Funding models in palliative care: Lessons from international experience.
Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them.



To assess national models and methods for financing and reimbursing palliative care.



Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms.



Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs.



Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest.
1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
E Iris
EI
Groeneveld
2 School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
J Brian
JB
Cassel
3 Department of Palliative Medicine, Munich University Hospital, Ludwigs-Maximilians-University Munich, Munich, Germany.
Claudia
C
Bausewein
4 PTE ÁOK Családorvostani Intézet, Hospice-Palliativ Tanszék, Pécs, Hungary.
Ágnes
Á
Csikós
5 Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland.
Malgorzata
M
Krajnik
6 Saint Francis Hospice and Mater Hospital, Dublin, Ireland.
Karen
K
Ryan
7 Regional Centre of Excellence for Palliative Care, Haukeland University Hospital, Bergen, Norway.|8 Department of Clinical Medicine K1, University of Bergen, Bergen, Norway.
Dagny Faksvåg
DF
Haugen
9 INSELSPITAL - University Hospital Bern, Bern, Switzerland.
Steffen
S
Eychmueller
10 Klinik für Palliative Care, Hospiz Im Park, Arlesheim, Switzerland.
Heike
H
Gudat Keller
11 Arohanui Hospice, Palmerston North, New Zealand.
Simon
S
Allan
12 Department of Anesthesiology, Pain and Palliative Care, RadboudUMC, Nijmegen, The Netherlands.
Jeroen
J
Hasselaar
13 Viceconsejería de Asistencia Sanitaria, Consejería de Sanidad de Madrid, Universidad Católica San Antonio de Murcia, Murcia, Spain.
Teresa
T
García-Baquero Merino
14 Southern Adelaide Palliative Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia.
Kate
K
Swetenham
15 Finance & Corporate Services, South Australia Health, Adelaide, SA, Australia.
Kym
K
Piper
16 Palliativa Utvecklingscentrum, Lund University and Region Skåne, Lund, Sweden.
Carl Johan
CJ
Fürst
1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
Fliss Em
FE
Murtagh
D004739:England; D005858:Germany; D017051:Hospice Care / Q000191:economics*; D006801:Humans; D006814:Hungary; D007494:Ireland; D018803:Models, Economic; D009426:Netherlands; D009520:New Zealand; D009664:Norway; D010166:Palliative Care / Q000191:economics*; D011044:Poland; D012051:Reimbursement Mechanisms / Q000191:economics*; D013030:Spain; D013548:Sweden; D013557:Switzerland; D014481:United States; D014852:Wales
Financing; health care systems; hospice; palliative care; reimbursement mechanisms