Financial Concerns

Financial coverage for care of dying patients is problematic. Medicare regulations restrict payment for many aspects of supportive care. Not all patients qualify for hospice care, and health care practitioners are often reluctant to certify the 6-mo prognosis required for coverage. Health care practitioners should ask themselves whether they would be surprised if their patient died in the next 6 mo. If they would not be surprised, discussion with the patient and family members about palliative care concerns and needs is indicated. Prognostication is difficult, and hospice programs can help by assessing eligibility. If patients referred to hospice live > 6 mo, there is no penalty; they can be discharged if their health improves and readmitted later if they decline clinically, again without penalty. Health care practitioners should know financing options and the financial effects of choices and discuss these issues with patients or with family members and friends.

This topic was last updated July 2006.