Fassbender Konrad, Fainsinger Robin, Brenneis Carleen, Brown Pam, Braun Ted, Jacobs Philip
Alberta Cancer Board Palliative Care Research Initiative, Edmonton.
Palliat Med. 2005 Oct;19(7):513-20. doi: 10.1191/0269216305pm1071oa.
De-institutionalization of health care services provided to terminally ill cancer patients is a cost-effective strategy that underpins health care reforms in Canada. The objective of this study therefore is to evaluate the economic implications associated with Canadian innovations in the delivery of palliative care services.
We identified 16,282 adults who died of cancer between 1993 and 2000 in two Canadian cities with newly introduced palliative care programs. Linkage of administrative databases was used to measure healthcare resource utilization. We sought to describe the utilization of palliative care services and its consequences for overall health care system costs.
Use of palliative services increased from 45 to 81% of cancer patients during the study period. Identifiable public health care services cost dollars 28093Cdn/patient (19033US dollars, 11,508GBł, 17,778 euro) for terminally ill cancer patients in their last year of life. Acute care accounted for two-thirds (67%) of these costs; physician (10%), residential hospice care (8%), nursing homes (6%), home care (6%) and prescription medications (3%) comprise the remainder. Increased costs associated with the introduction of palliative care programs were offset by cost savings realized when terminally ill cancer patients spent less time in hospital. Palliative home care and residential hospice care accounted for the bulk of this substitution effect. Cost neutrality was observed from the public perspective.
These results demonstrate that the introduction of comprehensive and community-based palliative care services resulted in increased palliative care service delivery and cost neutrality, primarily achieved through a decreased use of acute care beds.
为晚期癌症患者提供的医疗服务去机构化是一种具有成本效益的策略，是加拿大医疗改革的基础。因此，本研究的目的是评估加拿大姑息治疗服务提供创新所带来的经济影响。
我们在加拿大两个新引入姑息治疗项目的城市中，确定了1993年至2000年间死于癌症的16282名成年人。利用行政数据库的关联来衡量医疗资源的利用情况。我们试图描述姑息治疗服务的利用情况及其对整体医疗系统成本的影响。
在研究期间，姑息治疗服务的使用从癌症患者的45%增加到81%。对于晚期癌症患者，可识别的公共医疗服务在其生命的最后一年每位患者花费28093加元（19033美元、11508英镑、17778欧元）。急性护理占这些成本的三分之二（67%）；其余部分包括医生（10%）、住院临终关怀护理（8%）、养老院（6%）、家庭护理（6%）和处方药（3%）。引入姑息治疗项目带来的成本增加被晚期癌症患者住院时间缩短所实现的成本节约所抵消。姑息家庭护理和住院临终关怀护理占了这种替代效应的大部分。从公共角度观察到成本中性。
这些结果表明，引入全面的社区姑息治疗服务导致姑息治疗服务的提供增加和成本中性，主要是通过减少急性护理床位的使用来实现的。
