With about 80 percent of hospice care cases taking place in hospitals, the Ministry of Health and Welfare (MOHW) has increased the payment for home hospice care medical teams by up to 30 percent to encourage a dignified death at home, Minister of Health and Welfare Shih Chung-liang (石崇良) said yesterday.
Shih made the remarks on the sidelines of a conference on end-of-life care and ethics held by the Taiwan Academy of Hospice Palliative Medicine (TAHPM) in Taipei.
Having promoted hospice care for many years, Taiwan ranks high in the quality of death for terminally ill patients globally, but there is still room for improvement, especially in home hospice care, he said.
Photo: CNA
Shih said National Health Insurance (NHI) data shows that there were about 100,000 cases of hospice care each year, with 80 percent in hospitals, and while about 65 percent of cancer patients went into hospice care at the terminal stage, only about 35 percent of terminally ill non-cancer patients do the same.
A “good death at home” is based on the idea that a critically ill person stays in their familiar home environment, accompanied by their loved ones at the end of life, avoiding aggressive medical intervention, he said, adding that Taiwan has been promoting NHI-covered hospice care since 1996 to improve patients’ quality of life while reducing the strain on healthcare resources.
Currently, hospice care is categorized into three types — inpatient hospice care, hospice shared care and home hospice care — with the former two taking place in the hospital, accounting for about 80 percent of cases, he said.
The pay-for-performance model was introduced to hospice care to encourage better quality of care, Shih said, adding that, starting from this year, hospitals with home hospice care services would be scored across three tiers — good, excellent and outstanding.
An increased payment of 10 to 30 percent would be offered to medical teams according to their performance score, with a requirement that 60 percent of the added reward payment being designated to frontline healthcare providers, he added.
National Health Insurance Administration Chief Secretary Liu Lin-i (劉林義) said the incentive reward program was announced last year, and about 100 hospitals have applied so far, while the Joint Commission of Taiwan (JCT) has been commissioned to conduct the evaluations for this program.
On-site evaluations of home hospice care quality performance are scheduled to take place between next month and October, with a final review meeting at the end of the year to determine their scores and corresponding rewards, he added.
Regarding the long-standing controversy surrounding euthanasia, Shih said it is not merely a medical issue but also involves complex legal and ethical issues as well as societal values, and although Taiwan’s society is increasingly open to the topic, significant division remains.
Assisting in suicide is a crime under the Criminal Code, and active euthanasia involves physicians performing procedures to end a life, which presents ethical conflict with core medical values, and therefore most medical associations have a conservative stance on this issue, he said.
Therefore, the government has instead been promoting making advance medical decisions and palliative and hospice care under the Hospice Palliative Care Act (安寧緩和醫療條例) and the Patient Right to Autonomy Act (病人自主權利法), to achieve a dignified and peaceful death at home, he said.
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