The cost and quality of care – learning from patients in England, Ireland the USA

25th February 2020

It is well understood that the cost of care rises towards the end of life.  Understanding service use, costs and the patient’s experience of care can inform quality and provision of palliative care.  An international research study funded by The Atlantic Philanthropies and Cicely Saunders International has compared palliative care use in 3 different countries  – England, Ireland and the United States to identify differences in health and social care costs, the quality of care, and the drivers of care for older adults across these 3 countries.  The team carried out a survey of informal carers of patients who had received palliative care.

In all three countries hospital care accounted for over 80% of total care costs.  Palliative care accounted for 1 – 15% of costs.  In all countries the distribution of costs differed. They were the most homogenous in England.  Being a high cost user was associated with being older age (over 80) facing financial difficulties and having poor experiences of home care.  High cost use was not associated with having cancer or multimorbidity (multiple complex conditions). Palliative Care services consistently had the highest satisfaction. 

Poverty and poor home care drive high costs, suggesting that improving community palliative care may improve care value, especially as palliative care expenditure was low.  Care costs in the USA were high and highly variable, suggesting that high-cost low-value care may be prevalent in the USA. 

Yi D, Johnston BM, Ryan K, Daveson BA, Meier DE, Smith M, McQuillan R, Selman L, Pantilat S, Normand C, Morrison RS, Higginson IJ. Drivers of care costs and quality in the last 3 months of life among older people receiving palliative care: A multinational mortality follow-back survey across England, Ireland and the United States. Palliat Med. 2020 Feb 3:269216319896745. doi: 10.1177/0269216319896745. [Epub ahead of print]