Managing advanced illness: a quality and cost challenge to Medicare, Medicaid, and private insurers.

This background paper examines approaches to delivering and financing health services for persons with advanced chronic illness. Recognizing that the Medicare program is the major insurer of such services and that its share is likely to increase due to the aging of the population, the paper focuses on the nature and structure of Medicare hospice-and, to a very limited extent, palliative-care-benefits. It also explores Medicaid benefits, as well as coverage through private insurance, including indemnity, point-of-service,and preferred-provider-organization products. In addition to giving descriptive information on the various programs, the paper looks at quality concerns and cost and payment considerations.