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costs, health reform, hospice, palliative care, quality



  1. Fletcher, Devon S. MD
  2. Panke, Joan T. MA, RN, ACHPN


Despite having the highest per capita spending on healthcare in the world, seriously ill patients in the United States often do not receive the highest quality care. Improving the value of healthcare by increasing quality while reducing escalating costs is at the heart of US health reform. With the passage of the Patient Protection and Affordable Care Act of 2010, new healthcare delivery and payment models are being implemented to achieve these goals. This article reviews areas of health reform that have specific relevance for hospice and palliative care, highlights palliative care's positive outcomes, and reflects on current challenges within the healthcare system as well as within the field itself. Considerations regarding the language we use are explored, and recommendations are provided to ensure hospice and palliative care is represented in the planning and implementation of health reform initiatives.