Taiwan and Singapore lead Asia in quality of death, Hong Kong lags behind
Taiwan and Singapore retain top rankings in palliative care in Asia, but Hong Kong has been overtaken by Japan and South Korea, descending from the 3rd position in Asia in 2010 to the 5th position, according to the latest 2015 Quality of Death Index released by The Economist Intelligence Unit.
The 2015 Index, published in October, evaluated 80 countries based on 20 quantitative and qualitative indicators across five categories: palliative and healthcare environment (20 percent weighting), human resources (20 percent weighting), affordability of care (20 percent weighting), quality of care (30 percent weighting), and level of community engagement (10 percent weighting). It is an expansion to the 2010 Index, which evaluated the availability, affordability and quality of end-of-life care in 40 countries. [http://www.economistinsights.com/healthcare/analysis/quality-death-index-2015/fullreport]
Taiwan remains the best palliative care provider in Asia, ascending from the 14th position overall in 2010 to the 6th position in 2015. Singapore, the second best in Asia, ranks 12th in the 2015 Index, followed by Japan in the 14th position and South Korea in the 18th position. (Table 1)
Hong Kong now ranks 22nd overall, with a relatively low ranking in palliative and healthcare environment (28th position) despite its high income level. Its ranking in this category is lower than that of Panama (25th position), a middle-income country, and Mongolia (24th position), a low-income country. (Table 2)
According to authors of the report, “Hong Kong scores relatively poorly in terms of overall healthcare spending, the availability of research-based policy evaluation and its capacity to deliver palliative care services.”
Hong Kong’s ranking in level of community engagement is even lower, at the 38th position – far behind the top four Asian countries. (Table 2)
The countries leading the 2015 Index share the characteristics of a strong and effectively implemented national palliative care policy framework, high levels of public spending on healthcare services, extensive palliative care training resources for general and specialized medical workers, generous subsidies for palliative care services, and strong public awareness of palliative care.
Taiwan, however, has taken one step further by introducing new technology to promote home-based palliative care.
“We have introduced a programme for remote monitoring using smartphones and tablets,” said Dr. Ying-Wei Wang, Director of the Heart Lotus Hospice of Tzuchi General Hospital, Taiwan, who spoke in Hong Kong recently at the International Forum on Quality and Safety in Healthcare: Asia organized by the BMJ and the Cambridge-based nonprofit Institute for Healthcare Improvement.
“Patients enrolled into the programme are given equipment for remote monitoring of blood pressure, heart rate, blood oxygen, and heart and breathing sound. These data are uploaded to an integrated cloud platform accessible by healthcare professionals and case managers,” he continued. “Via the platform, patients and caregivers can report symptoms, consult the palliative care team through Skype video conferencing, and receive care instructions available in six languages. Volunteers provide translation for foreign health aides via the Internet.”
According to Wang, the programme has resulted in a 50 percent decrease in 14-day readmission rate. “The use of new technology enhances the quality of palliative care in the community. These initiatives, along with the increased reimbursements for home-based hospice and palliative care put in place since February 2015, will enable more patients to go through the final stage of life with dignity at home,” he said.
“Political will is very important for extending access to palliative care. In Singapore, our approach is to focus on preventable outcomes, and shift away from hospital-centric and doctor-centric care to a lower-cost model of community-based care,” said Professor Yam-Cheng Chee of the National Healthcare Group and Tan Tock Seng Hospital, Singapore, who also spoke at the Forum.
“Our community-based virtual hospital programme, which involves GPs, medical social workers and nurses who function as case managers, has resulted in 50-60 percent reductions in emergency department attendance and readmission to acute hospitals at 90 days post-enrollment,” Chee continued.
“In various parts of the world, a lot of work needs to be done in life-and-death education so that the public and healthcare professionals don’t see withholding resuscitation as doctors giving up on patients,” added Dr. Raymond Lo, President of the Federation of Medical Societies of Hong Kong.