One of the far-reaching effects of population aging is medical care. The health care industry should provide the necessary resources for these aging population. Take Shanghai, which has the highest aging population in China, for example, 3% of the elderly over 60 years old are seriously ill, and it is estimated that 6.3% (1.2000) need nursing care, some of them are dying patients. About 80% of the elderly who can't take care of themselves depend on their families, which face great difficulties. Many dying old people ask for hospice care. At the same time, people are increasingly aware that traditional and institutionalized forms of medical care may not be the most effective way to help and provide care for the dying elderly. For some people who are dying, although the medical and health care system continues to carry out technological innovation, it does not emphasize alleviating the suffering of patients and providing dignity. Every society has different habits and attitudes towards death. However, people agree that dying people should spend their last days in comfort and dignity. Hospice care is produced in the changes of population and culture.
The term "hospice care" can be traced back hundreds of years, when it was used to describe providing shelter for weak or sick travelers. This word is used for the first time in the contemporary sense, which means to give the dying elderly patients as much kind comfort, good care and help as possible, and let them die safely. The earliest nursing care for terminally ill patients was St. Christopher Hospice initiated by Sanders in London, England in 1967. So far, hospice care institutions have been developed and popularized in many countries.
2. The development of hospice care in America.
1974, the first hospice hospital in America was established. From 65438 to 0982, Congress issued a decree to add hospice care to the medical insurance plan (the medical care plan for the elderly), which provided financial support for patients to enjoy hospice care services and laid the foundation for the development of hospice care industry in the United States. The change of policy has caused a wave of hospice care to appear everywhere immediately. In recent ten years, the ability of American hospice care service in dealing with complex pain and symptoms has gradually increased, and the service organizations have also developed from small voluntary organizations to various formal non-profit and profit-making organizations.
Some factors in social development have greatly increased the demand for hospice care, such as the aging population, people's concern about dignified death and the increase of various institutional expenses in hospice care. The hospice care industry in the United States is developing rapidly, and the number of hospice care projects is increasing by nearly 17% every year. Today, the National Hospice Care Organization (NHO) has more than 365,438+000 hospice care projects in operation and planning in 50 states. 1998 alone, about 540,000 patients and their families in the United States have received this service. As the elderly population (currently 40 million) is expected to double in the next 30 years, the number of hospice patients in the United States will continue to grow.
3, the principle of hospice care
Hospice care in the United States is for those who are dying, that is, patients who are usually diagnosed with only six months or less. According to the regulations, hospice hospitals do not provide treatment for patients. The purpose of hospice care is neither to cure diseases or prolong life, nor to accelerate death. In fact, it is to improve the quality of the rest of your life by providing palliative care, pain control and symptom treatment. The patient's dignity is the most worrying thing. Hospice care emphasizes the emotional, psychological, social, economic and spiritual needs of patients and their families. Hospice care is mainly provided in patients' homes. When patients cannot choose home care, hospice care can be carried out in hospitals, nursing homes or other facilities.
Typical hospice care is provided by a professional team, which is an interdisciplinary team composed of registered nurses, doctors, social workers and priests or other legal advisers. When necessary, the nursing service also provides assistants, pharmacists, physical therapy, speech therapy and trained volunteers. Patients and their families receive services 24 hours a day, 7 days a week. After the death of the patient, relatives and friends can receive the annual funeral service.
From 65438 to 0995, according to the statistics of American National Hospice Organization, 60% hospice patients suffered from cancer, 6% from heart-related diseases, 4% from AIDS, 1% from kidney diseases, 2% from Alzheimer's disease and 27% from other diseases.
4. The current situation of hospice care in America.
(1) Demography
According to the statistics of American National Hospice Organization,1April 1998, 65% hospice hospitals in the United States are non-profit organizations, 16% are for-profit organizations, 4% are government organizations, and 15% are uncertain. From the organizational structure, about 28% hospice institutions in 1998 are independent legal persons, and 59% are not hospice hospitals (such as hospitals or family health care institutions), but belong to a legal person. 13% is uncertain.
From 65438 to 0995, 52% of the dying patients were male and 48% were female. Among male patients, 7 1% were over 65 years old, and 50-64 years old accounted for 17.2%. 10% is 18 ~ 49 years old; 1% is under 17 years old. Among the female patients, 74% were aged 65 and above, and 50-64 years old accounted for16.7; 8.6% were 18 ~ 49 years old; 1% is under 17 years old.
77% of the dying patients died in their own homes, 19% in institutions and 4% in other places. In all patients receiving hospice care program, the average survival time is 6 1.5 days, which is about two months.
(2) the financial situation of hospice care
Generally speaking, hospice care is an effective cost-saving nursing method, because it provides care for patients at home by family, friends and volunteers, and usually does not require expensive technology. In fact, according to the estimation of the national hospice care organization, more than 90% of hospice care time is provided in patients' homes, replacing high-cost institutional care. The study of 1995 shows that for every 1 USD spent on hospice medical insurance, 1.52 USD can be saved. The source of saving is the patient's treatment fee, medicine fee, hospitalization fee and nursing fee. In the last year of life, hospice patients spent $2,737 less than those who didn't need hospice care. In the last month of my life, I saved 3 192 dollars. Some savings of hospice care are not obvious. For example, many endangered patients with medical insurance often receive hospice care very late until a few weeks or days before their death.
In the United States, hospice care is included in most private health insurance plans, the federal government's old-age medical insurance plan and most national health assistance plans for the poor. Many shelters also accept charitable and voluntary donations and community support.
According to the statistics of American National Hospice Organization, in 1995, 65.3% of hospice patients are paid by medical insurance plan, 12% by private insurance, 7.8% by Medicaid, and 4.2% of poor patients are exempted from paying hospice fees.
(3) Hospice care and medical insurance plan
In the United States, most hospice care is provided by medical insurance. 1994, medical insurance spent1200 million of 200 billion on hospice care. In the medical insurance plan, the hospice care team provides complete case handling for medical insurance patients, including all services, drugs and equipment.
Patients who choose hospice care can wait for medical insurance to pay all the treatment expenses in the dying state. Medical insurance hospice care benefits include:
:: Nursing services; Doctor service; :: Medicine and biology; Medicine, surgery, speech therapy; Family health assistance and domestic service; Medical support and medical equipment; Short-term hospitalization care; Medical and social services; Psychological, dietary and other counseling; Professional training volunteers; Funeral service.
At the end of 1984, there were only 153 hospice care plans defined by medical insurance, but by 1995, the number had soared to 1857. According to the estimation of American health finance department, from fiscal year 1990 to fiscal year 1996, the medical insurance payment increased by 33. 1% annually, and the growth rate of hospice care service ranked first among all kinds of services.
(4) medical assistance plan
In addition to the medical insurance plan, medical assistance is a federal and state government plan to provide medical care for the poor, and the recipients need to provide their assets to hospice care services. From 65438 to 0999, medical assistance in 43 states and Colombia included hospice care. 1993, the cost of medical assistance for hospice care reached1290,000 USD.
5. Obstacles to hospice care
In many countries, including some countries with hospice care plans, there are more or less some obstacles that prevent hospice care from exerting its maximum benefits. For example, in many developing countries, including some developed countries, the reduction of extended family support makes it more difficult for many individuals receiving care at home to obtain hospice care.
In America, a long-standing obstacle is the difficulty of talking about death. Many individuals are unwilling to admit the doctor's diagnosis that they have reached the advanced stage, and they insist on receiving redundant treatment that usually proves ineffective. Many family members are also hesitant to discuss death. The National Hospice Organization of the United States found in1April, 1999 that14 Americans over the age of 45 said that they were unwilling to ask questions about their parents' death, even if their parents were terminally ill and would not live for six months. Although some people in society are afraid to discuss the issue of death, the study found that Americans are very clear about what they want when facing an incurable disease. The main tendencies of Americans are: (1) selectively obtaining services; (2) Emotional and spiritual support for patients and their families; (3) controlling pain according to patients' wishes; (4) The patient chooses to die in his own home or the home of one of his family members.
In the United States, because the conditions of hospice care are included in medical insurance, hospitals need to evaluate a patient's demand for hospice care and inform the patient to receive hospice care. Many doctors are also hesitant when they need to inform the terminally ill patients of their illness, because they don't want patients to give up the idea of continuing treatment. In addition, it is not easy to accurately predict the remaining life of patients.
6. Enlightenment of American hospice care to China.
In recent years, hospice care has also begun to attract social attention in China. 1In August, 988, Tianjin Hospice Research Center, the first institution in China, was established. Later, the professional committee of hospice care of China Mental Health Association and the hospice care fund were established one after another. 1988 Shanghai launched the first hospice care institution. 1992, Songtang Hospital, which enrolled endangered patients in Beijing, was formally established. In recent ten years, hospice hospitals have mushroomed in many cities, and hospice care in China is also developing.
The present situation of American hospice care is the future development direction of our country. As a developing country, we can get a lot of enlightenment from American hospice care.
(1) The impact of population aging on society is widespread in all countries. Not only developed countries, but also developing countries have hospice care needs. With the development of China's aging population, especially the emergence of a large number of urban only children, the demand for hospice care will become stronger and stronger. American experience shows that hospice care is an effective cost-saving nursing method and an important way to solve the difficulties of family care for endangered patients. In view of the fact that family planning has become a basic national policy in China, the society should pay attention to hospice care while advocating prenatal and postnatal care, so that the dying elderly can get the conditions for a good death as much as possible and bid farewell to their lives with dignity and peace.
(2) Although there are different types of hospice hospitals in the United States, most of them are non-profit organizations with obvious welfare. This is also an inspiration to the development of hospice care institutions in China: in the process of developing hospice care institutions, we should pay attention to multi-channels and welfare, and more need the government to organize and develop.
(3) Endangered patients need various services. Hospice care transfers the work of family members to the society, socializes nursing work, and essentially transfers the responsibility of the family to the society. Social commitment is inseparable from economic conditions, and the development of hospice care service must proceed from national conditions and national strength. Hospice care in China should not be rushed, but should be gradually expanded. At present, the work is: the society needs to re-recognize and help individuals facing the end of life to die with dignity and comfort, and emphasize that family members or caregivers provide love and help to the dying.
(4) Hospice care in the United States has been institutionalized, and most hospice care services have been included in medical insurance, thus expanding the coverage of hospice care services and allowing more patients to enjoy this benefit. In terms of specific operation, the United States has formulated a set of strict rules and regulations, which not only ensure the benefits of the system through all-round services, but also limit the services provided to the scope permitted by economic conditions from the perspective of realistic financial resources to ensure the healthy, orderly and lasting operation of hospice care services.
(5) Although hospice care requires the society to pay more service fees, for those terminally ill patients, receiving hospice care services can reduce many or even huge medical expenses. If the high and ineffective expenses of a few people are transferred to the treatment of most others with results, the medical insurance expenses will get the greatest benefit. From this, we realize that the moderate development of hospice care has important practical significance for the current reform of medical insurance system in China.