“It’s not personal. It’s just business.”

Is healthcare a business?  Should it be a business?  These are serious existential questions that need to be answered as palliative care works to be mainstream.  Hospice, the first incarnations of palliative care in the US, started as a volunteer charitable community project.  In 1982, a hospice benefit was added to Medicare, which led to development of a hospice industry.  It is wonderful that hospice is now available across the country but what are the cost? What has been loss and what are the unintended consequences?

If healthcare is a business, it is like no other.  Imagine a grocery store in which there are no prices on the items.  When you go to check out, the charges differ by a factor of 10  from one customer to the next.  The finally payment will often be only a fraction of the “asking” price.

As a friend of mine was dealing with a seriously ill loved one, he described the feeling that the hospital just wanted to free up a bed.  I was recently asked to reword a note so that the billing would be more efficient. These kinds of experiences can lead patients and families to distrust the healthcare system and for providers to despair when the “business” seems more important than the connection and caring.

I know that some of my colleagues have chosen to move into hospice and palliative care work because they perceive it to be removed from the business aspects.  I am not sure this is still true or will be for that much longer.  The answers in the long term will not be to wall off palliative care from the business of healthcare; it will be to decide if healthcare is a business or if some other model best serves all of us.


Koh, Singer & Edmondson (2019).  Health as a Way of Doing Business.  JAMA.

JAMA. 2019;321(1):33-34. doi:10.1001/jama.2018.18935

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