Financing palliative care services some examples from Spain by hpq74941

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									 Financing palliative care
        services:
some examples from Spain
      OSI meeting
    London, Nov 2007
            Xavier Gómez-Batiste
    Director, Education and Training, ICO
      Head, Palliative Care Service, ICO
             Presidente SECPAL
      Preliminary aspects
• Salaries are low in Spain, around 50-60% of
  the UK salaries
• There are differences in salaries between the
  acute and socio-health sector
• Staffing in units lower than in the UK
  standards
• Every region has a different model for
  financing, purchasing, and providing
  palliative care services, although types of
  services are similar
 Financing/purchasing models
• In Resources owned by NHS, usually a
  managerial contract focused in activity
  or other qualitative aspects
  (Extremadura)
• Units or Teams based in other
  providers: contracts with fees and or
  structure
• The spanish league against cancer
  owns 60 and finances 40 HCS teams
           Situación 2007 CCAA


                              • Alta coberura
                              • En progresión rápida
                              • Progreso lento
                              • Baja coberura




“Estrategia nacional” de cuidados paliativos
          Comparison dayly costs/prices
     Acute Conventional / PCU acute / PCU SHC


            100
             90
             80
             70
             60
             50
                                                        COST
             40
             30
             20
             10
              0
                   ACUTE     PCU ACU    PCU SHC

Gomez-Batiste X Organización de servicios y programas de cp, 2005
Sources: Catsalut / CHC
    Evidence from Catalonia
Comparison terminal cancer patients attended by
  HCST and conventional services in Mataró (BCN)
Results:
- Reduction Hospital stays, length stay,
  emergencies
- Increase death at home
- Economic impact: 1.000 euros / patient / 1
  month follow up
- Estimation of the impact in Catalonia: 9.5
  milion euros

        Serra-Prat et al Palliat Med 2001; 15:271-278
     80
     70
     60
     50
     40                                                 1992
                                                        2002
     30
     20
     10
      0
          ADMIS   LENGTH EMERG         HOME        COST



URSPAL: Comparison 1992-2002 of Use/Cost
“Savings”: 3286 / patient
      Gomez-Batiste X et al, J Pain Symptom Manage 2006; 31:522-532
                 Extremadura
•   1.100.000 habitants, sparse
•   8 Home/hospital care support teams
•   6 AH, 30 SH, and 110 NH beds
•   NHS owned
•   Systematic evaluation
•   Yearly managerial contracts
•   Capitation tendency

Herrera et al, J Pain Symptom Manage 2007; 33 (5): 591-598
       Extremadura
Total cost              2.242.000

 % budget               0.2-03%

Cost / patient           633

Cost / Hospital visit     81

Cost / Home visit        171
                Catalonia
• Services: Units (in AH, SHCs, or NH), HSTs,
  HCSTs, Outpatient’s and day care (total: 183
  dispositives)
• 70%: Non profit Trusts or Consortiums
• Payment Concepts:
- Structure for HCSTs and HSTs
- Daily fee for Units, 3 fee levels
- Process (activity) for Outpatients
- Quality incentives: 3%
        Catalonia: payment
Fees (+ 3% “quality aims”):

•   Units in SHCs: 90 – 120 euros in SHCs
•   Units in A Hosp: process in AHs
•   HCSTs: 180.000 (DoH) + 27.000 (DSS)
•   HSTs: 124.000 - 340.000
•   Outpatients: 350 x process
  Estimation global regional
       cost / “savings”
• Global Cost specialist services:
  40.334.000 euros PCUs + Outps (52%),
  HCSTs (30%), HSTs (17%), strong
  opioids (<1%)
• Individual savings / process / patient:
  2.225 euros (Mataró vs URSPAL)
• Total savings : 48 milion euros / year
• Net savings : 8 milion euros
Gomez-Batiste X et al, J Pain Symptom Manage 2007; 31:522-532
       PCSs at the ICO
• ICO: Comprehensive cancer center
• 3 Hospitals (Duràn-Reynals, Badalona,
  and Girona)
• 40% of cancer patients in Catalonia
• 3 Palliative Care Teams (2.200 new
  patients / year), 24 beds in 2 units, 3
  Hospital Support Teams
• Home care Support teams in the
  community and Units in Sociohealth
  Centers around
Costs PCS at the ICO (2006)
             PCS             ICO          %

Personel     2.000.000       27.000.000   7.46
Pharmacy     115.000         30.000.000   0.39
Material     65.000          2.000.000    3.24
Labs Xrays   171.000         8.900.000    1.48
Other        732.000         8.800.000    8.32
Structure    128.000         2.568.000    5.00
TOTAL        3.200.000 (*)   81.900.000   3.90



  Cost / patient: 1.450 euros
  (*) Financed by Catsalut: 2.400.000 euros
                                              Source: ICO
     PCSs at Sta Creu
• Non profit trust and Socio-Health
  center 180 beds
• PCU 20 beds + HCST + HST
• 350 new patients/year
• Public Financing:
- PCU: 612.000 euros
- HCST and HST: 300.000
- 3% quality
• Total: 912.000 + 3%
        Conclusions
• High variability among regions
• Salaries and staffing lower
• Costs of units 35-50% than
  conventional beds
• % global budget near 0.3%
• Evidence of reduction use acute beds,
  emergencies, and cost
• Need of including financing in the
  national strategy

								
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