Geographical variation in palliative cancer care in a tax-based healthcare system: drug reimbursement in Denmark

Cecilie Daugaard; Mette Asbjoern Neergaard; Anne Høy Seemann Vestergaard; Mette Kjærgaard Nielsen; David C Goodman; Søren P Johnsen

doi:10.1093/eurpub/ckz211

Geographical variation in palliative cancer care in a tax-based healthcare system: drug reimbursement in Denmark

Cecilie Daugaard, Mette Asbjoern Neergaard, Anne Høy Seemann Vestergaard, Mette Kjærgaard Nielsen, David C Goodman, Søren P Johnsen

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

BACKGROUND: In Denmark, a tax-based universal healthcare setting, drug reimbursement for terminal illness (DRTI) should be equally accessible for all terminally ill patients. Examining DRTI status by regions provides new knowledge on inequality in palliative care provision and associated factors. This study aims to investigate geographical variation in DRTI among terminally ill cancer patients.

METHODS: We linked socioeconomic and medical data from 135 819 Danish cancer decedents in the period 2007-15 to regional healthcare characteristics. We analyzed associations between region of residence and DRTI. Prevalence ratios (PR) for DRTI were estimated using generalized linear models adjusted for patient factors (age, gender, comorbidity and socioeconomic profile) and multilevel models adjusted for both patient factors and regional healthcare capacity (patients per general practitioner, numbers of hospital and hospice beds).

RESULTS: DRTI allocation differed substantially across Danish regions. Healthcare capacity was associated with DRTI with a higher probability of DRTI among patients living in regions with high compared with low hospice bed supply (PR 1.13, 95% CI 1.10-1.17). Also, the fully adjusted PR of DRTI was 0.94 (95% CI 0.91-0.96) when comparing high with low number of hospital beds. When controlled for both patient and regional healthcare characteristics, the PR for DRTI was 1.17 (95% CI 1.14-1.21) for patients living in the Central Denmark Region compared with the Capital Region.

CONCLUSION: DRTI status varied across regions in Denmark. The variation was associated with the distribution of healthcare resources. These findings highlight difficulties in ensuring equal access to palliative care even in a universal healthcare system.

Original language	English
Journal	European Journal of Public Health
Volume	30
Issue	2
Pages (from-to)	223-229
Number of pages	8
ISSN	1101-1262
DOIs	https://doi.org/10.1093/eurpub/ckz211
Publication status	Published - Apr 2020

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10.1093/eurpub/ckz211

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@article{d38d35918dcd412fb1a1b401147369ac,

title = "Geographical variation in palliative cancer care in a tax-based healthcare system: drug reimbursement in Denmark",

abstract = "BACKGROUND: In Denmark, a tax-based universal healthcare setting, drug reimbursement for terminal illness (DRTI) should be equally accessible for all terminally ill patients. Examining DRTI status by regions provides new knowledge on inequality in palliative care provision and associated factors. This study aims to investigate geographical variation in DRTI among terminally ill cancer patients.METHODS: We linked socioeconomic and medical data from 135 819 Danish cancer decedents in the period 2007-15 to regional healthcare characteristics. We analyzed associations between region of residence and DRTI. Prevalence ratios (PR) for DRTI were estimated using generalized linear models adjusted for patient factors (age, gender, comorbidity and socioeconomic profile) and multilevel models adjusted for both patient factors and regional healthcare capacity (patients per general practitioner, numbers of hospital and hospice beds).RESULTS: DRTI allocation differed substantially across Danish regions. Healthcare capacity was associated with DRTI with a higher probability of DRTI among patients living in regions with high compared with low hospice bed supply (PR 1.13, 95% CI 1.10-1.17). Also, the fully adjusted PR of DRTI was 0.94 (95% CI 0.91-0.96) when comparing high with low number of hospital beds. When controlled for both patient and regional healthcare characteristics, the PR for DRTI was 1.17 (95% CI 1.14-1.21) for patients living in the Central Denmark Region compared with the Capital Region.CONCLUSION: DRTI status varied across regions in Denmark. The variation was associated with the distribution of healthcare resources. These findings highlight difficulties in ensuring equal access to palliative care even in a universal healthcare system.",

author = "Cecilie Daugaard and Neergaard, {Mette Asbjoern} and Vestergaard, {Anne H{\o}y Seemann} and Nielsen, {Mette Kj{\ae}rgaard} and Goodman, {David C} and Johnsen, {S{\o}ren P}",

year = "2020",

month = apr,

doi = "10.1093/eurpub/ckz211",

language = "English",

volume = "30",

pages = "223--229",

journal = "European Journal of Public Health",

issn = "1101-1262",

publisher = "Oxford University Press",

number = "2",

}

Geographical variation in palliative cancer care in a tax-based healthcare system: drug reimbursement in Denmark. / Daugaard, Cecilie ; Neergaard, Mette Asbjoern ; Vestergaard, Anne Høy Seemann et al.
In: European Journal of Public Health, Vol. 30, No. 2, 04.2020, p. 223-229.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Geographical variation in palliative cancer care in a tax-based healthcare system: drug reimbursement in Denmark

AU - Daugaard, Cecilie

AU - Neergaard, Mette Asbjoern

AU - Vestergaard, Anne Høy Seemann

AU - Nielsen, Mette Kjærgaard

AU - Goodman, David C

AU - Johnsen, Søren P

PY - 2020/4

Y1 - 2020/4

N2 - BACKGROUND: In Denmark, a tax-based universal healthcare setting, drug reimbursement for terminal illness (DRTI) should be equally accessible for all terminally ill patients. Examining DRTI status by regions provides new knowledge on inequality in palliative care provision and associated factors. This study aims to investigate geographical variation in DRTI among terminally ill cancer patients.METHODS: We linked socioeconomic and medical data from 135 819 Danish cancer decedents in the period 2007-15 to regional healthcare characteristics. We analyzed associations between region of residence and DRTI. Prevalence ratios (PR) for DRTI were estimated using generalized linear models adjusted for patient factors (age, gender, comorbidity and socioeconomic profile) and multilevel models adjusted for both patient factors and regional healthcare capacity (patients per general practitioner, numbers of hospital and hospice beds).RESULTS: DRTI allocation differed substantially across Danish regions. Healthcare capacity was associated with DRTI with a higher probability of DRTI among patients living in regions with high compared with low hospice bed supply (PR 1.13, 95% CI 1.10-1.17). Also, the fully adjusted PR of DRTI was 0.94 (95% CI 0.91-0.96) when comparing high with low number of hospital beds. When controlled for both patient and regional healthcare characteristics, the PR for DRTI was 1.17 (95% CI 1.14-1.21) for patients living in the Central Denmark Region compared with the Capital Region.CONCLUSION: DRTI status varied across regions in Denmark. The variation was associated with the distribution of healthcare resources. These findings highlight difficulties in ensuring equal access to palliative care even in a universal healthcare system.

AB - BACKGROUND: In Denmark, a tax-based universal healthcare setting, drug reimbursement for terminal illness (DRTI) should be equally accessible for all terminally ill patients. Examining DRTI status by regions provides new knowledge on inequality in palliative care provision and associated factors. This study aims to investigate geographical variation in DRTI among terminally ill cancer patients.METHODS: We linked socioeconomic and medical data from 135 819 Danish cancer decedents in the period 2007-15 to regional healthcare characteristics. We analyzed associations between region of residence and DRTI. Prevalence ratios (PR) for DRTI were estimated using generalized linear models adjusted for patient factors (age, gender, comorbidity and socioeconomic profile) and multilevel models adjusted for both patient factors and regional healthcare capacity (patients per general practitioner, numbers of hospital and hospice beds).RESULTS: DRTI allocation differed substantially across Danish regions. Healthcare capacity was associated with DRTI with a higher probability of DRTI among patients living in regions with high compared with low hospice bed supply (PR 1.13, 95% CI 1.10-1.17). Also, the fully adjusted PR of DRTI was 0.94 (95% CI 0.91-0.96) when comparing high with low number of hospital beds. When controlled for both patient and regional healthcare characteristics, the PR for DRTI was 1.17 (95% CI 1.14-1.21) for patients living in the Central Denmark Region compared with the Capital Region.CONCLUSION: DRTI status varied across regions in Denmark. The variation was associated with the distribution of healthcare resources. These findings highlight difficulties in ensuring equal access to palliative care even in a universal healthcare system.

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U2 - 10.1093/eurpub/ckz211

DO - 10.1093/eurpub/ckz211

M3 - Journal article

C2 - 31747006

SN - 1101-1262

VL - 30

SP - 223

EP - 229

JO - European Journal of Public Health

JF - European Journal of Public Health

IS - 2

ER -

Geographical variation in palliative cancer care in a tax-based healthcare system: drug reimbursement in Denmark

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