July 15th, 2010
08:37 AM ET
Great Britain leads the world in the quality of care it provides the dying, leaving many developed nations trailing behind, according to a study released Wednesday.
A well-established network of hospices as well as strong government support for end-of-life care placed Britain at the top of the list of 40 countries, despite not having the best health care system, said the report from the Economist Intelligence Unit, a research arm of The Economist.
Researchers looked at factors including public awareness, access to painkillers and doctor-patient transparency, financial burden to patients and government-led national palliative care strategy to compile the "quality of death" index.
Australia came in second followed by New Zealand. Ireland, Belgium and Germany were also within the top 10 positions.
The report placed the U.S. in the No. 9 spot, highlighting flaws within the American health care system.
While the U.S. ranked well in its infrastructure, its overall score was dragged down because of the financial burden of end-of-life health care on patients, the report said, citing the low availability of public funding and Social Security spending as the key issues.
The report also noted that while the U.S. has government-funded reimbursements for hospice care through Medicare and Medicaid, patients in the U.S. need to give up curative treatment in order to obtain reimbursements.
“That’s completely different than from the U.K., where people can continue to have cancer treatment alongside palliative care. So in the U.S., hospice care typically is about end-of-life care,” professor Sheila Payne, director of the International Observatory on End-of-Life Care, says in the report.
Spencer Levine from the Hospice Foundation of America said that despite the either-or option, opting for hospice care in the U.S. doesn’t mean patients have reached a dead end.
“If there’s a curative therapy that comes along, experimental or otherwise, and you say ‘I want to give this a try,’ you can opt out of the hospice benefit, and at a later date, if or when conditions for you change, you opt back in again without penalty,” he told CNN.com.
“People kind of think of it like Hotel California – you can check in but never leave – but it’s not like that. You do have choices you can exercise,” he added.
Most hospices in the U.S., especially not-for-profits ones, also provide financial assistance for those who do not have personal medical insurance.
Many rich nations were unexpectedly in the bottom half of the list, including Denmark (22) and Japan (23). India bottomed the list at number 40, with Russia, Portugal and South Korea also in the bottom 10.
In the worst cases, the study found the quality and access to care was often poor; policy coordination was lacking.
The report suggested that richer countries might have scored poorly because they have “strong hospital medical-care programmes that see little value in hospices,” and instead, “value the service of oncologist and the power of medicine.”
The report cited data from the Worldwide Palliative Care Alliance, showing that more than 100 million patients and their family caregivers need palliative support annually, but fewer than eight percent of them get access to it.
"Governments and providers are in a race against time," the study said, warning that the rate of aging demographics was rapidly outpacing efforts to provide the care needed.
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