Offer coverage for end-of-life care: Experts

Patients are staying in hospitals longer than they need to because insurance companies do not pay for palliative care in hospices, say experts.
Patients are staying in hospitals longer than they need to because insurance companies do not pay for palliative care in hospices, say experts. PHOTO: BUSINESS TIMES FILE

Patients stay in hospitals longer than needed as insurance plans do not cover hospice care

With demand for palliative care expected to double in the next five years, experts have called for the authorities to make it more affordable by having it covered by insurance.

End-of-life care experts say that patients are staying in hospitals longer than they need to because insurance companies do not pay for palliative care in hospices.

"Most people do not want to be in hospital once they know medical interventions will no longer benefit them," said Dr Cynthia Goh, senior consultant at the National Cancer Centre Singapore and chair of the Asia Pacific Hospice Palliative Care Network.

"Yet some patients are stuck in hospital because their insurance plans do not cover care at a hospice. Insurance companies here still have not realised that better care can be obtained at a hospice at a fraction of the cost of the hospital."

In Singapore, insurance companies and MediShield Life do not cover care in hospices.

But countries such as Australia include palliative consultations under a medical benefits scheme, and private insurance is used as a source of financing.

Reviewing the model of financing behind palliative care is one of the suggestions brought up by experts, after results from a global ranking on palliative care were released last week.

According to the Quality of Death Index by the Economist Intelligence Unit, Singapore is the 12th best place in the world to die.

This makes the city state second best in Asia, behind Taiwan. Britain topped the index, followed by Australia and New Zealand.

Singapore was strongest in affordability of care (sixth place), quality of care (eighth) and human resources (eighth), according to the index of 80 countries.

It was the weakest in community engagement (22nd).

But experts say there is still room for improvement. Philanthropic organisation Lien Foundation, which commissioned the index, also did a survey last year that found that two in three Singaporeans cannot correctly define what hospice palliative care is.

It is an approach that seeks to improve the quality of life of patients who have life-threatening illnesses.

By 2020, more than 10,000 people a year are expected to need palliative care, up from the 6,000 in 2013.

The lack of public awareness on such care is not surprising, given that doctors and nurses themselves struggle with it.

About six in 10 doctors and four in 10 nurses said their basic training did not prepare them to handle patients with life-threatening illnesses, another Lien Foundation survey showed.

Its chief executive, Mr Lee Poh Wah, said palliative care should be made a core component of training for all healthcare professionals.

"Healthcare workers need to be trained to pick cases up and do referrals because only about 20 per cent to 30 per cent of those who pass away each year use palliative care services, when research shows that 70 per cent to 80 per cent of all deaths in high-income countries would require such care," said Mr Lee.

A version of this article appeared in the print edition of The Straits Times on October 15, 2015, with the headline 'Offer coverage for end-of-life care: Experts'. Print Edition | Subscribe