Hospice providers in the U.S. are on the horns of a dilemma. Survival of individual programs may require accreditation for third party reimbursement, but this stronger alignment with the business world of medicine may jeopardize their unique philosophy of care for dying persons. Hospice's current business/philosophy dilemma was expressed succinctly by a study participant as attempting to incarnate heaven. Data gathered through an ongoing participant observation study reveals the effects of current third party reimbursement on hospice practice. Further, these effects have implications for current U.S. health care reform efforts which are discussed in conclusion.

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