Hardly a day goes by without a discussion or debate between physicians and other health care professionals about staggering health care costs and the national health reform initiatives. There are many different opinions about the cause of rising costs with almost as many ways to fix the situation. These conversations are always thought-provoking; however, many need relief now and don't have the time to wait for a remedy.

One of the reasons for the increase in health care costs is directly related to the expectations of physicians as well as those of our patients and their families.

Life expectancy has increased over the past century. The average U.S. life expectancy in 1900 was only 47 years; in 2007, it had risen to 75 years for men and 81 years for women. This is due to advances in clinical medicine, better public health practices and an increase in standards of living.

Today, many illnesses are treatable, and this translates into an increase in the prolongation of the dying process, while in the past patients would have died shortly after diagnosis.

There is an expectation to keep even terminally ill patients alive using extraordinary means — no matter what the financial cost. This can translate into exorbitant medical bills and often a diminished quality of life for a terminally ill patient.

National Hospice/Palliative Care Month in November serves as a reminder that hospice care plays an important role in the continuum of care for patients and their families. Accepting the concept of hospice care admittedly may not be easy for many. Our culture has deemed that accepting that a loved one may soon die is akin to giving up hope and relinquishing our duty to do everything possible to save their lives.

It's important to note that hospice is not designed to hasten death or "help" someone die, but rather to help patients live the remainder of their lives as fully as possible. Hospice care affirms life and sees death as a natural process.

Indeed, accepting hospice care requires a new mindset. It elevates the role of end-of-life care, ascribing its importance to be on par with pre-natal care and the labor and delivery process that ensure the health and well-being of the newborn. Although they are on opposite ends of the care spectrum, both are important stages of our lives. We should not accept one and deny the other.

St. Francis Healthcare System was the first to introduce hospice care to Hawaii in 1978 and is the largest provider of home hospice care supported by two inpatient hospice facilities. Other hospice organizations in Hawaii share the same focus. Rather than curing an illness, the emphasis is on alleviating pain and symptoms and improving the quality of a patient's life.

Hospice care, combined with the separate but related discipline of palliative care that focuses on pain and symptom management, allows terminally ill patients to be present in body, mind and spirit, surrounded by family and friends, instead of being in pain and relegated to a sterile hospital room alone.

The U.S. health care system has been slow to adapt to issues facing elderly Americans at the end of their long life. The final chapter of life usually has some of the most intense costs and treatments. According to one estimate, end-of-life care accounts for about 10 percent to 12 percent of all health care spending. About 27 percent of the total Medicare budget of $327 billion in 2005 was spent on services for Medicare beneficiaries in the last year of their life and 40 percent spent in the last 30 days.

As our population in Hawaii continues to age and have more complex and chronic illnesses, there will be an increased demand and spending for medical services. With rising health care costs and budgetary constraints, the challenge is to provide appropriate affordable health care for all.

Hospice care may be a viable solution to this complex issue. Most people, if asked, will say they would like a peaceful, comfortable death at home surrounded by their loved ones. A hospice interdisciplinary team of trained professionals works together to honor those wishes and at a price tag that is far better.