Financing palliative care services: some examples from Spain

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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

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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

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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

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Situación 2007 CCAA

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

Estrategia nacional de cuidados paliativos
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Comparison dayly costs/prices Acute Conventional
/ PCU acute / PCU SHC
Gomez-Batiste X Organización de servicios y
programas de cp, 2005 Sources Catsalut / CHC
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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 15271-278

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URSPAL Comparison 1992-2002 of Use/Cost
Savings 3286 / patient
Gomez-Batiste X et al, J Pain Symptom Manage
2006 31522-532
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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

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Extremadura
Total cost 2.242.000
budget 0.2-03
Cost / patient 633
Cost / Hospital visit 81
Cost / Home visit 171
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Catalonia

• Services Units (in AH, SHCs, or NH), HSTs,
  HCSTs, Outpatients 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

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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
  

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Estimation global regional cost / savings

• Global Cost specialist services 40.334.000 euros
  PCUs Outps (52), HCSTs (30), HSTs (17),
  strong opioids (lt1)
• 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 31522-532
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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

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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
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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

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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