A new Health Justice Monitor commentary on the
government’s monetary power to provide health care.
Allowing For-Profit Hospice: The Worst Health Policy Idea Ever?
By David Himmelstein and Steffie Woolhandler
Summary
For-profit ownership has reached two-thirds of hospice agencies. Yet for-profit status is associated with fewer services, less clinically skilled staff, more formal complaints, more discharges of sicker patients, and more hospital and emergency department use. Removing for-profit ownership is part of health reform.
Excerpt
Hospice Tax Status and Ownership Matters for Patients and Families
(behind a paywall) JAMA Internal Medicine
August 1, 2021
By Melissa D. Aldridge.
From the article:
The increase in ownership of hospices by private equity (PE) firms and publicly traded companies … follows almost 2 decades of steady growth of for-profit ownership of hospice agencies, from one-third of hospices in 2000 to almost two-thirds by 2017. Why is this noteworthy? It is difficult to identify a health care sector more detrimentally affected by the mismatch between profit maximization incentives and quality of care than hospice. . . .
For-profit compared with nonprofit hospices provide narrower ranges of services to patients, use less skilled clinical staff, care for patients with lower-skilled needs over longer enrollment periods, have higher rates of complaint allegations and deficiencies, and provide fewer community benefits, including training, research, and charity care. For-profit hospices are more likely than nonprofit hospices to discharge patients prior to death, to discharge patients with dementia, and to have higher rates of hospital and emergency department use. In one analysis of 355 hospices, 90% of those with the lowest spending on direct patient care (eg, patient home visits) and the highest rates of hospital use were for-profit hospices.
Commentary
Allowing for-profit hospices is crazy. The deranged care documented in the commentary above (each statement is referenced in the original article) is the predictable result of reimagining dying patients as prudent shoppers in a commercial transaction. Medicare pays for the overwhelming majority of hospice care and could proscribe the participation of for-profits – it excluded for-profit home care agencies until 1980.
With more and more health care providers being snapped up by for-profit firms, and evidence of their misbehaviors mounting, proscribing for-profit ownership has become an essential element of health care reform.
—David Himmelstein and Steffie Woolhandler
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The McCanne Health Justice Monitor (HJM) is a health policy blog focused on the U.S. health system failings and single payer reform. A core team of health policy experts and guest contributors write posts several times per month, addressing topics ranging from healthcare inequity and waste, distortions introduced by profit motives, racism and racial inequities in health care, climate and environmental justice, global health and more.
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