Singapore ranked 12th best place in the world to die: Quality of Death index 2015

Republic is 12th best on palliative care index
National strategy pushes it up from 18th place in 2010 in global ranking on quality of death
By Janice Tai, The Straits Times, 7 Oct 2015

Singapore has been ranked the 12th best place in the world to die, up from 18th in 2010, in a global index on palliative care. It is also the second best in Asia, behind Taiwan.

This is according to the Quality of Death Index 2015 released yesterday by Economist Intelligence Unit (EIU).

The improvement was due largely to the drafting and implementation of a national strategy on palliative care in recent years and making such care more affordable.

Palliative care seeks to improve the quality of life of patients who have life-threatening illnesses.

As in the first ranking five years ago, Britain topped the index, followed by Australia and New Zealand.

The index, which was commissioned by local philanthropic organisation Lien Foundation, ranked 80 places on end-of-life care. It is scored on 20 indicators across five categories: Palliative and healthcare environment, human resources, affordability of care, quality of care and community engagement.

In 2010, when the index was developed, Singapore was ranked 18th out of 40. The index has since been tweaked to make it more rigorous and to include more entries.

Mr David Line, managing editor of industry and management research at the EIU, said at the press conference: "The new index is structured differently from the previous one, so we can't make direct comparisons. But it is clear that Singapore has since made improvements in its palliative care definitively and relatively to others."

Singapore was strongest in affordability of care (sixth place), quality of care (eighth) and human resources (eighth), according to the index. It was the weakest in community engagement (22nd).

The EIU's 2010 index sparked a series of policy debates over the provision of palliative care around the world.

In Singapore, the first index led to the Government tasking the Lien Centre for Palliative Care to develop a coordinated national strategy for palliative care, which was released in 2012. The strategy includes coordination of care and recruitment of workers to improve palliative care. New national guidelines on end-of-life care were also unveiled last year.

Singapore's strengths in the field, according to the EIU report, include funding that lowers financial barriers, such as increasing the Medisave withdrawal limits for palliative care from January this year.

Dr Angel Lee, chairman of the Singapore Hospice Council, said: "There have been positive changes in funding, new services and in-patient facilities, guidelines and new training programmes - all in a short span of time since the implementation of the national strategy."

A new area that the report assesses is the demand for palliative care. Singapore was placed 23rd, partly because of its greying population.

Demand is rising as the population ages and the incidence of cancer and chronic diseases also increases. By 2020, more than 10,000 people a year are expected to need palliative care, up from the 6,000 patients in 2013.

Places with a high quality of death share several characteristics, said the report. These include generous subsidies for patients and strong public awareness of palliative care.

Associate Professor Cynthia Goh, chair of the Asia Pacific Hospice and Palliative Care Network, said: "Public awareness of palliative care in Singapore needs to be strengthened by getting people to talk about dying or planning for advance care as early as when they hit their 40s when they are still well."

Lien Foundation chief executive Lee Poh Wah said: "It is incumbent upon each of us to remove the barriers buried in our healthcare systems and cultural practices as well as to demand greater accountability from our governments to improve care for the dying."

With ageing populations across the globe, the importance of the issue of palliative care is beginning to emerge. The...
Posted by The Economist Intelligence Unit on Wednesday, October 7, 2015

Patients 'will pay more' to be pain-free
By Janice Tai, The Straits Times, 7 Oct 2015

How much would you be willing to pay to extend your life by a year if you were sick? Not much, says a study done by researchers from the Lien Centre for Palliative Care (LCPC).

Older adults are willing to fork out only $1,587 - about $4.35 a day. However, they will happily pay six times that amount ($9,358) to be kept free from pain and double the sum ($3,712) to be able to die at home.

Patients with advanced cancer feel the same way, but were ready to pay more.

These were the maximum amounts of money researchers estimated participants were willing to pay after questioning them.

The study, which has been accepted for publication in the international Health Policy journal, surveyed 542 adults aged 50 and above, and 332 advanced-cancer patients.

It was done because past research showed that caregivers place more emphasis on life extension and will pay more for moderately life-extending treatments than patients; but it was not known if patients themselves or the public felt the same way, said Dr Eric Finkelstein, director of the LCPC, which led the study.

He noted that older adults' and patients' willingness to pay for an extra year of life is lower than what policymakers are willing to pay for healthcare schemes in other places.

He said: "This suggests that health-reform efforts should not overemphasise financing high-cost treatments that only moderately extend life."

Britain tops Quality of Death index that studies palliative care in 80 countries; Singapore is 12th
The Straits Times, 6 Oct 2015

LONDON (AFP) - Britain topped an 80-country "quality of death" study released on Tuesday (Oct 6), which warned that 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 (EIU), found Britain to be the best at palliative care. Singapore came in at No. 12.

"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.

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.

The report praised progress made by less wealthy states.

"Many developing countries are still unable to provide basic pain management due to limitations in staff and basic infrastructure," it said.

"Yet some countries with lower income levels demonstrate the power of innovation and individual initiative."

It said Panama (31st) was building palliative care into its primary care services, Mongolia (28th) had seen rapid growth in hospice facilities, while Uganda (35th) had made impressive advances in the availability of opioid painkillers.

China (71st) was found to be among the most vulnerable from population ageing and rising incidences of conditions such as cardiovascular disease.

"The adoption of palliative care in China has been slow, with a curative approach dominating healthcare strategies," the study found.

"Many other developing countries will also need to work hard to meet rising future need as the incidence of non-communicable disease increases and their populations grow older," the report said.

The study found that income levels correlated strongly with success in delivering palliative care, though some, such as Singapore (12th), Hong Kong (22nd) and Saudi Arabia (60th), were lagging.

The study said that, overall, palliative care was rising up the agenda as "seismic demographic shifts" force governments to confront the reality of providing for ageing populations.

Wealthy nations will have to shift from curative care to managing long-term conditions.

Meanwhile developing countries would have to deal with booming populations and increasingly unhealthy lifestyles that will force healthcare systems to adapt to chronic condition like diabetes.

Offer coverage for end-of-life care: Experts
Patients stay in hospitals longer than needed as insurance plans do not cover hospice care
By Janice Tai, The Straits Times, 15 Oct 2015

With demand for palliative care expected to double in the next five years, experts have called for the authorities to make it more affordable by having it covered by insurance.

End-of-life care experts say that patients are staying in hospitals longer than they need to because insurance companies do not pay for palliative care in hospices.

"Most people do not want to be in hospital once they know medical interventions will no longer benefit them," said Dr Cynthia Goh, senior consultant at the National Cancer Centre Singapore and chair of the Asia Pacific Hospice Palliative Care Network.

"Yet some patients are stuck in hospital because their insurance plans do not cover care at a hospice. Insurance companies here still have not realised that better care can be obtained at a hospice at a fraction of the cost of the hospital."

In Singapore, insurance companies and MediShield Life do not cover care in hospices.

But countries such as Australia include palliative consultations under a medical benefits scheme, and private insurance is used as a source of financing.

Reviewing the model of financing behind palliative care is one of the suggestions brought up by experts, after results from a global ranking on palliative care were released last week.

According to the Quality of Death Index by the Economist Intelligence Unit, Singapore is the 12th best place in the world to die.

This makes the city state second best in Asia, behind Taiwan. Britain topped the index, followed by Australia and New Zealand.

Singapore was strongest in affordability of care (sixth place), quality of care (eighth) and human resources (eighth), according to the index of 80 countries.

It was the weakest in community engagement (22nd).

But experts say there is still room for improvement. Philanthropic organisation Lien Foundation, which commissioned the index, also did a survey last year that found that two in three Singaporeans cannot correctly define what hospice palliative care is.

It is an approach that seeks to improve the quality of life of patients who have life-threatening illnesses.

By 2020, more than 10,000 people a year are expected to need palliative care, up from the 6,000 in 2013.

The lack of public awareness on such care is not surprising, given that doctors and nurses themselves struggle with it.

About six in 10 doctors and four in 10 nurses said their basic training did not prepare them to handle patients with life-threatening illnesses, another Lien Foundation survey showed.

Its chief executive, Mr Lee Poh Wah, said palliative care should be made a core component of training for all healthcare professionals.

"Healthcare workers need to be trained to pick cases up and do referrals because only about 20 per cent to 30 per cent of those who pass away each year use palliative care services, when research shows that 70 per cent to 80 per cent of all deaths in high-income countries would require such care," said Mr Lee.