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Palliative care: the perverse effects of funding

Standardised hospital charges are not ideal for promoting quality palliative care.

Developing quality palliative care for terminally ill patients is an issue of both healthcare and social welfare.

The funding of palliative care has perverse effects, as is revealed in a report published by France’s national consultative committee on ethics (Comité consultatif national d’éthique) in 2010.

The current hospital activity-based funding formula known in France as "tarification à l’activité" or "T2A" promotes the performance of codified diagnostic and therapeutic acts. It is unsuited to fields where technology is not the whole solution, or when care cannot be standardised, as is the case with palliative care.

Despite adjustments made to the T2A system for palliative care, a bed occupied by a person for 40 days brings the hospital establishment only half the income generated by 5 people each staying 4 days (even though the bed remains unoccupied for 20 days). Hence the systematic shunting of patients between different departments and between hospital and home.

Patients are sometimes wrongly classified as needing palliative care, which is better funded than other medical activities, but it does not provide them with the treatment and support that is appropriate to their needs.

In short, the quality of care for the terminally ill is jeopardised by the T2A system: palliative care is more a question of personal care and support than codified technical acts for a clearly defined duration.

This conclusion also applies to a number of other medical activities.

©Prescrire June 2010

Source: "Soins palliatifs : un financement parfois pervers" Rev Prescrire 2010 ; 30 (319) : 377.