• E Iris Groeneveld, J Brian Cassel, Claudia Bausewein, Ágnes Csikós, Malgorzata Krajnik, Karen Ryan, Dagny Faksvåg Haugen, Steffen Eychmueller, Heike Gudat Keller, Simon Allan, Jeroen Hasselaar, Teresa García-Baquero Merino, Kate Swetenham, Kym Piper, Carl Johan Fürst, and Fliss Em Murtagh.
• 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
• Palliat Med. 2017 Apr 1; 31 (4): 296-305.

BackgroundFunding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them.AimTo assess national models and methods for financing and reimbursing palliative care.DesignInitial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms.ResultsFunding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs.ConclusionFunding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest.

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