Xavier Gómez-Batiste MD, PhD
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Institut Català d’Oncologia Xavier Gómez-Batiste MD, PhD Director, WHO Collaborating Center for Public Health Palliative Care Programs WHO Meeting OSI/WHOCC Workshop 9: legislation, standards, financing models
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OSI/WHOCC Workshop 9: legislation, standards, financing models. Xavier Gómez-Batiste MD, PhD Director, WHO Collaborating Center for Public Health Palliative Care Programs. The legislation of palliative care includes. - PowerPoint PPT Presentation
Transcript of Xavier Gómez-Batiste MD, PhD
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
[email protected]+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
