social worker, and a physician, Saunders developed and advanced the modern hospice movement to reflect her commitment to patient-centered care, pain management, research, and education. The philosophy and practice of the St. Christopher’s Hospice program has since spread to all countries in the developed world and to many developing countries.

Hospice services are designed to provide comprehensive interdisciplinary team-based palliative care for patients with life-limiting illness and a prognosis of six months or less if the disease follows its natural course. Hospice services in the United States (US) are an insurance benefit reimbursed by Medicare, Medicaid, and other payers.

In the US, hospice was initially a grass roots and volunteer response to bring attention to the needs of the dying, with the goal of providing patient-centered care and avoiding unnecessary medical intervention. In 1982, the Medicare hospice benefit was authorized under part A of the Medicare program [1].

The past two decades have seen a dramatic increase in the number of hospice programs internationally and within the US. For example, in the US [2,3]:

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Literature review current through: Nov 2017. | This topic last updated: Feb 03, 2017.
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