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- Groeneveld, E. Iris, et al.
(author)
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Funding models in palliative care : Lessons from international experience
- 2017
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In: Palliative Medicine. - : SAGE Publications. - 0269-2163 .- 1477-030X. ; 31:4, s. 296-305
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Research review (peer-reviewed)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.
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| 2. |
- Sobanski, Piotr, et al.
(author)
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End-of-life matters in chronic heart failure patients
- 2014
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In: CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE. - : Lippincott, Williams and Wilkins. - 1751-4258. ; 8:4, s. 364-370
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Research review (peer-reviewed)abstract
- Purpose of review Until recently, concepts of care for people with heart failure had rarely included preparation for unavoidable imminent death or caring for the dying. The purpose of this review is to provide an update on current end-of-life issues specific to heart failure patients. Recent findings Mortality in the heart failure population remains high, especially shortly after the first acute heart failure hospitalization. Patients with systolic heart failure die more frequently from progressive heart failure or sudden cardiac death; patients with diastolic heart failure for noncardiovascular reasons and sudden cardiac death. The mode of haemodynamic decline leading to heart failure death can be characterised by low cardiac output (with or without secondary end-organ dysfunction), congestion, or a combination of both. A new model of end-of-life trajectories has been proposed which takes into account influence of comorbidities on the prognosis of heart failure. Advance care planning for patients with implanted cardiac devices has been shown to be unsatisfactory. A recent strategy for managing implantable cardioverter defibrillators in patients approaching death is presented. Summary There is an emerging need to define specific challenges for end-of-life care for approaching death in heart failure patients. More research and education are needed to improve care for dying heart failure patients, including those with implanted cardiac devices.
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