Abstract：
While hospital-based Palliative Care services are usually covered through the main funding healthcare framework, traditional reimbursement methods have been criticized for their appropriateness. The present study investigates for the first time the case of treating end-of-life cancer patients in a Greek public hospital in terms of cost and reimbursement.
This retrospective observational study used health administrative data of 135 deceased cancer patients who were hospitalized in the end of their lives. Following the cost estimation procedure, which indentified both the individual patient and overhead costs, we compared the relevant billing data and reimbursement requests to the estimated costs.
The average total cost per patient per day was calculated to be 97 EUR, with equal participation of individual patient\'s and overhead costs. Length of stay was identified as the main cost driver. Reimbursement was performed either by per-diem fees or by Diagnosis Related Groups\' (DRGs), which were correspondingly associated with under or over reimbursement risks. In the case of the combined use of the two available reimbursement alternatives a cross-subsidization phenomenon was described.
Although the cost of end-of-life care proved to be quite low, the national per-diem rate fails to cover it. DRGs designed for acute care needs are rather unsuitable for such sub acute hospitalizations.
There is a concrete need for reconsidering the current reimbursement schemes for this group of patients as part of any national plan concerning the integration and reformation of Palliative Care services. Otherwise, there is a serious danger for public institutions\' reluctance to admit them with a serious impact on access and equity of end-of-life cancer care.
This retrospective observational study used health administrative data of 135 deceased cancer patients who were hospitalized in the end of their lives. Following the cost estimation procedure, which indentified both the individual patient and overhead costs, we compared the relevant billing data and reimbursement requests to the estimated costs.
The average total cost per patient per day was calculated to be 97 EUR, with equal participation of individual patient\'s and overhead costs. Length of stay was identified as the main cost driver. Reimbursement was performed either by per-diem fees or by Diagnosis Related Groups\' (DRGs), which were correspondingly associated with under or over reimbursement risks. In the case of the combined use of the two available reimbursement alternatives a cross-subsidization phenomenon was described.
Although the cost of end-of-life care proved to be quite low, the national per-diem rate fails to cover it. DRGs designed for acute care needs are rather unsuitable for such sub acute hospitalizations.
There is a concrete need for reconsidering the current reimbursement schemes for this group of patients as part of any national plan concerning the integration and reformation of Palliative Care services. Otherwise, there is a serious danger for public institutions\' reluctance to admit them with a serious impact on access and equity of end-of-life cancer care.
摘要：
背景：虽然基于医院的姑息治疗服务通常通过主要的筹资医疗保健框架来覆盖，传统的报销方法因其适当性而受到批评。本研究首次调查了在希腊公立医院中治疗临终癌症患者的费用和报销情况。
方法：这项回顾性观察性研究使用了135名死亡癌症患者的卫生管理数据，这些患者在生命结束后住院。按照成本估算程序，它确定了单个患者和间接费用，我们将相关的账单数据和报销请求与估计成本进行了比较。
结果：每位患者每天的平均总费用为97欧元，每个患者和间接费用的平等参与。住院时间被确定为主要成本动因。报销是通过每日津贴或诊断相关组(DRG)进行的，相应地与偿还风险不足或过度相关。在合并使用两种可用的偿还替代方案的情况下，描述了交叉补贴现象。
结论：尽管事实证明，临终关怀的费用相当低，国家每日津贴率无法覆盖。为急性护理需求而设计的DRG相当不适合这种亚急性住院。
UNASSIGNED：具体需要重新考虑目前针对这类患者的报销计划，作为任何关于姑息治疗服务整合和改革的国家计划的一部分。否则,对于公共机构来说，这是一个严重的危险，他们不愿承认他们对临终癌症护理的获取和公平产生严重影响。
方法：这项回顾性观察性研究使用了135名死亡癌症患者的卫生管理数据，这些患者在生命结束后住院。按照成本估算程序，它确定了单个患者和间接费用，我们将相关的账单数据和报销请求与估计成本进行了比较。
结果：每位患者每天的平均总费用为97欧元，每个患者和间接费用的平等参与。住院时间被确定为主要成本动因。报销是通过每日津贴或诊断相关组(DRG)进行的，相应地与偿还风险不足或过度相关。在合并使用两种可用的偿还替代方案的情况下，描述了交叉补贴现象。
结论：尽管事实证明，临终关怀的费用相当低，国家每日津贴率无法覆盖。为急性护理需求而设计的DRG相当不适合这种亚急性住院。
UNASSIGNED：具体需要重新考虑目前针对这类患者的报销计划，作为任何关于姑息治疗服务整合和改革的国家计划的一部分。否则,对于公共机构来说，这是一个严重的危险，他们不愿承认他们对临终癌症护理的获取和公平产生严重影响。
