End-of-life care: a public health crisis and an opportunity for managed care.

American society is failing to provide humane care for people who are dying. Unnecessary physical suffering continues even in our most prestigious institutions, and the enormous burden on family caregivers remains unrecognized. The cost of health services and burdensome regulations remain major barriers to improving the quality of care. Healthcare planners and policy makers are gradually awakening to the realities of an increasingly older population and a looming labor shortage of qualified paid caregivers. Several features of palliative care render it attractive within managed care. Evidence is emerging that palliative care, focused on meticulous prospective care planning and coordination, delivers high quality and cost-effective end-of-life care. Innovative demonstration projects around the country are exploring models for integrating palliative care within the routine operational processes and protocols of health systems and are providing examples of feasible "best practices" crucial for raising public expectations and framing possible solutions for policymakers and planners. Ultimately, it will be a marketing asset for a managed care organization to be known as a center of excellence in palliative care, and in some markets it will be a necessity. The goals of managed care and palliative care are already well aligned, joint efforts among clinicians, provider institutions, insurers, and employee health benefit managers can address the needs and preferences of dying patients and families, while increasing public trust in managed care.