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The magnitude, share and determinants of unpaid care costs for home-based palliative care service provision in Toronto, Canada
- Authors:
- CHAI Huamin, et al
- Journal article citation:
- Health and Social Care in the Community, 22(1), 2014, pp.30-39.
- Publisher:
- Wiley
Little is known about the economic outcomes associated with home-based unpaid care-giving at the end of life. This Canadian study examines the magnitude and share of unpaid care costs (ie by family caregivers) in total healthcare costs for home-based palliative care patients, from a societal perspective and also considers the sociodemographic and clinical factors that account for variations in this share. One hundred and sixty-nine caregivers of patients with a malignant neoplasm were interviewed from time of referral to a home-based palliative care programme provided by palliative care services in Toronto, Canada, until death. Information regarding palliative care resource utilisation and costs, time devoted to caregiving and sociodemographic and clinical characteristics was collected between July 2005 and September 2007. Over the last 12 months of life, the average monthly cost was $14 924 (2011 CDN$) per patient. Unpaid care-giving costs were the largest component – $11 334, accounting for 77% of total palliative care expenses, followed by public costs ($3211; 21%) and out-of-pocket expenditures ($379; 2%). In all cost categories, monthly costs increased exponentially with proximity to death. The share of unpaid care costs of total costs was driven by patients' and caregivers' sociodemographic characteristics. Results suggest that overwhelming the proportion of palliative care costs is unpaid care-giving. This share of costs requires urgent attention to identify interventions aimed at alleviating the heavy financial burden and to ultimately ensure the viability of home-based palliative care in future. (Edited publisher abstract)
Developing a new approach to palliative care funding
- Author:
- NHS ENGLAND
- Publisher:
- NHS England
- Publication year:
- 2015
- Pagination:
- 35
- Place of publication:
- Leeds
This document presents the 2015/16 palliative care development currency. The currency is a first attempt to group specialist palliative care into packages of care that are similar in terms of resource need and clinical input. The currency is not mandatory and will be further tested and refined during 2015/16.The aim is that it will provide a meaningful tool to support service planning and commissioning. Section 2 provides some background to the project. Section 3 is an overview of what currencies are and how they are used, while section 4 explains how the currency was developed. Section 5 outlines briefly plans for developing the currency in 2015/16. (Edited publisher abstract)
Moving toward Medicare home health coverage for people with Alzheimer’s disease
- Author:
- CABIN William D.
- Journal article citation:
- Journal of Gerontological Social Work, 51(1/2), 2008, pp.77-86.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Over 75% of care for people in the USA with Alzheimer’s disease or other dementias is provided by family members, imposing a significant personal burden in terms of stress, depression, social isolation and other problems. Despite the existence of reputable evidence in favour of the benefits of home- and community-based palliative care provision, this is not incorporated within Medicare which is dominated by the curative, drug-focused medical model. As a result, there are significant unmet client and carer needs, and high costs to all parties including Medicare when, for example, premature admission to institutional care follows the failure to provide any support for carers. There is a strong case for the federal government to fund a demonstration project to test the efficacy of palliative home care for improving quality of life and reducing costs for Medicare clients with Alzheimer’s disease, and for their carers. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Enhancing a community palliative care service with telehealth leads to efficiency gains and improves job satisfaction
- Authors:
- HAYDON Helen M, et al
- Journal article citation:
- Journal of Telemedicine and Telecare, 27(10), 2021, pp.625-630.
- Publisher:
- Sage
- Place of publication:
- London
Telepalliative care services enable clinicians to provide essential palliation services to people with a life-limiting illness in or closer to home. This study aims to explore the costs, service activity and staff experiences resulting from the introduction of telehealth in a community palliative care service in Queensland, Australia. Pre- and post-activity and cost data from the 2016–2017 and 2019–2020 financial years were examined and staff members interviewed. Accounting for inflation and standard wage increases, the labour costs before and after the addition of telehealth were approximately equal. There were small variations in non-labour costs, but these were not directly attributable to the expansion of the telehealth services. Overall, the service activity increased by 189% for standard doctor and nurse consultations, due to the increased efficiency of telehealth compared to the previous outreach (travel) model. Thematic analysis of the staff interview data generated an overarching theme of Increased Job Satisfaction which staff attributed to the patient-centred nature of the telepalliative care service, the increased peer support and increased professional development. Compared with the traditional in-person service, the new telehealth-supported model resulted in equivalent costs, greater efficiency by allowing palliative care to reach more patients and improved staff job satisfaction. (Edited publisher abstract)
Economic evaluations of palliative care models: a systematic review
- Authors:
- MATHEW Christine, et al
- Journal article citation:
- Palliative Medicine, 34(1), 2020, pp.69-82.
- Publisher:
- Hodder Arnold
BACKGROUND: Palliative care aims to improve quality of life by relieving physical, emotional, and spiritual suffering. Health system planning can be informed by evaluating cost and effectiveness of health care delivery, including palliative care., AIM: The objectives of this article were to describe and critically appraise economic evaluations of palliative care models and to identify cost-effective models in improving patient-centered outcomes., DESIGN: This study conducted a systematic review and registered the protocol in PROSPERO (CRD42016053973)., DATA SOURCES: A systematic search of nine medical and economic databases was conducted and extended with reference scanning and gray literature. Methodological quality was assessed using the Drummond checklist., RESULTS: This study identified 12,632 articles and 5 were included. This study included two modeling studies from the United States and England, and three economic evaluations from England, Australia, and Italy. Two studies compared home-based palliative care models to usual care, and one compared home-based palliative care to no care. Effectiveness outcomes included hospital readmission prevented, days at home, and palliative care symptom severity. All studies concluded that palliative care was cost-effective compared to usual care. The methodological quality was good overall, but three out of five studies were based on small sample sizes., CONCLUSION: Applicability and generalizability of evidence is uncertain due to small sample sizes, short duration, and limited modeling of costs and effects. Further economic evaluations with larger sample sizes are needed, inclusive of the diversity and complexity of palliative care populations and using patient-centred outcomes. (Edited publisher abstract)
World Alzheimer Report 2016: improving healthcare for people living with dementia. Coverage, quality and costs now and in the future
- Authors:
- PRINCE Martin, et al
- Publisher:
- Alzheimer's Disease International
- Publication year:
- 2016
- Pagination:
- 131
- Place of publication:
- London
Reviews research evidence on the elements of healthcare for people with dementia, and, using economic modelling, suggests how it should be improved and made more efficient. The report argues that current dementia healthcare services are over-specialised, and that a rebalancing is required with a more prominent role for primary and community care. This would increase capacity, limit the increased costs associated with scaling up coverage of care, and, coupled with the introduction of care pathways and case management, improve the coordination and integration of care. Modelling of the costs of care pathways was carried out in Canada, China, Indonesia, Mexico, South Africa, South Korea and Switzerland, to estimate the costs of dementia healthcare under different assumptions regarding delivery systems. (Edited publisher abstract)
Approaches to capturing the financial cost of family care-giving within a palliative care context: a systematic review
- Authors:
- GARDINER Clare, et al
- Journal article citation:
- Health and Social Care in the Community, 24(5), 2016, pp.519-531.
- Publisher:
- Wiley
The economic burden faced by family caregivers of people at the end of life is well recognised. Financial burden has a significant impact on the provision of family care-giving in the community setting, but has seen limited research attention. A systematic review with realist review synthesis and thematic analysis was undertaken to identify literature relating to the financial costs and impact of family care-giving at the end of life. This paper reports findings relating to previously developed approaches which capture the financial costs and implications of caring for family members receiving palliative/end-of-life care. Seven electronic databases were searched from inception to April 2012, for original research studies relating to the financial impact of care-giving at the end of life. Studies were independently screened to identify those which met the study inclusion criteria, and the methodological quality of included studies was appraised using realist review criteria of relevance and rigour. A descriptive thematic approach was used to synthesise data. Twelve articles met the inclusion criteria for the review. Various approaches to capturing data on the financial costs of care-giving at the end of life were noted; however, no single tool was identified with the sole purpose of exploring these costs. The majority of approaches used structured questionnaires and were administered by personal interview, with most studies using longitudinal designs. Calculation of costs was most often based on recall by patients and family caregivers, in some studies combined with objective measures of resource use. While the studies in this review provide useful data on approaches to capturing costs of care-giving, more work is needed to develop methods which accurately and sensitively capture the financial costs of caring at the end of life. Methodological considerations include study design and method of administration, contextual and cultural relevance, and accuracy of cost estimates. (Publisher abstract)
Societal costs of home and hospital end-of-life care for palliative care patients in Ontario, Canada
- Authors:
- YU Mo, GUERRIERE Denise N., COYTE Peter C.
- Journal article citation:
- Health and Social Care in the Community, 23(6), 2015, pp.605-618.
- Publisher:
- Wiley
In Canada, health system restructuring has led to a greater focus on home-based palliative care as an alternative to institutionalised palliative care. However, little is known about the effect of this change on end-of-life care costs and the extent to which the financial burden of care has shifted from the acute care public sector to families. The purpose of this study was to assess the societal costs of end-of-life care associated with two places of death (hospital and home) using a prospective cohort design in a home-based palliative care programme. Societal cost includes all costs incurred during the course of palliative care irrespective of payer (e.g. health system, out-of-pocket, informal care-giving costs, etc.). Primary caregivers of terminal cancer patients were recruited from the Temmy Latner Centre for Palliative Care in Toronto, Canada. Demographic, service utilisation, care-giving time, health and functional status, and death data were collected by telephone interviews with primary caregivers over the course of patients' palliative trajectory. Logistic regression was conducted to model an individual's propensity for home death. Total societal costs of end-of-life care and component costs were compared between home and hospital death using propensity score stratification. Costs were presented in 2012 Canadian dollars ($1.00CDN = $1.00USD). The estimated total societal cost of end-of-life care was $34,197.73 per patient over the entire palliative trajectory (4 months on average). Results showed no significant difference (P > 0.05) in total societal costs between home and hospital death patients. Higher hospitalisation costs for hospital death patients were replaced by higher unpaid caregiver time and outpatient service costs for home death patients. Thus, from a societal cost perspective, alternative sites of death, while not associated with a significant change in total societal cost of end-of-life care, resulted in changes in the distribution of costs borne by different stakeholders. (Publisher abstract)
Developing a new approach to palliative care funding: a revised draft for discussion
- Author:
- NHS ENGLAND
- Publisher:
- NHS England
- Publication year:
- 2014
- Pagination:
- 33
- Place of publication:
- Leeds
This document sets out the draft palliative care development currency and provides supporting guidance. It has been published to support NHS England's engagement with the palliative care sector, including clinicians, commissioners and providers. In the context of healthcare a currency is made up of consistently identified units of care that can be used as the basis for payment between commissioners and providers. The palliative care development currency is a first attempt to create a set of currency units that are suitable for use across all organisations providing palliative care in England, whether to adults or children. (Edited publisher abstract)
Palliative healthcare: cost reduction and quality enhancement using end-of-life survey methodology
- Author:
- FALLS Christopher E.
- Journal article citation:
- Journal of Gerontological Social Work, 51(1/2), 2008, pp.53-76.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This paper begins by looking at the costs of end-of-life care in the USA, many of which are absorbed by fruitless attempts to prolong the patient’s life, and notes the significantly lower costs of palliative compared with curative care. Americans are increasingly demanding honesty about prospects at the end of life, and life review is discussed as a potentially useful response to this demand for the terminally ill patient, their families and society at large. The paper also looks at the shortcomings of the largely curative focus of American medicine, including the lack of training offered to doctors on end-of-life issues, arguing that it diminishes the end-of-life experience of both patients and their families. America needs to learn from other countries that palliative care complements curative medicine and that death should not be viewed as professional failure. Finally, the current and potential role of social workers in end-of-life care is discussed. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).