Marianne Desmedt

The Costs of Treating Terminal Patients

CONTEXT In addition to the effectiveness of terminal care, policy makers and health care payers are concerned about the costs of treating terminal patients in a context of spiraling health care costs and limited resources. OBJECTIVES This article aims to review the international literature on the costs of treating terminal patients. METHODS Studies were identified by searching PubMed, Centre for Reviews and Dissemination databases, Cochrane Database, and EconLit, up to April 2009. Studies were included that contrasted costs in different health care settings and that compared palliative care with alternative therapeutic approaches for terminal patients. RESULTS The few studies that focused on treatment of terminal patients across health care settings showed that hospitalization costs represent the principal component of palliative care costs. In the hospital setting, palliative care tends to be cheaper than usual care or care delivered in units other than the palliative care unit. Palliative care costs depend on patient characteristics, such as diagnosis, status of disease, and age. Also, different care models appear to target different patient groups and offer varied packages of services. Finally, there is some evidence pointing to cost advantages of palliative care at home as compared with alternative care models, although this needs to be corroborated by further research. CONCLUSION Different approaches to deliver palliative care are not substitutes of each other and, thus, have different costs. From a cost perspective, hospitals need to pay attention to admitting patients to the palliative care unit at the right time.

Costs of terminal patients who receive palliative care or usual care in different hospital wards

BACKGROUND In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. METHODS A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. RESULTS Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. CONCLUSIONS This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

Palliative care services in Belgium: benefits and shortcomings of a legal framework

Abstract All health services dealing with the terminally ill are called upon to dispense palliative care. We shall, however, be making a distinction between palliative care services and other forms of services: in fact, the main activity of a palliative care service is palliative medicine, which is dispensed by its trained and experienced personnel. In Belgium, the first specialist palliative care services developed autonomously, and the absence of a planning policy isolated them from the rest of the health system. The Belgian health authorities decided to put an end to this situation by legislation: the laws introduced determine the number, mission and modus operandi of the various palliative care services, as well as the links to be established between them (interaction of the home care support team and the mobile function in hospitals or institutions for the elderly and association for cooperation). The following is a presentation and critical analysis of this legislation.