It is time for better care at the end of life: a worldwide call to action from the OECD.

An important report from the Organisation for Economic Co-operation and Development (OECD) has highlighted common challenges and called for greater priority to be given to policies that improve how people experience the end of their life. Paola SILLITTI from the OECD tells us about their new report ‘Time for Better Care at the End of Life’ and why change is needed.

Populations around the world are ageing and people increasingly live with chronic diseases. In 2019, nearly seven million people needed end of life care across the 38 member countries of the OECD, a number expected to grow up to ten million by 2050. How can we make sure that people receive the high-quality care they deserve, and in the place that they prefer? Despite being a priority for many countries, there is still a long way to go for people who are in need to receive timely and appropriate care at the end of life.

Access to end of life care is still limited and care does not always reflect people’s wishes.

Only 40% of people in need receive end of life care and, despite a preference to die at home, many still die in hospital due to a lack of at home and community-based support and because mechanisms to ensure timely access are scarce. For instance, less than a third of the OECD countries have national programmes to monitor how long people need to wait between receiving a referral and accessing end-of-life care services. People’s preferences are also rarely recorded, with less than a half of older people having a document defining what end of life care they would want or nominating a person to speak on their behalf.

Mean percentage of people using palliative care or hospice who died at age 65 or over by country. Source: Survey of Health, Ageing and Retirement in Europe (SHARE – Waves 7-8), Health and Retirement Study (HRS – Wave 14).

When people receive end of life care, it is often inadequate.

Too much emphasis is often placed on treatment which hopes to cure the individual with not enough attention given to palliative care and their psychological and social needs. According to the Survey of Health, Ageing and Retirement in Europe, between 10% and 25% of people who died at the age of 65 or older had previously complained of receiving too little pain medication, or too little help with breathing or their anxiety. Alongside under-treatment, one third of older patients who are hospitalised at the end of life receive treatment that is not likely to provide comfort or prolong life, nor is it cost-effective. There are also marked inequalities in access with people from higher education twice as likely to receive end of life care services than those with low education.

OECD analysis suggests that in order to improve access to end of life care and to deliver more adequate and people-centred care, countries should address staffing shortages and improve health and care professional end of life training. It is also important that the stigma around death is addressed in order to create more conversations about the end of life – amongst health and care professionals as well as in society. Multidisciplinary teams, already in place in several OECD countries, can also support the delivery of good people-centred end of life care by facilitating advanced care planning (discussing and recording care preferences with patients and their relatives) and improving care co‑ordination.

End of life care also often lacks adequate funding.

Public funding does not cover all end of life care services across OECD countries, meaning that people who are at the end of their life, as well as their relatives, often have to pay, even when they cannot afford to. Existing public funding is mostly geared towards hospital settings which most likely restrains equal access to care in the community and other non-hospital settings.

Incentivising cost-effective end of lifeservices can support a shift towards more financially sustainable publicly funded care. For instance, international evidence has shown that non-hospital palliative care provides potential benefits for people receiving care and their relatives while also being cost-effective, reducing the use of acute care at the end of life and decreasing overall health expenditure.

The OECD is actively supporting countries to improve end of life care. This report is an important step forward, and the OECD will continue to collect international indicators on end of life care to support evidence-based policies that allow people to experience their own and their relatives’ end of life in the good and humane way they deserve.

Links and resources

About the author

Paola Sillitti is a Research Officer at the Health Division at the Organisation for Economic Co‑operation and Development (OECD). She has Bachelor of Science degree in Economics and a Master of Science in Economics and Management from Bocconi University. She has also studied Economics at HEC Lausanne and International Affairs at Sciences Po Paris. Twitter: SillittiPaola LinkedIn: paola-sillitti

This entry was posted in ADVOCACY & POLICY, NATIONAL & INTERNATIONAL REPORTS. Bookmark the permalink.

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