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Incompatible: end-of-life care and health economics
  1. Katharina Diernberger1,
  2. Bethany Shinkins2,
  3. Peter Hall1,
  4. Stein Kaasa3 and
  5. Marie Fallon4
  1. 1 Cancer Research UK, Institute of Genetics and Molecular Medicine, University of Edinburgh Western General Hospital, Edinburgh, UK
  2. 2 Faculty of Medicine and Health, Academic Unit of Health Economics, University of Leeds, Leeds, UK
  3. 3 Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
  4. 4 Department of Palliative Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
  1. Correspondence to Katharina Diernberger, University of Edinburgh Western General Hospital, Edinburgh EH4 2XU, UK; Katharina.Diernberger{at}

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When it comes to death, the statistics are stark. 100% of us will die. The question is what are we all going to do about that? How are we going to create confidence in the care that we may need?1

During the last year of life, major healthcare resources are spent, not only in lifetime monetary terms, but also on professional time. Reflecting on this quote, it seems counterintuitive that health economics could play a major role in tackling the main challenges in end of life care. However, the escalating cost of healthcare, combined with an ever-increasing range of therapeutic and patient management options, has brought difficult budget allocation decisions to the fore.

What is the value of health care?

The value of healthcare can be considered as what is gained relative to what is lost. In our context, there are three value dimensions:

  1. Population: how well assets are distributed to different subgroups in society (equity in resource distribution).

  2. Technical: how well resources are used for outcomes for all people in need in the population (improving quality and safety of services).

  3. Personal: how well the outcome relates to the values of each individual (understanding what matters most to the patient).

Contrary to popular misconception, value is not the same as quality of care or how much money is spent. High-quality care to the wrong patient or at the wrong time (or in the wrong place), is still low value. Similarly, better value is not necessarily achieved by more money. Nevertheless, even to the right person at the right time, it will still have an inevitable cost

However, maximising value in healthcare resources requires understanding both what we seek to achieve and the effectiveness of the means to achieve it; this is the purpose of health …

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