OSI/WHOCC
Workshop 9: legislation, standards,
financing models
Xavier Gómez-Batiste MD, PhD
Director, WHO Collaborating Center for
Public Health Palliative Care Programs
WHO Meeting
Institut Català d’Oncologia
The legislation of palliative care
includes
• The insertion of palliative care in the existing
policies and financing models (Global or specific
Health plans for Cancer, Geriatric, Aids, and other
chronic conditions)
• The formal approval and recognition of the National
Plan
• Basic legislation (Law, decree, or ministerial order)
that could be generic
• Specific changes to assure opioid availability
• Other related legislations: advance directives and
autonomy, rights of patients, ethical committees,
support (funding or changes in labour legislation)
for careers
Institut Català d’Oncologia
Legislation and standards
•
•
•
•
National Plan
General or definition: law or decret (generic)
Financing systems (specific for services)
Opioid and essential medicines availability (the
simplest, the best)
• Standards of services (description)
• Other legislations (respite, support of families, etc)
“The simplest, the best”
Institut Català d’Oncologia
Financing models
• Insert in the common financing model
• Combine: structure, activity, results, and
quality
• Concept of “cathalitic” investment
• Reallocation
• Estimate expected savings
“The simplest, the best”
Institut Català d’Oncologia
Costs Medicare last year life
70
60
50
40
30
20
10
0
1er trim.
2do trim.
3er trim.
4to trim.
Lubitz and Riley, 1993
Institut Català d’Oncologia
Efficiency of PCSs
• Multicenter longitudinal study on the use of resources by cancer patients
attended by PCSs
• Comparison with previous use without PCSs
• 171 teams / 395 patients
Institut Català d’Oncologia
Institut Català d’Oncologia
Institut Català d’Oncologia
The palliative care network saves
more money than its costs
Institut Català d’Oncologia
Costs and savings
Type of service
Calculation
Subtotal / type
Estimated
Euros
HCST
229,000 x 72 services
16,488,000 (31%)
HST
279,000 x 49 services
13,671,000 (26%)
TOTAL
SAVINGS:
3,000 / patient x
23,100
=
69,300,000
PCU
96 x 209,000 stays
20,064,000 (38%)
OUTPAT
155
1,395,000 (3%)
PST
190,000 x 5 services
TOTAL
x
9,000
processes
savings;
950,000 (2%)
TOTAL
COSTS:
52,568,000/ year
NET
SAVINGS:
16,732,000 / year
Institut Català d’Oncologia
Institut Català d’Oncologia
Institut Català d’Oncologia
Institut Català d’Oncologia
Institut Català d’Oncologia
Standards of services
Description of
• Palliative care measures in
conventional services
• Specialist services:
Basic description of:
-Structure
- Process or activities
- Basic outputs
- Basic outcomes
ICO DiR. Centre Col·laborador de l’OMS per Programes
Públics de Cures Pal·liatives
Institut Català d’Oncologia
Institut Català d’Oncologia
Exercise
Part I:
1. Review your general pal care legislation
Apart from opioids)
2. Propose changes for the next year
Part II:
1. Review your financing system
2. Propose a model for palliative care
financing
ICO DiR. Centre Col·laborador de l’OMS per Programes
Públics de Cures Pal·liatives
Institut Català d’Oncologia
.
The ‘Qualy’ End of Life Care Observatory
WHO Collaborating Centre for Public Health Palliative Care Programmes
whocc.info@iconcologia.net
+34 93 260 77 36
Institut Català d’Oncologia
ICO l’Hospitalet
Hospital Duran i Reynals
Gran Via de l’Hospitalet, 199-203
08908 l’Hospitalet de Llobregat
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating
Centre for Public Health Palliative Care Programmes
Institut Català d’Oncologia