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Palliat Med. 2017 Apr;31(4):296-305. doi: 10.1177/0269216316689015. Epub 2017 Feb 3.

Funding models in palliative care: Lessons from international experience.

Author information

1
1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
2
2 School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
3
3 Department of Palliative Medicine, Munich University Hospital, Ludwigs-Maximilians-University Munich, Munich, Germany.
4
4 PTE ÁOK Családorvostani Intézet, Hospice-Palliativ Tanszék, Pécs, Hungary.
5
5 Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland.
6
6 Saint Francis Hospice and Mater Hospital, Dublin, Ireland.
7
7 Regional Centre of Excellence for Palliative Care, Haukeland University Hospital, Bergen, Norway.
8
8 Department of Clinical Medicine K1, University of Bergen, Bergen, Norway.
9
9 INSELSPITAL - University Hospital Bern, Bern, Switzerland.
10
10 Klinik für Palliative Care, Hospiz Im Park, Arlesheim, Switzerland.
11
11 Arohanui Hospice, Palmerston North, New Zealand.
12
12 Department of Anesthesiology, Pain and Palliative Care, RadboudUMC, Nijmegen, The Netherlands.
13
13 Viceconsejería de Asistencia Sanitaria, Consejería de Sanidad de Madrid, Universidad Católica San Antonio de Murcia, Murcia, Spain.
14
14 Southern Adelaide Palliative Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia.
15
15 Finance & Corporate Services, South Australia Health, Adelaide, SA, Australia.
16
16 Palliativa Utvecklingscentrum, Lund University and Region Skåne, Lund, Sweden.

Abstract

BACKGROUND:

Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them.

AIM:

To assess national models and methods for financing and reimbursing palliative care.

DESIGN:

Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms.

RESULTS:

Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs.

CONCLUSION:

Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest.

KEYWORDS:

Financing; health care systems; hospice; palliative care; reimbursement mechanisms

PMID:
28156188
PMCID:
PMC5405831
DOI:
10.1177/0269216316689015
[Indexed for MEDLINE]
Free PMC Article

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