Funding models in palliative care: Lessons from international experience

E Iris Groeneveld, J Brian Cassel, Claudia Bausewein, Ágnes Csikós, Malgorzata Krajnik, Karen Ryan, Dagny Faksvåg Haugen, Steffen Eychmueller, Heike Gudat Keller, Simon Allan, Jeroen Hasselaar, Teresa García-Baquero Merino, Kate Swetenham, Kym Piper, Carl Johan Fürst, Fliss Em Murtagh

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    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.

    Original languageEnglish
    Pages (from-to)296-305
    JournalPalliative Medicine
    Volume31
    Issue number4
    Early online date3 Feb 2017
    DOIs
    Publication statusPublished - Apr 2017

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