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Financing palliative care services: some examples from Spain

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

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Financing palliative care services: some examples from Spain

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  1. 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

  2. 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

  3. 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

  4. Situación 2007 CCAA • Alta coberura • En progresión rápida • Progreso lento • Baja coberura “Estrategia nacional” de cuidados paliativos

  5. Comparison dayly costs/prices Acute Conventional / PCU acute / PCU SHC Gomez-Batiste X Organización de servicios y programas de cp, 2005 Sources: Catsalut / CHC

  6. 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

  7. URSPAL: Comparison 1992-2002 of Use/Cost “Savings”: 3286 / patient Gomez-Batiste X et al, J Pain Symptom Manage 2006; 31:522-532

  8. 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

  9. Extremadura

  10. 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%

  11. 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

  12. 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

  13. 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

  14. Costs PCS at the ICO (2006) Cost / patient: 1.450 euros (*) Financed by Catsalut: 2.400.000 euros Source: ICO

  15. 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%

  16. 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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