By Christian Sinclair, Special to The Kansas City Star

November is National Hospice and Palliative Care Month, which marks the 30th year of this designation.

It is especially significant this year with the recent death of Florence Wald, former dean of the Yale School of Nursing and founder of the first hospice in the United States.

The remarkable growth of hospice in America in the last three decades is a testament to the need for quality compassionate care for patients with life-threatening illness.

The success and important role of hospice have led to the development and formal recognition of a new specialty: hospice and palliative medicine.

Palliative medicine applies the same hospice philosophy to patients who may still be seeking curative or restorative treatments.

There are now fellowships for physicians and certification exams to test for this specialized knowledge and to recognize physicians and nurses who acquire it.

Locally, Kansas City has participated in the development of this medical field.

For the past three years, Kansas City has been home to a palliative medicine fellowship through collaboration between Kansas City Hospice & Palliative Care and the University of Kansas Hospital.

Numerous area hospitals have developed successful palliative care programs to benefit patients when medicine may no longer be able to overcome a progressive illness.

It is important to realize that, despite the improvements in access to quality end-of-life care, continued availability depends primarily on the support of Medicare and commercial insurance.

Unfortunately Medicare is reducing its support for hospice through a reduction in reimbursement of 4.5 percent over three years.

Commercial insurance reimbursement is uneven and very limited in many instances.

Patients, families, and the health care system all benefit from strong hospice and palliative care programs.

We have come a long way in 30 years, and we need to make sure good end-of-life care is an essential part of our medical future by helping our employers, insurance companies and elected officials understand the importance of this vital service.

Christian Sinclair is associate medical director for Kansas City Hospice & Palliative Care. He lives in Shawnee.