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UK rated top for 'quality of death'

The UK has topped an index investigating the provision of end-of-life care services in 40 countries

A 'Quality of Death' Index, commissioned by the philanthropic organisation, the Lien Foundation, has been published by the Economist Intelligence Unit (EIU) and ranks 40 countries according to their provision of end-of-life care services.

The UK, which has led the way globally in terms of its hospice care network and statutory involvement in end-of-life care, tops the chart overall, scoring 7.9. Despite being placed equal 28th in the Basic End-of Life Healthcare Environment sub-category (20 per cent of the overall score), it ranks first in the Quality of End-of-Life Care sub-category, which covers public awareness, training availability, access to painkillers and doctor-patient transparency (40 per cent of the overall score).

Many rich nations fall a long way down the Index with their overall scores, including Denmark (22nd), Italy (24th) and South Korea (32nd), where the quality and availability of care are often poor and policy co-ordination is lacking.

The lowest-ranking countries are the developing and BRIC countries, such as China (score: 2.3), Brazil (score: 2.2), India (bottom of the Index at 1.9) and Uganda (score: 2.1) where, despite notable exceptions, such as the Indian state of Kerala, and services delivered through Hospice Africa Uganda, progress on providing end-of-life care is slow. In China and India, with vast populations, end-of-life coverage extends to only a fraction of those in need.

The EIU has produced a white paper analysing the Index results. It found that: combating perceptions of death and cultural taboos are crucial to improving palliative care; public debates about euthanasia and physician-assisted suicide raise awareness, but relate to only a small minority of deaths; drug availability is the most important practical issue; state funding of end-of-life care is limited and often prioritises conventional treatment and more palliative care may mean less health spending as, by increasing the proportion of community and homecare, palliative care can reduce the costs associated with hospital stays and emergency admissions.

The Index measured end-of life care services across 30 Organisation for Economic Co-operation and Development (OECD) nations and 10 others for which data was available. The researchers interviewed a variety of doctors, specialists and other experts. Countries were measured across four categories: Basic End-of-Life Healthcare Environment (20 per cent); Availability of End-of-Life Care (25 per cent); Cost of End-of-Life Care (15 per cent); and Quality of End-of-Life Care (40 per cent), which together covered 24 indicators.

The full white paper is available via: www.eiu.com/sponsor/lienfoundation/qualityofdeath

14th July 2010

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