Hospices and palliative care are the final chapter of life, where people spend their final days, ideally in comfort and peace. The World Health Organization stresses it should be part of universal health coverage for anyone with a serious illness. Yet palliative care in Japan, until recently, had been reserved for cancer patients, and non-cancer patients have suffered as a result. A new study sheds light on this imbalance.
Palliative care aims to improve the quality of life of anyone who has a serious or life-limiting condition. As such, palliative care should be accessible to non-cancer patients. However, the reality in Japan still shows a wide imbalance between cancer and non-cancer patients.
Non-cancer deaths account for about 73% of all deaths in Japan. Despite this, only 15.2% of the inpatient hospice and palliative care facilities we surveyed had admitted non-cancer patients. Indeed, that's a huge disparity, though the overall health system and other factors provide some explanation for this status quo."
Professor Jun Hamano, lead researcher of the study
For one, a very different number, 59.1%, expressed willingness to accept non-cancer patients, but with a catch - the health insurance system must cover the costs at the same level as that for cancer patients. This is one area where Japan's universal coverage disadvantages non-cancer patients; only cancer patients, mainly those in the terminal stages, are insured for inpatient palliative care. This also means facilities have mainly been developed to care for advanced cancer patients. Caring for other terminal illnesses may be more complex and require different facilities and training.
Professor Hamano's study surveyed 264 hospices/palliative care units in Japan. These facilities were asked about their size and specifics, and the numbers and percentages of cancer and non-cancer admissions. They were also asked for their views on the need for insurance coverage and their willingness to accept non-cancer patients, as well as their support needs and conditions for non-cancer patients.
A total of 39.4% said they would be "very willing" or "willing" to accept non-cancer patients with insurance coverage. Add in the "somewhat willing," and the total reached 59.1%. Meanwhile, 75% of facilities stressed the need for insurance coverage, underscoring the present system's shortfall. Over 75% also reported needs such as "clarification of admission criteria" and an "education and training system." Thus, the disparity evidently owes in large part to finances and preparedness.
"We have to establish a health insurance system that delivers and supports palliative care irrespective of disease," Professor Hamano emphasizes. "The admission criteria need clarifying, and we need programs for educating the healthcare providers on palliative care for non-cancer patients, such those with chronic respiratory or hepatic failure."
Until these are established and clarified, especially insurance support, the disparity between hospice and palliative care in favor of cancer patients may continue.
This study was supported in part by JSPS Grant-in-Aid for Scientific Research (grant Nos. 19H03866 and 22H03305). The sponsor played no role in the study design, collection, analysis, or interpretation of the data; writing of the report; or in the decision to submit the paper for publication.
Hamano, J., et al. (2023) Current situation and support need for non-cancer patients' admission to inpatient hospices/palliative care units in Japan: a nationwide multicenter survey. Annals of Palliative Medicine. doi.org/10.21037/apm-22-743.