1. Institut Català d’Oncologia Xavier Gómez-Batiste MD, PhD Director, WHO Collaborating Center for Public Health Palliative Care Programs WHO Meeting OSI/WHOCC Workshop 9: legislation, standards, financing models

2. Institut Català d’Oncologia The legislation of palliative care includes The insertion of palliative care in the existing policies and financing models (Global or specific Health plans for Cancer, Geriatric, Aids, and other chronic conditions) The formal approval and recognition of the National Plan Basic legislation (Law, decree, or ministerial order) that could be generic Specific changes to assure opioid availability Other related legislations: advance directives and autonomy, rights of patients, ethical committees, support (funding or changes in labour legislation) for careers

3. Institut Català d’Oncologia Legislation and standards National Plan General or definition: law or decret (generic) Financing systems (specific for services) Opioid and essential medicines availability (the simplest, the best) Standards of services (description) Other legislations (respite, support of families, etc) “The simplest, the best”

4. Institut Català d’Oncologia Financing models Insert in the common financing model Combine: structure, activity, results, and quality Concept of “cathalitic” investment Reallocation Estimate expected savings “The simplest, the best”

5. Institut Català d’Oncologia Costs Medicare last year life Lubitz and Riley, 1993

6. Institut Català d’Oncologia Efficiency of PCSs Multicenter longitudinal study on the use of resources by cancer patients attended by PCSs Comparison with previous use without PCSs 171 teams / 395 patients

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9. The palliative care network saves more money than its costs

10. Institut Català d’Oncologia Costs and savings Type of serviceCalculationSubtotal / typeEstimated savings; Euros HCST229,000 x 72 services16,488,000 (31%)TOTAL SAVINGS: 3,000 / patient x 23,100 = 69,300,000 HST279,000 x 49 services13,671,000 (26%) PCU96 x 209,000 stays20,064,000 (38%) OUTPAT155 x 9,000 processes 1,395,000 (3%) PST190,000 x 5 services950,000 (2%) TOTALTOTAL COSTS: 52,568,000/ year NET SAVINGS: 16,732,000 / year

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15. Standards of services Description of Palliative care measures in conventional services Specialist services: Basic description of: -Structure - Process or activities - Basic outputs - Basic outcomes ICO DiR. Centre Col·laborador de l’OMS per Programes Públics de Cures Pal·liatives

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17. Exercise Part I: 1.Review your general pal care legislation Apart from opioids) 2.Propose changes for the next year Part II: 1.Review your financing system 2.Propose a model for palliative care financing ICO DiR. Centre Col·laborador de l’OMS per Programes Públics de Cures Pal·liatives

18. Institut Català d’Oncologia ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes. The ‘Qualy’ End of Life Care Observatory WHO Collaborating Centre for Public Health Palliative Care Programmes whocc.info@iconcologia.net +34 93 260 77 36 ICO l’Hospitalet Hospital Duran i Reynals Gran Via de l’Hospitalet, 199-203 08908 l’Hospitalet de Llobregat Institut Català d’Oncologia