institut català d’oncologia xavier gómez-batiste md, phd director, who collaborating center for...

Institut Català d’Oncologia

Xavier Gómez-Batiste MD, PhDDirector, WHO Collaborating Center

for Public Health Palliative Care Programs

WHO Meeting

OSI/WHOCCWorkshop 9: legislation, standards, financing models

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

0

10

20

30

40

50

60

70

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 savingsType of service Calculation Subtotal / type Estimated

savings; Euros

HCST 229,000 x 72 services

16,488,000 (31%) TOTAL SAVINGS: 3,000 / patient x 23,100 = 69,300,000 HST 279,000 x 49

services13,671,000 (26%)

PCU 96 x 209,000 stays

20,064,000 (38%)

OUTPAT 155 x 9,000 processes

1,395,000 (3%)

PST 190,000 x 5 services

950,000 (2%)

TOTAL 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’OncologiaICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

.

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

ICO l’HospitaletHospital Duran i ReynalsGran Via de l’Hospitalet, 199-20308908 l’Hospitalet de Llobregat

Institut Català d’Oncologia