Hospital palliative care teams in the process of rationalizing health care. Between ideological commitment and financial constraints
Les équipes hospitalières de soins palliatifs dans le processus de rationalisation des soins. Entre engagement idéologique et contraintes financières
Résumé
In a context of scarce resources, rationalizing health care has become imperative. At the same time, hospitals emphasize the difficulties in managing end-of-life patients and encourage palliative practices. We studied in a thesis how these two rationales are articulated and sought to assess the integration of hospital palliative care teams in the rationalization process. The first part of the work presents the current situation of hospital palliative care: while this activity is recognized as a national priority, its modalities of development and of financial backing are subject to criticism. The second part of the work presents a general framework for the economic analysis of palliative care: (1) the characteristics of patients being cared for, the nature of continuity of care and the costs associated with hospital stays were studied, and the major dimensions for the patients were identified; (2) two alternative funding models to those currently used are discussed: a model of hospital days weighted by the type of care and a model of annual fixed budgets.
Dans un contexte de ressources rares, rationaliser les soins est devenu un impératif. Parallèlement, les difficultés de l’hôpital à gérer la fin de vie sont soulignées et les pratiques palliatives, encouragées. Nous avons étudié dans une thèse comment ces deux logiques s’articulaient et posé la question de l’intégration des équipes hospitalières de soins palliatifs au processus de rationalisation. La première partie du travail présente un état des lieux des soins palliatifs à l’hôpital : si cette activité est reconnue comme une priorité nationale, ses modalités de développement et de financement sont sujettes à critiques. La seconde partie du travail définit un cadre général d’analyse économique pour les soins palliatifs : (1) les caractéristiques des patients pris en charge, la nature des suivis et les coûts associés aux séjours ont été étudiés et les dimensions importantes pour les malades, dégagées ; (2) deux modèles de financement alternatifs à ceux en vigueur ont été discutés : un modèle à la journée pondérée par le type de soins et un modèle d’enveloppes annuelles forfaitaires. Summary In a context of scarce resources, rationalizing health care has become imperative. At the same time, hospitals emphasize the difficulties in managing end-of-life patients and encourage palliative practices. We studied in a thesis how these two rationales are articulated and sought to assess the integration of hospital palliative care teams in the rationalization process. The first part of the work presents the current situation of hospital palliative care: while this activity is recognized as a national priority, its modalities of development and of financial backing are subject to criticism. The second part of the work presents a general framework for the economic analysis of palliative care: (1) the characteristics of patients being cared for, the nature of continuity of care and the costs associated with hospital stays were studied, and the major dimensions for the patients were identified; (2) two alternative funding models to those currently used are discussed: a model of hospital days weighted by the type of care and a model of annual fixed budgets.