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Aust ranks second in 'quality of death' index

Aust second in 'quality of death' index
Photo: Aust second in 'quality of death' index
Australia has come in overall second in the 2015 Quality of Death Index, which looks at palliative care, but current policies may change this.

Australia has come in second in an 80-country "quality of death" study that warns ageing and booming populations would make palliative care a growing worldwide issue.

The 2015 Quality of Death Index, compiled by the London-based Economist Intelligence Unit, found Britain to be the best at palliative care.

"Its ranking is due to comprehensive national policies, the extensive integration of palliative care into the National Health Service, a strong hospice movement, and deep community engagement on the issue," the EIU said.
Britain was followed by Australia, New Zealand, Ireland, Belgium and Taiwan.

Yet even in countries that have robust policies and funding for palliative care, gaps in provision exist, gaps that may increase with the rise in the proportion of older citizens in the coming years, the report says.

In Australia, which ranks second in the overall index and third in the palliative and healthcare environment category, responsibility for healthcare is devolved to the states, which can lead to inconsistency in care delivery.

"There isn't an equitable spread of funding across the country," says Liz Callaghan, chief executive of Palliative Care Australia, in the report.

"You'd hope it would be based on what the population needs. Everyone talks about it, but that's very far away. In some states, funding for palliative care is extremely low so the multidisciplinary team might be just a doctor and a nurse."

Australia tops the list for provision of specialist care, followed by the UK and Germany.

However, while Australia is in first place, for example, Yvonne McMaster, a retired palliative care doctor and advocate for palliative care, identifies gaps in this. She cites the case of NSW, which is home to one-third of Australia's population.

"In the rural and regional areas outside the Sydney metropolitan cluster, most palliative care is done by nurses," she says in the report.

"There are only four specialist doctors in NSW outside the Sydney area. And even though more are being trained the funding isn't being provided for the positions."

Government funding is essential to increase access to care. In this category, Australia, Belgium, Denmark, Ireland and the UK top the list.

However, changes in funding models as part of broader healthcare reforms in the country are creating some uncertainty for those in need of care, the report says.

This is the case with community and home care, which has traditionally been funded through the Home and Community Care program. This program is being wound up and will be incorporated into a Home Support program, explains PCA's Ms Callaghan.

"A huge amount of reform is happening in the way community care services are provided," she says. "But we are unclear as to what happens to palliative care as a result of those changes."

Australia also topped the list for providing quality services and access to painkillers such as opioids, along with the UK and Sweden, but placed ninth overall for community engagement in providing palliative care and awareness of the issue.

Palliative care provision was found to be worst in Iraq among the 80 countries studied, with Bangladesh, the Philippines, Nigeria and Myanmar rounding out the bottom five.

TOP 10 COUNTRIES (SCORES OUT OF 100):
93.9 - Britain
91.6 - Australia
87.6 - New Zealand
85.8 - Ireland
84.5 - Belgium
83.1 - Taiwan
82.0 - Germany
80.9 - Netherlands
80.8 - United States
79.4 - France

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