Disciplining Dying: A Political History of the Medicare Hospice Benefit and its Impact on Contemporary End-of-Life Care in the United States

2.50
Hdl Handle:
http://hdl.handle.net/10755/152307
Type:
Presentation
Title:
Disciplining Dying: A Political History of the Medicare Hospice Benefit and its Impact on Contemporary End-of-Life Care in the United States
Abstract:
Disciplining Dying: A Political History of the Medicare Hospice Benefit and its Impact on Contemporary End-of-Life Care in the United States
Conference Sponsor:Sigma Theta Tau International
Conference Year:2007
Author:Buck, Joy, PhD, RN
P.I. Institution Name:University of Pennsylvania
Title:Post Doctoral Fellow
[Research Presentation] Purpose: To analyze the impact of the Medicare hospice benefit on the context and outcomes of contemporary end-of-life care in the United States. Methods:áThe methods of political history were used to investigate the factors that led to changes in national end-of-life care policy and the impact of these changes on its intended targets.áPrimary sources include oral histories and archival collections of those integral to the hospice movement; Congressional record, testimony, and legislative histories.áSignificance:áThis study explored larger questions of how norms and boundaries about health-care are created and recreated in a market-oriented society, and in turn, how innovations are shaped as they are institutionalized.áIn doing so, it offers a more nuanced understanding of the links between class, agency, professional domain and the politics of reform that remain invisible in much of the policy and palliative care literature. Its findings are particularly germane to contemporary discourse on end-of-life care policy that transcends disciplinary and national boundaries. Results:áAt the inception of the American hospice movement, hospice was defined by an international cadre of researchers and clinicians eager to reform care for the dying that they believed had become impersonal and technologically managed.áIn the United States, advocates successfully put forth hospice as a humane and cost-effective alternative to institutionalized dying and secured reimbursement for hospice under the Medicare program. As a legislated model of care, hospiceáwas redefined by the vagaries of the politics of health policy and the health-care industry.áWithin this context, tensions between competing social, economic and political forces created a paradoxical benefit that both decreased and increased barriers to care, and ultimately served to further fragment, medicalize,áinstitutionalize and increase the cost of end-of-life care.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDisciplining Dying: A Political History of the Medicare Hospice Benefit and its Impact on Contemporary End-of-Life Care in the United Statesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/152307-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Disciplining Dying: A Political History of the Medicare Hospice Benefit and its Impact on Contemporary End-of-Life Care in the United States</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Buck, Joy, PhD, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Pennsylvania</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Post Doctoral Fellow</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">joybuck@adelphia.net</td></tr><tr><td colspan="2" class="item-abstract">[Research Presentation] Purpose: To analyze the impact of the Medicare hospice benefit on the context and outcomes of contemporary end-of-life care in the United States. Methods:&aacute;The methods of political history were used to investigate the factors that led to changes in national end-of-life care policy and the impact of these changes on its intended targets.&aacute;Primary sources include oral histories and archival collections of those integral to the hospice movement; Congressional record, testimony, and legislative histories.&aacute;Significance:&aacute;This study explored larger questions of how norms and boundaries about health-care are created and recreated in a market-oriented society, and in turn, how innovations are shaped as they are institutionalized.&aacute;In doing so, it offers a more nuanced understanding of the links between class, agency, professional domain and the politics of reform that remain invisible in much of the policy and palliative care literature. Its findings are particularly germane to contemporary discourse on end-of-life care policy that transcends disciplinary and national boundaries. Results:&aacute;At the inception of the American hospice movement, hospice was defined by an international cadre of researchers and clinicians eager to reform care for the dying that they believed had become impersonal and technologically managed.&aacute;In the United States, advocates successfully put forth hospice as a humane and cost-effective alternative to institutionalized dying and secured reimbursement for hospice under the Medicare program. As a legislated model of care, hospice&aacute;was redefined by the vagaries of the politics of health policy and the health-care industry.&aacute;Within this context, tensions between competing social, economic and political forces created a paradoxical benefit that both decreased and increased barriers to care, and ultimately served to further fragment, medicalize,&aacute;institutionalize and increase the cost of end-of-life care.</td></tr></table>en_GB
dc.date.available2011-10-26T11:31:24Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T11:31:24Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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