Ranking of Palliative Care Development in the Countries of the European Union.
There is growing interest in monitoring palliative care (PC) development internationally. One aspect of this is the ranking of such development for comparative purposes.



To generate a ranking classification and to compare scores for PC development in the countries of the European Union, 2007 and 2013. PC "development" in this study is understood as a combination of the existence of relevant services in a country ("resources") plus the capacity to develop further resources in the future ("vitality").



"Resources" comprise indicators of three types of PC services per population (inpatient palliative care units and inpatient hospices, hospital support teams, and home care teams). "Vitality" of PC is estimated by numerical scores for the existence of a national association, a directory of services, physician accreditation, attendances at a key European conference and volume of publications on PC development. The leading country (by raw score) is then considered as the reference point against which all other countries are measured. Different weightings are applied to resources (75%) and vitality (25%). From this, an overall ranking is constructed.



The U.K. achieved the highest level of development (86% of the maximum possible score), followed by Belgium and overall The Netherlands (81%), and Sweden (80%). In the resources domain, Luxembourg, the U.K., and Belgium were leading. The top countries in vitality were Germany and the U.K. In comparison to 2007, The Netherlands, Malta, and Portugal showed the biggest improvements, whereas the positions of Spain, France, and Greece deteriorated.



The ranking method permitted a comparison of palliative care development between countries and shows changes over time. Recommendations for improving the ranking include improvements to the methodology and greater explanation of the levels and changes it reveals.
Institute for Culture and Society, University of Navarra, Pamplona, Spain; Institute for Health Research of Navarra, Pamplona, Spain. Electronic address: kwoitha@unav.es.
Kathrin
K
Woitha
Institute for Culture and Society, University of Navarra, Pamplona, Spain; Institute for Health Research of Navarra, Pamplona, Spain.
Eduardo
E
Garralda
Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain.
Jose María
JM
Martin-Moreno
School of Interdisciplinary Studies, University of Glasgow, Glasgow, Scotland, United Kingdom.
David
D
Clark
Institute for Culture and Society, University of Navarra, Pamplona, Spain; Institute for Health Research of Navarra, Pamplona, Spain.
Carlos
C
Centeno
D005062:European Union; D006295:Health Resources / Q000592:standards*; D006801:Humans; D010166:Palliative Care / Q000592:standards*
Europe; Ranking; development; palliative care