Gordon Robert, Eagar Kathy, Currow David, Green Janette
Centre for Health Service Development, University of Wollongong, New South Wales, Australia.
J Pain Symptom Manage. 2009 Jul;38(1):68-74. doi: 10.1016/j.jpainsymman.2009.04.002.
This article overviews current funding and financing issues in the Australian hospice and palliative care sector. Within Australia, the major responsibilities for managing the health care system are shared between two levels of government. Funding arrangements vary according to the type of care. The delivery of palliative care services is a State/Territory responsibility. Recently, almost all States/Territories have developed overarching frameworks to guide the development of palliative care policies, including funding and service delivery structures. Palliative care services in Australia comprise a mix of specialist providers, generalist providers, and support services in the public, nongovernment, and private sectors. The National Palliative Care Strategy is a joint strategy of the Commonwealth and States that commenced in 2002 and includes a number of major issues. Following a national study in 1996, the Australian National Subacute and Nonacute Patient (AN-SNAP) system was endorsed as the national casemix classification for subacute and nonacute care. Funding for palliative care services varies depending on the type of service and the setting in which it is provided. There is no national model for funding inpatient or community services, which is a State/Territory responsibility. A summary of funding arrangements is provided in this article. Palliative care continues to evolve at a rapid rate in Australia. Increasingly flexible evidence-based models of care delivery are emerging. This article argues that it will be critical for equally flexible funding and financing models to be developed. Furthermore, it is critical that palliative care patients can be identified, classified, and costed. Casemix classifications such as AN-SNAP represent an important starting point but further work is required.
本文概述了澳大利亚临终关怀与姑息治疗领域当前的资金和融资问题。在澳大利亚，管理医疗保健系统的主要职责由两级政府分担。资金安排因护理类型而异。姑息治疗服务的提供是州/领地的职责。最近，几乎所有州/领地都制定了总体框架，以指导姑息治疗政策的制定，包括资金和服务提供结构。澳大利亚的姑息治疗服务包括公共、非政府和私营部门的专科提供者、全科提供者及支持服务的混合体。《国家姑息治疗战略》是联邦和州的联合战略，始于2002年，涵盖若干重大问题。1996年进行全国性研究后，澳大利亚国家亚急性和非急性患者（AN-SNAP）系统被认可为亚急性和非急性护理的全国病例组合分类。姑息治疗服务的资金因服务类型和提供环境而异。对于住院或社区服务，没有全国统一的资金模式，这是州/领地的职责。本文提供了资金安排的概述。澳大利亚的姑息治疗继续快速发展。越来越灵活的循证护理模式正在出现。本文认为，制定同样灵活的资金和融资模式至关重要。此外，关键是要能够识别、分类和计算姑息治疗患者的费用。诸如AN-SNAP之类的病例组合分类是一个重要的起点，但还需要进一步开展工作。
