Here's a classic half-full, half-empty health care scenario.

Some hospitals and communities are vastly improving the way they take care of seriously ill patients.

Some aren't.

The Center to Advance Palliative Care and its close collaborator the National Palliative Care Research Center recently completed a "report card" complete with interactive maps on palliative medicine nationwide. Despite the growth of palliative medicine as a field in recent years, they found large variation in access and quality. Only three states—Montana, New Hampshire and Vermont—got an "A." Overall, the country got a "C." Generally speaking, the South and portions of the West lag in palliative care. In Mississippi, for instance, less than 10 percent of hospitals have a palliative care program; in Vermont every single hospital has one. Big hospitals are more likely than small hospitals to have palliative care, for-profit hospitals were less likely than nonprofits (even though these two research groups have found that palliative care is cost-effective), and safety net public hospitals which serve large numbers of the uninsured also tend to lag.

Why does this matter? Palliative care emphasizes care coordination, pain and symptom management, and family support during chronic and serious illness—including but not exclusively at the end of life. These are not the strong points of U.S. medicine. The report reminds us that nearly three out of four of the 1.5 million Americans who die of chronic illness each year will spend at least some time in the hospital in the last six months of life. One-in-four seriously ill people in hospitals report inadequate treatment of pain and shortness of breath. A third say they are not provided with arrangements for follow-up care after they leave the hospital, and the same proportion say they were not taught how to treat their pain and other symptoms after discharge. One-in-three families said they did not get adequate emotional support.

What should be done about it? The recommendations range from incorporating more pain management and palliative care training into medical school as well as continuing medical education for doctors, to making sure that states include palliative care measurements in their quality assessments, and incentives for doctors and nurses to go into palliative care. The field is still new; nurturing it pays off in fiscally-responsible, quality-enhancing ways.