States Strategize to Improve Palliative Care Quality & Access

Palliative care providers across the nation are working with state lawmakers to reshape and streamline policies that could increase awareness of and access to their services.

The very nature of interconnected services involved in palliative care often poses accessibility challenges. Fewer than 5% of patients with serious illnesses who stand to benefit from palliative care actually receive it, according to a May 2019 report by the National Academy for State Health Policy (NASHP). Challenges include lack of workforce capacity, public stigmas, high health care costs,  and state policies that prevent timely patient access.   

To address challenges and embed palliative services across a variety of settings, state policies need to be better woven into the overall scope of health care.


“Adding palliative care to treatment has been shown to improve health outcomes and quality of life, while lowering costs an average of $7,000 per patient in high-need, high-cost populations,” the NASHP report stated. “If states employ a range of policy strategies, they can play an important role in improving access to palliative care and the quality of services delivered.”

With funding support from The John A. Hartford Foundation, NASHP is working to develop a 50-state comprehensive set of recommendations and guidelines, including a new toolkit that will be available on their resource hub this spring. The toolkit will feature resources for states to better manage the symptoms and stressors of disease, improve quality of care and reduce cost of palliative care service integration.

“Streamlining appropriate palliative care methods and treatment plans across the health care continuum results in better quality of patient care and longer life spans,” said Senior Project Director of NASHP, Kitty Purington, in a recent webinar. “It also gives providers an opportunity to be more comprehensive and inclusive in their approach to integrate palliative care into their scope of services.” 


Potential state actions that could boost access to palliative care include  sustainable reimbursement mechanisms for the continuum of palliative care services and identifying target populations who can benefit most from palliative care. Additionally, palliative care providers can benefit from state support for education and awareness programs, as well as legislation  to develop strategies that build the palliative care workforce.

A number of states have been taking action during 2019 and 2020 to expand the use of palliative care. As of Dec. 2018, 27 states had passed laws to promote palliative care, according to the NASHP. Though details of the legislation vary among the states, they each serve the goal of bringing palliative care to more patients with serious, chronic, or life-limiting conditions.

During 2019, Ohio, New Jersey and Kentucky pursued such legislation. In January, New Jersey passed a law designed to raise public awareness of palliative care. The state’s legislature is mulling over two more bills related to palliative care.

A Journal of Palliative Medicine study found that as many as 71% of people in the United States have little to no understanding of what palliative care is, including many clinicians in a position to refer patients to palliative care or hospice.

“If states employ a range of policy strategies, they can play an important role in improving access to palliative care and the quality of services delivered,” the NASHP report stated.

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