Establishing and improving the hospice care system is an integrant part of healthy ageing. Currently, hospice care has been a part of the national healthcare services, and models of provision of hospice care using multi-agent approaches have been formed in China. Furthermore, the inpatient-outpatient-home-based hospice care model has begun to take shape. And some regions have also explored the guidance center-demonstration base-professional institutions-based system for promoting hospice care. However, many problems have been revealed during the development of the hospice care system, such as low coverage of hospice care, uneven distribution of hospice care resources, imperfect mechanisms for eligibility approval, performance assessment and ineligibility exit targeting hospice care provision institutions, and the absence of an integrated hospice care model. In view of this, we put forward the following recommendations: legally defining hospice care belonging to essential healthcare services in essence, improving the inpatient-outpatient-home-based hospice care model, building an integrated hospice care system focusing on home-based hospice care in communities, and establishing a national center-regional center-professional institutions-based hospice care promotion system.
In the 21st century, Japan has carried out hospice care services, and developed a sound home-based hospice care system to address the social issues of "fewer children, more older people". And the development of the system is also a key part of Japan's healthcare provision system reform. We introduced Japan's home-based hospice care in terms of concept and ideas, provision institutions, providers and service profile, as well as laws ensuring corresponding imbursement, and put forward the following recommendations for the development of home-based hospice care and for the protection of rights and interests of older people to pass away at home via a sound system design in China: improving the laws about hospice care under appropriate conditions, stably developing home-based hospice care during the implementation of the current healthcare provision system, establishing and improving a collaborative mechanism in providing hospice care, and providing essential financial support for the development of home-based hospice care.
The Act on Decisions on Life-sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life (hereinafter referred to as the Hospice Care Act) enacted by South Korea in 2016, clearly defines the definition of hospice care and the premise of implementing hospice care, stipulates the hospice care responsibilities and liabilities for the country's government, and sets up the framework of the hospice care system, which is of great significance to promote the development of hospice care and to protect the rights and interests of passing away peacefully in end-of-life patients in South Korea. We introduced the main contents of the Hospice Care Act, and the achievements obtained in South Korea since its implementation, aiming at providing insights into the promotion of hospice care legislation in China. To provide an all-round and refined legal protection for hospice care reform, innovation and high-quality development in China to support healthy dying in end-of-life patients, we put forward the following recommendations: clarifying the rights for hospice care patients, enacting specific regulations on hospice care when conditions are ripe, building a government-led hospice care system, affirming the concept of ineffective medical treatment, and stipulating the process of utilization of hospice care.
Community home-based hospice care service plays an important role in hospice care service. Focusing on community home-based hospice care is the future direction of hospice care service development. As the early countries to develop community home-based hospice care delivery, the United Kingdom and the United States have accumulated rich experience in patient admission standard, service team and content, and funding guarantee of community home-based hospice care delivery, a relatively sound community home-based hospice care delivery system has been established in these two countries. China can appropriately learn from the development experience of community home-based hospice care in the United Kingdom and the United States, in order to formulate the admission standards of community home-based hospice care, strengthen the construction of multidisciplinary hospice care teams, incorporate the non-drug therapy into the scope of community home-based hospice care, implement the payment method of per-diem, so that the patients can die peacefully and dignifiedly in a familiar environment with their hospice rights protected.
