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Malcolm Masso Centre for Health Service Development

Malcolm Masso Centre for Health Service Development. Maree Banfield Palliative Care Outcomes Collaboration. How is palliative care paid for? The Australian perspective Health Economics of Palliative Care Research Methods and Funding Approaches 12 November 2007.

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Malcolm Masso Centre for Health Service Development

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  1. Malcolm Masso Centre for Health Service Development Maree Banfield Palliative Care Outcomes Collaboration How is palliative care paid for?The Australian perspectiveHealth Economics of Palliative CareResearch Methods and Funding Approaches12 November 2007

  2. History of palliative care funding • Prior to 1988 services for the terminally ill largely provided by charitable organisations • 1988 – Australian Government funding to States to enable dying patients to remain at home • Palliative care service provision determined at State-level: • Various funding models • Variation in range, quality and accessibility of palliative care services • Strongly influenced by geography

  3. Australian health financing

  4. Who pays for what?

  5. National Palliative Care Program • Australian Health Care Agreements: • 5 year agreements between Australian and State governments • Includes $A201 for palliative care: • $A188 on per capita basis to provide services • $A13 to fund national initiatives • Local Palliative Care Grants Program: • $A34 (over 5 years) for grants to help health-related services better support people requiring palliative care and their families • Palliative Care in the Community: • $A63 (over 5 years) to improve palliative care in the community

  6. Casemix classifications in Australia

  7. Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) • Developed in 1996 • Inpatient palliative care - 11 classes • Ambulatory palliative care - 32 classes • Based on a study of 30,057 episodes (4,530 palliative care) episodes in 104 services in Australia and New Zealand • Discriminators – phase, RUG-ADL, age • Second version developed in 2006 Eagar et al (2004) An Australian casemix classification for palliative care: lessons and policy implications of a national study. Palliative Medicine 18: 227-233.

  8. Funding in New South Wales • State divided into 8 area health services • Resource Distribution Formula (RDF) used to allocate funding to each area health service: • Needs-based funding based on size and needs of local population • RDF has different components for different programs, including palliative care • Historically – limited casemix (output based) funding within area health services

  9. Palliative Care Outcomes Collaboration National initiative funded by the Australian Government to introduce routine assessment of palliative care outcomes across Australia. PCOC aims to: • Support continuous development of palliative care • Introduce a benchmarking service that will improve practice • Demonstrate outcomes (service and patient/caregiver) • Standardise palliative care assessment • Develop a “common language”

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