EAPC Atlas of Palliative Care in Europe 2019

Chapter 3. Integration of Palliative Care
in national health systems in Europe
EUROPEAN CONTEXT
B
TECHNICAL DATA ON THE 2019
EAPC SURVEY ON PALLIATIVE CARE
IN NATIONAL HEALTH SYSTEMS
IN EUROPE
Population: 54 countries of the Europe WHO region
and Lichtenstein.
Survey 1 Details
Areas explored: 8 main health indicators on Public
Health (Arias-Casais N et al, 2019): health policies,
legislation and norms, health management,
funding.
Questionnaire: online survey, 72 questions,
answered in (average): 80 minutes .
Participants: 92 national Key persons for palliative
care development, nominated from National Associations
or identified by publications and/or previous
publications.
Coverage: 51/54 countries (94%): with two respondents
29/51 countries (57%), with one respondent
20/51 (39%), other sources 2/51 (4%).
Survey 2 Details
Areas explored:
—3 indicators on time of stay of patients in specialised
PC, database on PC provision, National program
on Chronic diseases (specially developed for
this survey by authors).
—8 main indicators on public health (Arias-Casais
N et al, 2019).
Questionnaire: online survey, 13 questions, time
answered in (average) 32 minutes.
Participants: 29 national experts in Palliative Care
Public Health issues.
Profile of experts (affiliation): 15 University, 4
PC Service, 3 National Association, 2 Minister of
Health, 2 Open Society and 1 Primary Care.
Coverage: 26/54 countries (48%): with one
respondent 23/26 (88%) countries, with 2
respondent 3/26 (11%).
Data collection: 12/2018 to 3/2019 (4 months).
Project Management: ATLANTES Research Group,
Institute for Culture and Society, University of Navarra,
Pamplona (Navarra), Spain.
Scientific Advice: Luc Deliens (Belgium), Xavier
Gómez Batiste (Spain).
Promotor: European Association for Palliative
Care (EAPC).
“PALLIATIVE Care for all
WHO need it!”.
In this simple way the European
Association for Palliative Care
(EAPC) stated the heart of its
vision and mission years ago. In
2007 this voice was reinforced when
the World Health Assembly adopted
the 67·19 resolution (1) on the need
of strengthening and improving health
coverage by integrating PC into national
health systems. In 2018, The Lancet
Commission on PC claimed that
35·5 million people experienced serious
health-related suffering due to
life-threatening and life-limiting conditions
(2). Recently, the Declaration
of Astana’s Global Conference on Primary
Health Care stepped towards the
decisive inclusion of PC as an essential
service to achieve universal health coverage
by 2030 (3).
This chapter presents an overview of
the integration of PC into the National
Health Systems across Europe by looking
at the countries´ regulatory framework,
health strategies and application
of health policies in practice.
The right for PC
and the legislation
The majority of European countries
(76%) have adapted their General
Health Laws and included PC as a mandatory
service, as a right of the patient,
or even as a human right. PC is included
in the list of primary care health services
in 36 countries (71%). Greece
guarantees PC in the first Article of the
Primary Health Care Law whereas other
countries cover PC in the general
legislation. In Austria, PC is defined in
the latest legislation as a medical task,
in some German states GPs trained in
basic PC (40 hrs) are entitled to be paid
Carlos Centeno, Luc Deliens, Xavier Gómez-Batiste.
for PC services. and in other countries
like the Netherlands, general health
care professionals are obliged to provide
PC services at home. Eight countries
have a dedicated Law to PC.
National Plans or Strategies
National PC Plans are available in almost
all Western European countries except
for smaller states or the United Kingdom
and Belgium where a different way to
deal with health policy exists. In politically
decentralised countries such as
Spain, Switzerland or the Czech Republic,
regional authorities promote rather
regional PC strategies. Poland was one
of the first Eastern European countries
to have a national PC programme and
in Russia a special sub-programme on
PC development included in the State
Health Programme “Health Care development
in Russia” has recently been
developed. Other countries like Germany
do not have a National Plan or Strategy
but an equivalent Law on Hospice and
Palliative Care (December 2015) that is
being carefully implemented.
The management
of policies in practice
The existence of a person in the Department
of Health responsible for PC policies
has been considered the most relevant
policy indicator by the experts of
this EAPC survey. Interestingly, 35/51
countries (83% in Western Europe and
56% in Central and Eastern Europe)
report a designated person with this role.
Having data is crucial to apply appropriate
policies and some countries like Italy,
Georgia, Hungary, Sweden, Denmark
and Belgium have started registering PC
provision outcomes in national databases.
(De Schreye R, 2017).
EAPC Atlas of Palliative Care in Europe
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