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J Urban Health. 2008 Mar;85(2):281-90. doi: 10.1007/s11524-008-9258-y.

A review of barriers to utilization of the medicare hospice benefits in urban populations and strategies for enhanced access.

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  • 1Palliative Care Service, Department of Family and Social Medicine, Montefiore Medical Center, Bronx, New York, NY, USA.


Disparities in access to health care extend to end-of-life care. Lack of access to hospice mirrors lack of access to health maintenance and primary care. Patients who are served by hospice nationally are disproportionately white and likely to reside in economically stable communities. In many urban low-income communities, less than 5% of decedents receive hospice care in the last 6 months of life. This review focuses on barriers to palliative care and hospice in urban, predominantly low-income communities, including cultural and reimbursement factors and the paucity of hospice providers, outreach projects, and in-patient hospice beds in urban communities. This review will also address some strategies that are being implemented by hospices locally and nationally to overcome demographic barriers to hospice care.

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