title: Problems and challenges for palliative care: what are the views of different stakeholders on the meso and macro level of the health system?
abstract: OBJECTIVE
  To study the views of a wide range of representatives from organizations and institutions at the meso and macro level of the health system regarding palliative care in Germany.
  
  
  METHODS
  442 organizations and institutions were included (e.g. medical associations, political boards, health insurances). Using a standardized questionnaire, the main topics included the most recent health care reform, quality in palliative care and living will.
  
  
  RESULTS
  The response rate was 67%. Most of the respondents (69.9%) rated the recently introduced specialist outpatient palliative care positively. The majority of the interviewees agreed that the effectiveness (74.2%) and efficiency (56.4%) of palliative care services need to be further evaluated. Two-thirds believed that political regulations of living wills could help minimize uncertainties concerning end-of-life decisions; palliative care specialists were less likely to be of that opinion compared to the other groups.
  
  
  CONCLUSIONS
  The recent political measures go into the right direction in order to further improve health care of severely ill and dying people in Germany. However, the effects on the health care system and on the routine delivery of care are uncertain. It is important to further develop palliative care on a broad societal, political and scientific base.
authors.affiliation: Hannover Medical School, Department of Epidemiology, Social Medicine and Health System Research, Hannover, Germany. schneider.nils@mh-hannover.de
authors.forename: Nils
authors.initials: N
authors.lastname: Schneider
authors.forename: Sara Lena
authors.initials: SL
authors.lastname: Lückmann
authors.forename: Mareike
authors.initials: M
authors.lastname: Behmann
authors.forename: Susanne
authors.initials: S
authors.lastname: Bisson
mesh_terms: D000328:Adult; D001290:Attitude; D003695:Delivery of Health Care; D005260:Female; D005858:Germany; D018166:Health Care Reform; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards; D011634:Public Health; D013727:Terminal Care