Introduction
Palliative care is a practical interdisciplinary medical approach to caregiving that mitigates suffering and improves healthcare outcomes for terminally ill patients. It plays a significant role in improving the quality of life among individuals despite the untreatable nature of the ailments. The main aim of the care is to alleviate pain and ensure that individuals receive both physical, spiritual, and psychological treatment. One of the key determinants of the quality of palliative care received is the insurance plan. This literature review examines the relationship between the quality and type of care provided and an individual’s insurance plan.
Types of Care Services
People with severe health conditions, such as stage four cancer or heart failure, require a specialized set of treatments for improved pain management and quality of life. While the primary aim of palliative care is to relieve pain, it may also address the symptoms of the disease. The range of services included in the care plan is determined by the healthcare insurance, as posited by Yosick et al. (2019).
Another study by Bazargan & Bazargan-Hejazi (2021) agreed with Yadav et al. (2020) by stating that individuals with comprehensive insurance were eligible to access more specialized home care treatment plans than those with limited insurance coverage. The home-based care services were more effective, providing holistic access to care, with all symptoms managed and ample time with family members, resulting in better healthcare outcomes. On the other hand, another study by Enguidanos et al. (2020) found that holders of limited healthcare insurance plans were eligible only for hospice care. The findings of the different authors therefore indicate that the insurance plan has a direct relationship with the quality of palliative care received.
Palliative care enhances health outcomes and may lead to recovery, as in hospice, which is explicitly meant for end-of-life care. Further, unlike hospice care, which begins only when a team of physicians determines that a patient has less than six months to live, palliative care may be withdrawn at any stage. The differences in the onset of the ailments imply a cost implication in the provision of care.
Research by Parajuli et al. (2020) shows that Medicaid funds hospice services and have a restricted start date, while individuals pay for palliative care and can therefore control their healthcare outcomes. Generally, the 7 Cs of palliative care show a significant difference in the form of care compared to other forms of care. The Cs promote communication, coordination, symptom control, continuity, continued learning, care support, and comprehensive care for dying (Reid et al., 2019). Having comprehensive care coverage, therefore, indicates that a person is likely to benefit from extensive care at any stage. At the same time, one with limited insurance will get regular treatment and only get compassion during end-of-life care.
Copayments and Financial Barriers to Palliative Care
The extent of the palliative care that the individual may access is further affected by financial constraints. Research by Grant et al. (2021) found that individuals who preferred out-of-pocket expenses and other copayments experienced delays in starting palliative care at healthcare facilities. Further research by Bazargan & Bazargan-Hejazi (2021) also concluded that hospital management prefers to admit patients to palliative care if they have a sustainable payment source, due to the extensive care required at that level.
Yosick et al. (2019) also provided a convincing argument that hospital management had faith in extensive insurance plans that could offset medical bills without straining as much as out-of-pocket expenses. Generally, there are different insurance plans depending on the financial capacity and ability of the patients or their employers to remit. Employers remitting higher premiums for their patients in healthcare insurance indicate they can offer high-quality services, unlike plans with limited funding. Since the form of payment determines the care received, it follows that insurance plans determine the care received.
The disparity in service provision results in individuals being treated differently based on the financial factors at stake. For example, individuals with comprehensive coverage have a substantial financial base that may afford palliative care as early as the diagnostic stage, when the ailment can be well managed, and the chances of survival may increase. On the other hand, the regular insurance that is meant for curative care will focus on hospice care when the patient has been declared to have less than six months.
Research by Cardenas et al. (2022) found that the average number of days a person may spend in hospice is 70, whereas there is no predetermined time in palliative care. Further, some insurance plans have limited financial provisions and may limit the quality of care received compared to other forms of private insurance that provide a financial basis for effective patient treatment (Yosick et al., 2019). The difference in insurance plans has a significant impact on the type of palliative care received.
Emerging trends in changing plans in the USA show that different insurance plans offer unique healthcare and medication benefits. Research by Bazargan & Bazargan-Hejazi (2021) showed that there is a shift from public coverage to private issuance, which requires financial caps. In 2022, private healthcare insurance was more prevalent at 65.6% compared to public coverage at 36.1% (Cardenas et al., 2022). The shift indicates that private insurance is preferred because it does not have financial limitations, such as caps. Based on the trend and Grant et al.’s (2021) arguments that the insurance plan’s monetary base serves as a starting point for admission, it may be concluded that the plan has served as a starting point for admission. Insurance with higher premium contributions allows the patient to choose palliative care, unlike other insurance plans, which place a person under care only when they are critically ill.
Geographical Disparities and Policy Changes
The regional balance in the provision of palliative care services is a repetitive theme in the literature under review. Reid et al. (2019) noted that healthcare infrastructure is limited in rural areas and medically underserved regions. They may not be able to provide adequate palliative care to the patients. Since care provision varies by geographic location, with the stated regions lacking effective palliative care, insurance plans play a significant role in expanding the scale of care provision.
The lack of palliative care services in rural areas further aggravated disparities in care. The research by Rehner et al. (2021) showed that there is strong evidence to prove that healthcare insurance is determined by the geographic location where care is provided and, therefore, offers different plans. In areas where palliative care is not easily available, insurance coverage will not cover it.
Policy changes to boost the financial capacity of insurance services are a sign that insurance plans have a significant impact on the quality of care received. In the USA, for example, two bills are currently under scrutiny to expand healthcare insurance coverage, enabling people to access better healthcare services (Rehner et al., 2021). The Patient Protection and Affordable Care Act and the quest to expand Medicaid show that current offerings are limited and may hinder adequate service provision (Cardenas et al., 2022). The two policies suggest that current healthcare provision is not based on health equity and that people receive different levels of medical attention depending on their insurance coverage. It is imperative to note that categorizations are made based on the insurance plan and the level of care people are bound to receive.
The intersection of healthcare insurance coverage and the policies it provides demonstrates a direct relationship between healthcare quality and the insurance plan a person uses. For example, palliative care is an expensive, holistic care that requires expensive funding. If the insurance model lacks sufficient funding, such as Medicaid, which has limitations, patients may not receive the services they need.
Further research by Enguidanos et al. (2020) underscored that palliative care is offered at different levels based on insurance plan. The advocacy to change policies related to healthcare outcomes, such as Medicaid expansion, demonstrates that people’s insurance plans determine the quality of care they receive. The research by Bazargan & Bazargan-Hejazi (2021) showed that recent policies and advocacy in the USA aim to improve healthcare insurance plans to enable people to access quality palliative care regardless of their financial status or insurance coverage. The research findings show that the palliative care received depends on the insurance plan one has, and people must therefore strive to have insurance plans that ensure they receive effective palliative care to improve their quality of life.
Insurance Coverage and Provider Networks
The provider networks in the insurance realm shape an array of services and professionals that are available for palliative care. Each insurance plan has a predetermined package of services. For example, research by Cardenas et al. (2022) underscored the different network restrictions within some care plans. According to the findings, some insurance plans offer a wide range of professionals and services, whereas others offer limited access to professionals, networks, and facilities.
In the USA, choosing an insurance plan offers additional benefits, including access to palliative care and other specialized facilities. Since the choice of an insurance plan is determined by individuals’ financial capacity or existing governmental policies, it also affects the quality of care provided and the palliative care a patient will receive (Rehner et al., 2021). Consequently, an insurance plan determines the type of palliative care received through the provider networks linked to the services and professional care offered.
Healthcare networks have a direct impact on the quality of care that is offered to patients. Rehner et al. (2021) posited that provider networks have a direct impact on quality of life and limit the services provided in the discourse research by Milki et al. (2021), because since palliative care is an expensive venture for medical facilities, it is restricted in most of the general insurance plans that are only available operational in private insurance plans that are funded by either private employers or other organizations. Compared to other forms of payment, such as out-of-pocket expenses, people may face challenges in the type of palliative care they receive. It is imperative to note that people with more comprehensive insurance plans do not face any limitations or restrictions on the quality of care they receive, which may lead to better healthcare outcomes and well-planned, holistic palliative care.
Quality of Palliative Care
Palliative care, like other forms of medication, has different stages and levels of quality of care. For example, palliative care delivered by a multidisciplinary team and with more care hours is considered high-quality palliative care provision. It is considered high-quality palliative care because it has all the relevant specialists and promptly attends to the patient.
On the other hand, low-quality palliative care occurs when a single physician attends to the patient and has all other issues addressed through booking, which may take longer. The quality, therefore, depends on the financial dispensation provided by the insurance plan. Research by Milki et al. (2021) demonstrated that high-quality palliative care is characterized by effective pain management, prompt response time, and patient satisfaction, all of which depend on the quality of care. Based on the literature, it is possible to infer that the insurance plan determines the quality of palliative care and, therefore, the quality of life, given its unique financial disposition based on outcomes.
Patient-Family Preferences and Barriers to Access
Palliative care should be aligned with the patient’s or family’s preferences to enhance the quality of life provided by care providers. Whenever the patient’s will or their family’s predilections are not considered in the quality of care provided, the patient may have a poor quality of life. Research by Rehner et al. (2021) investigated the influence of insurance plans and family and patient preferences on the provision of palliative care. It is inferred that there are cases in which the palliative care provided under the insurance plan conflicted with the family’s preference.
For example, the comprehensive insurance coverage offered patients the option of being placed under home care with a complete set of healthcare professionals. In other instances, patients who wanted to be placed in home care could not receive services because of their insurance plans. Generally, insurance plans affected customer preferences and their families, and, in cases of conflict, compromised the quality of care provided, according to the discourse.
Insurance-driven palliative care is categorized, and people are likely to receive services based on their outcomes. The exploration of the decision-making process in palliative care shows that people are accorded treatment and the ability to choose the quality of their palliative care based on the quality of the medication they receive. Enguidanos et al. (2020) inferred that there are barriers to accessing palliative care based on a person’s insurance status. For example, those with comprehensive insurance coverage have the liberty to decide the quality of care they receive. In contrast, others with regular insurance coverage have no option to select high-quality palliative care.
Research by Yosick et al. (2019) identified numerous barriers, including bureaucratic delays in initiating palliative care treatment, systemic challenges, and other quality issues, depending on the care plan a person has. Consequently, the type of palliative care is influenced by the insurance plan, which can pose obstacles to certain aspects of care quality. Patients with more comprehensive insurance plans are likely to experience fewer barriers to high-quality palliative care than those with other plans.
Conclusion
The literature review on insurance policies for palliative care highlights multifaceted concerns. Insurance plans provide financial compensation to healthcare facilities for the services they provide. The financial provisions determine the differences in the healthcare plans. The focus on expanding Medicaid indicates that additional financial support is needed to provide high-quality palliative care. Due to financial restrictions in insurance plans, people access different services depending on the policy they hold. In conclusion, one’s insurance plan determines the type of palliative care because it affects the financial base, shapes patient preferences, influences the quality of care, and creates barriers.
References
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Cardenas, V., Rahman, A., Zhu, Y., & Enguidanos, S. (2022). Reluctance to accept palliative care and recommendations for improvement: Findings from semi-structured interviews with patients and caregivers. American Journal of Hospice and Palliative Medicine, 39(2), 189-195.
Enguidanos, S., Rahman, A., Fields, T., Mack, W., Brumley, R., Rabow, M., & Mert, M. (2020). Challenges in using insurance claims data to identify palliative care patients for a research trial. Journal of Pain and Symptom Management, 60(5), 1012–1018.
Grant, M. S., Back, A. L., & Dettmar, N. S. (2021). Public perceptions of advance care planning, palliative care, and hospice: a scoping review. Journal of Palliative Medicine, 24(1), 46-52.
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