Financial Aspects of Inpatient Palliative Care
The economics of hospital inpatient palliative care is a subject of significant policy interest internationally. Older people, and particularly those with multiple serious chronic conditions, account disproportionately for hospital admissions (McCusker et al. 2003), and up to half of recorded deaths worldwide occur in hospital (Bekelman et al. 2016; Broad et al. 2013). Hospitalization costs represent the main component of end-of-life costs across healthcare settings (Simoens et al. 2010a). Economic studies of palliative care for adult hospital inpatients suggest that persons who receive palliative care have lower costs and earlier discharge than matched patients who receive usual care only, as well as improved outcomes. Additionally, palliative care’s effect is larger when provided earlier (raising questions of when palliative care should be introduced in the trajectory of illness for people both inside and outside the hospital) and is also larger for adults with higher numbers of comorbidities (suggesting that complex interdisciplinary interventions are more effective for complex clinical cases, an insight with major potential policy relevance worldwide).
Further economic evaluations of palliative care beyond the hospital silo to evaluate impacts across whole trajectories of care are needed. Only then will policymakers have the full story on the costs and benefits of complex care for those with complex illness.
- American Cancer Society. Cancer facts and figures 2015. Atlanta: American Cancer Society; 2015.Google Scholar
- Broad JB, Gott M, Kim H, Boyd M, Chen H, Connolly MJ. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health. 2013;58(2):257–67.PubMedCrossRefGoogle Scholar
- Centeno C, Lynch T, Donea O, Rocafort J, Clark D. EAPC Atlas of palliative care in Europe. Milan: EAPC Press; 2013.Google Scholar
- Davies E, Higginson IJ. The solid facts: palliative care. Copenhagen: World Health Organization, Regional Office for Europe; 2004. 9789289010917.Google Scholar
- Jones AM. Models for health care. York: Health Economics and Data Group, University of York; 2010.Google Scholar
- May P, Garrido MM, Cassel JB, Morrison RS, Normand C. Using length of stay to control for unobserved heterogeneity when estimating treatment effect on hospital costs with observational data: issues of reliability, robustness and usefulness. Health Serv Res. 2016;51(5):2020–43.PubMedPubMedCentralCrossRefGoogle Scholar
- Morrison RS, Meier D, Carlson M. The healthcare imperative: lowering costs and improving outcomes. Washington, DC: Institute of Medicine; 2011.Google Scholar
- Radbruch L, Payne S. White paper on standards and norms for hospice and palliative care in Europe: part 2. Eur J Palliat Care. 2010;17(1):22–33.Google Scholar