Caring for people at the end of life is becoming a central concern of health systems. The belief that palliative and hospice services are the most appropriate for the terminally ill, and that everyone has a right to these services at the end of life, is gaining ground in health systems throughout the world. In recent years, the health funds and the Ministry of Health have made efforts to develop such services in Israel. These efforts have been supported over the years by various voluntary organizations, in particular the UJA federations Detroit and New York. Despite these efforts, currently only 10-15% of cancer patients receive palliative care.
This study examines the quality and cost of care for patients who received home-hospice care, in comparison to similar patients who did not. This, in order to broaden the understanding of how to improve the quality of care provided for terminal cancer patients and to provide policymakers with information on the benefits and costs of receiving home hospice.
The study design had two components:
An analysis of the administrative data on 429 deceased metastasized cancer patients in the northern district of the Clalit health plan regarding healthcare service utilization in the last six months life and the costs incurred.
Personal interviews with 193 family caregivers of the deceased patients, that provided information on quality of treatment
Among the main findings:
Only 21% of the patients received palliative care by home-hospice services.
The quality of care of patients receiving home hospice was better than that of patients not receiving home-hospice with regard to:
- More home hospice patients received opiate medication and appropriate treatment for anxiety and depression
- More died at the place of their choice
- Less received curative care in the last month of life
- More had advance directives and received explanations about their rights.
The average cost of care for the last six months was $13,648 for home-hospice patients, compared to $18,503 for patients without home-hospice. Hospitalization contributed 32% to the total cost of patients with home-hospice care and 64% to the cost of those with it.
The findings were presented to decision-makers in Israel's Ministry of Health, health plans and to service providers as well as to the UJA Federation of New York and other involved organizations. They provide insight into decision-making and policymaking regarding the development of palliative services and hospice units in hospitals and the community. They serve as an informed basis for the continuing implementation of the 2009 directives of the director-general of the Ministry of Health requiring all healthcare settings to implement palliative care for patients suffering from incurable diseases. The research team continues to be involved in the development and evaluation of these processes.
The study was conducted with the support of a grant from Guy and Nora Barron, Michigan.
*Not in print, available only on the website.