Integrating palliative care and symptom relief
into primary health care
52
Additional proposed indicators of the effectiveness and value
of palliative care integration into PHC
Standard health metrics such as the quality-adjusted life year (QALY) and disability-adjusted life year (DALY)
do not adequately measure some important
objectives of health systems, including prevention and relief of
patient’s suffering and financial risk protection and poverty reduction for patients and their families
(118).
To
address this short-coming, two new research concepts have been proposed:
1. A method of health policy assessment – extended cost-effectiveness analysis (ECEA) – would enable
a broader assessment of the effect on the well-being of both patients and families of a policy for
integrating palliative care into PHC. ECEA
examines public policies, whether health or intersectoral
policies, that have an impact on the health of populations. Specifically, it evaluates the health and
financial consequences of public policies in four domains: (i)
health gains; (ii) financial risk protection
benefits for patients and their families; (iii) total
costs to the policy-makers; and (iv) distributional or
equity benefits
(1,119).
2. A measurement of suffering-adjusted life-years (SALYs) might provide crucial
information beyond that
contained in existing measures of burden of ill health (QALYs and DALYs)
(1).
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