Much of the U.S. health care system has been organized to deliver acute treatment and life sustaining intensive care. Palliative and hospice care were added relatively recently to address the undertreatment of pain as well as the personal/familial suffering associated with chronic disease and end of life. The first formal palliative care program in the U.S. was created as a philanthropic project during the 1970's and closed about a decade later due to lack of funds.* Palliative care is still struggling to be recognized as a valuable specialty service. Hospice care was made a permanent Medicare benefit for terminally ill in 1986. This made Hospice a nationally guaranteed benefit and an accepted part of the health care.
Curative care can be defined as: the active pursuit of treatment to halt or eliminate a disease process.
Palliative care is described by the World Health Organization as care that "improves the quality of life of patients and their families facing life-threatening illness by providing pain relief and management of other distressing and debilitating symptoms. Palliative care services are appropriate from the time of diagnosis of a life-threatening illness and throughout the course of the illness." Palliative care is operationalized through effective management of pain and other distressing symptoms, while incorporating psychosocial and spiritual care with consideration of patient/family needs, preferences, values, beliefs, and culture.*
Hospice care is described by The National Hospice and Palliative Care Organization as support and care for persons in the last phase of an incurable disease so that they may live as fully and comfortably as possible.
Medicare hospice benefits are described by the U.S. Social Security Administration as "services to terminally ill persons with life expectancies of 6 months or less who elect to forgo the standard Medicare benefits for treatment of their illness and to receive only hospice care for it. Such care includes pain relief, supportive medical and social services, physical therapy, nursing services, and symptom management. However, if a hospice patient requires treatment for a condition that is not related to the terminal illness, Medicare will pay for all covered services necessary for that condition. The Medicare beneficiary pays no deductible for the hospice program but does pay small coinsurance amounts for drugs and inpatient respite care."*