Organisation des soins palliatifs en Belgique - KCE

22 Palliative Care KCE reports 115
3.3.3 Definitions used by the national health care systems
This chapter summarizes the definitions used in other Western countries (see the
methodology section). The objective was to find the definition of a palliative patient in
those countries i.e., criteria that allow him to benefit of specific care, support or
financial help. The Belgian definition (INAMI/RIZIV) as well as the criteria were
presented in the introduction of this report.
62, 63
3.3.3.1 France
A French law defines the palliative patient. It stipulates that ‘every ill person who needs
it has the right to access to palliative care and to benefit from a support’. Next to the
access to palliative care, patient is entitled to receive a financial help, i.e. an intervention
from the health insurance for 85% to 90% of his/her out-of-pocket expenses in function
of his/her revenues (with a threshold). The eligibility is based on a medical record made
by a specialized recognized team (network, team of home hospitalization or mobiles
hospital team). The help also encompasses domestic help at home and ‘life auxiliaries’.
The relative(s) can receive a special leave that allows them to stop working during
maximum 3 months.
There is no explicit prognosis or duration linked to the decision to identify a patient as
palliative. Nevertheless, the special leave is limited to a 3 month period.
3.3.3.2 The Netherlands 64
There are no explicit criteria to decide if a patient is eligible for palliative care. It is left
to the assessment of the GP. The financial consequence is the payment of an additional
amount to the GP by the health insurer. Health Insurance could control it afterwards.
The carers can also negotiate with their employer to get a leave to take care of the
palliative patient.
65, 66
3.3.3.3 United-Kingdom
In the UK, the palliative care services act from the diagnosis (supportive care) through
the cure phase and rehabilitation to the potential death (palliative care). They also give a
psychological support to the family (bereavement). To be eligible for home care
services, the death should be expected in the next six months.
The NHS propose to use the Gold Standards Framework 67 , a framework of strategies,
tasks and enabling tools to help primary care teams to deliver the best possible care for
people nearing the end of their lives. The three main processes of GSF involve the
identification of patients in need of palliative/supportive care towards the end of life, the
assessment of their needs and a planning of their care based on their needs and
preferences. Seven key tasks are summarized by 7 C’s i.e., Communication, Coordination,
Control of symptoms, Continuity of care, Continued learning, Carer
support, Care in the dying phase.
3.3.3.4 Switzerland 68
3.3.3.5 Denmark 53
There are no explicit criteria to identify palliative patients. The physician asks for
specific support according to the progressively deteriorating health status of the patient.
The “terminal declaration” is a document that gives right to economic benefits and
more intensive care for the patient whose life expectancy prognosis is less than 6
months. This declaration gives the entitlement to increased reimbursement of medicines
and to a paid leave of an informal carer either full time or part-time.
This declaration could be used as a proxy for formal terminal diagnosis.