The Medicare hospice benefit was instituted in 1983 with two basic intentions: to improve quality of life for the dying and to reduce unnecessary expenditures. Hospice was conceived of in England in the 1960s and developed in the 1970s by Dame Cicely Saunders, who observed that the fate of persons who were terminally ill was often marked by physical pain and emotional anguish. In addition, it was observed that the curative model of health care services did not often distinguish or identify the goals and preferences of patients who were dying, potentially resulting in wasteful spending. The Medicare hospice benefit was enacted in 1983 to address these concerns. The creation of the Medicare hospice benefit acknowledged a cultural conversation about death, dying, and the concept ...

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