Buck Joy
School of Nursing & Department of Family Medicine, West Virginia University, Eastern Division, 2500 Foundation Way, Martinsburg, West Virginia, 25401.
J Hosp Palliat Nurs. 2011 Nov;13(6):S35-S43. doi: 10.1097/NJH.0b013e3182331160.
During the twentieth-century, dramatic changes in the manner and location of care for the dying resulted in the conception and birth of the modern American hospice movement. Idealistic nurses, clergy, and others concerned about the plight of terminally ill cancer patients launched hospice as a necessary health care reform. As new hospice programs opened across the country, the idealism of the early leaders gave way to more pragmatic issues such as program viability. As hospice was studied and integrated into the health care system, it came to be redefined by the politics of health policy and the health care industry. As a result, there is a disarticulation between the needs of seriously ill persons and their families and the health care that is available to them. Important lessons can be learned from the history of the Medicare hospice benefit to help guide current palliative care policy initiatives. While formalized reimbursement for hospice enhanced organizational sustainability, many critical issues remain.
在20世纪，临终关怀的方式和地点发生了巨大变化，导致了现代美国临终关怀运动的构想和诞生。理想主义的护士、神职人员以及其他关心晚期癌症患者困境的人发起了临终关怀运动，将其作为一项必要的医疗保健改革。随着全国各地新的临终关怀项目的开展，早期领导者的理想主义让位于诸如项目可行性等更务实的问题。随着临终关怀被研究并融入医疗保健系统，它开始由卫生政策政治和医疗保健行业重新定义。结果，重症患者及其家庭的需求与他们所能获得的医疗保健之间出现了脱节。可以从医疗保险临终关怀福利的历史中吸取重要教训，以帮助指导当前的姑息治疗政策举措。虽然临终关怀的正式报销提高了组织的可持续性，但许多关键问题仍然存在。
