Understanding funding models in palliative care: Who pays and who provides?

This month’s Editor’s Choice from Palliative Medicine . . .

Fliss Murtagh, Professor of Palliative Care, Hull York Medical School, UK, and Visiting Professor at the Cicely Saunders Institute, King’s College London, UK, explains the background to a longer article selected as ‘Editor’s Choice’ in the April 2017 issue of Palliative Medicine.

Professor Fliss Murtagh

We are delighted to hear that our recent paper ‘Funding models in palliative care: Lessons from international experience, has been chosen as ‘Editor’s Choice’ for the April issue of Palliative Medicine. Not least because this has been one of the most challenging papers we have ever written!

It began back in 2012 just before the 7th World Research Congress of the European Association for Palliative Care (EAPC), in Trondheim, Norway. We were embarking on a programme of research to understand case mix, complexity, resource use, and outcomes in palliative care. Searching for a better understanding of how palliative care was resourced, we had been reading and finding out about different funding models for palliative care in different countries. Some people could tell us part of the story but it was so often incomplete. It was also hard to find out about specific funding and policy information without talking to the ‘locals’ from each country. So we decided to investigate further, and seek ‘country experts’ from a range of countries to find out more detail . . .

Trondheim: Courtesy of Enrico Strocchi

Amidst the beautiful Trondheim location, we started formally interviewing a range of international colleagues, choosing countries to represent a range of different health systems across Europe. Of course, as the interviews progressed, and the experts started to answer our questions, it became clear that it was even more complex than we had at first thought.

We began to build up a picture of what was happening in each of the countries we included, but the very complexity of our findings made it hard to find a uniform way to describe funding models across every country. Not only did each place have a different way of funding palliative care, but each country also had a very different overall health system, and sometimes several systems working sometimes together or sometimes in competition. A breakthrough came when we discovered a very useful theoretical framework from a Canadian group; this proved to be the key in making systematic sense of our complicated and diverse findings.

We had to go back and re-interview our experts; partly to understand in the context of the theoretical framework, and partly because nothing stands still; the funding of palliative care changes and we needed to update the work. EAPC conferences in Prague, Lleida, and Copenhagen had happened by this time! But after persisting, we were able to report useful findings, highlighting the patterns among funding models across countries.

Some valuable insights emerge; providers of palliative care are rarely paid in a way that directly reflects either individual needs or population needs; inequities in ‘the system’ are often perpetuated by the existing funding models; and most palliative care is funded by an extremely ‘mixed’ economy of charitable, public and private funds, with all the advantages and disadvantages this brings.

A huge thank you to Iris Groeneveld, whose perseverance has been outstanding, and to all our co-authors without whom this paper would not have been written.

Read the full article in Palliative Medicine

Download your free copy of this month’s Editor’s Choice article here on the EAPC website.

This blog post relates to the longer article, Funding models in palliative care – lessons from international experience’ by 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, published in Palliative Medicine, Vol. 31 (4) 2017, 296-305. DOI: 10.1177/0269216316689015. You can find out more here where the paper is freely available.

How to download previously published ‘Editor’s choice’ articles
EAPC members and registered users of the EAPC website can download all ‘Editor’s choice’ papers free of charge from the EAPC website but you will need to register or login first. Please follow the instructions in the top right-hand corner of the EAPC home page and scroll down to the article. Click here to view other EAPC-originated papers.

Read earlier Editor’s Choice posts on the EAPC Blog.

This entry was posted in EAPC-LINKED JOURNALS, Palliative Medicine: Editor's Choice, RESEARCH and tagged . Bookmark the permalink.

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