Integral ecology

Really, are palliatives a major cost to the system?

Specialized palliative care not only improves the well-being of patients with severe suffering, but also represents a significant saving for each hospital center and for the national health systems (NHS) of the countries.

Rafael Miner-February 12, 2021-Reading time: 4 minutes

Approximately half of the patients with a serious illness accompanied by intense suffering do not receive specialized palliative care treatment in Spain. Some studies put this figure at six out of ten, i.e., 60 percent.

Globally, the figure is higher, taking into account, for example, a lower implementation of services that provide this type of care, and the lower and even scarce consumption of opioids in some areas of the planet.

Some health economists and managers, together with health professionals, have been studying for some time the reluctance observed in some countries and settings to implement palliative care services. One of them, and not the least, is the potential costs.

The idea that palliative care is more expensive has been the subject of a global review.

Miguel Sánchez Cárdenas- Atlantes program researcher

The concern is the following. Let's put ourselves in the role of a health planner, who is told that apart from providing patient care, for example by the team of cardiologists, another team must be called in to take care of the patient. A priori it sounds like they are going to increase costs. "If I have to call in an additional team to the one treating the disease, that sounds expensive," he explains. Miguel Sánchez CárdenasBut this way of arguing has been the subject of a global review", says the researcher of the Atlantes program of the Culture and Society Institute of the University of Navarra.

Report of Jama Internal Medicine

One of the most widely analyzed reports is the one published by Jama Internal Medicine, a journal published by the American Medical Association in 2018. It was conducted by Mount Sinai Health System y Trinity College of Dublin, Ireland, and pooled data from six previous studies involving more than 130,000 adults admitted to U.S. hospitals between 2001 and 2015. Of these patients, 3.6 percent received a palliative care consultation in addition to their other hospital care.

According to the report, hospitals saved an average of $3,237 per patient (nearly €2,700 at current exchange rates), over the course of a hospital stay, when palliative care was added to their routine care compared to those who did not receive palliative care. Palliative care was associated with cost savings, per hospital stay, of $4,251 (€3,542) per cancer patient and $2,105 (€1,754) for those with non-cancer diagnoses. Savings were greater for patients with a higher number of diseases.

Hospitals saved an average of $3,237 per patient receiving hospice care

The causes of the savings were summarized by the author of the analysis, John Commins, as follows Palliative care saves your hospital money. Palliative care programs that better address pain and improve care coordination result in shorter hospital stays and lower costs, particularly for sicker patients, according to the report, whose lead author was Peter May, a research fellow in health economics at the Center for Health Policy and Management at the Trinity College of Dublin.

Catalan hospitals, too

Sánchez Cárdenas was consulted about the work of the Dr. Gómez Batistewho maintained more than a decade ago that specialized palliative care saves the system 60 percent of the costs that a terminally ill patient would incur without such care, pointed out that the time factor is important in calculating savings.

"Gómez Batiste found that there is a decrease in costs per patient treated with palliative care of an average of 3,000 euros, but other studies have made other estimates," the Atlantes researcher points out. "It also depends on when the patient comes to the palliative care program: whether it is an early stage, or more advanced in the disease. What is clear is that the earlier the patient arrives, the more savings there are for the system. Essentially, because it avoids treatments that are unnecessary at the end of life, and that instead of curing or alleviating a symptom, what they do is increase people's suffering."

The earlier palliative care begins for the patient, the more savings there are for the system.

The study by Dr. Xavier Gómez Batiste revealed that in Catalonia alone, palliative care saved 33.5 million euros each year in 2006, an amount higher than the total cost of the structural expenditure of all palliative care in the autonomous community, reported ABC. In his opinion, the conclusion can be extrapolated to the whole country. The reason for his conclusions is that "well-planned and well-done hospital or home palliative care prevents many problems and avoids patients resorting to emergency care or ending up in acute care units, because it is the easiest or the only way they have at hand when they need medical attention".

Sánchez Cárdenas considers that "it should also be noted that the studies that evaluate the cost of palliative care coincide in pointing out that the earlier palliative care is provided, the more successful it will be in terms of the efficacy of the treatments. In other words, it is possible to weigh up the treatments that are good for the patients, but also those that will generate addiction to the treatment, that do not improve the patient's quality of life and that do worsen the cost to the system".

On the other hand, executives from the healthcare sector, such as Zacarías Rodriguez, of the New Health Foundation, have stated that "investing in palliative care is saving the system, making it more sustainable and improving people's quality of life. Along these lines, the foundation argues that with the implementation of appropriate management methods, "palliative care would save the healthcare system between 20 and 35 percent in costs, improving the quality of life of patients and increasing the satisfaction of patients, family members and caregivers by up to 97 percent".

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