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Singapore ranks 18th in first global Quality of Death Index
 DEVELOPED Asian nations have fared badly in the area of giving quality care to the dying.
The first global Quality of Death Index has ranked Singapore 18th in a field of 40 countries and territories; economic powerhouse Japan fared even worse – at 23rd.
The ranking was done by the Economist Intelligence Unit and commissioned by the philanthropic Lien Foundation last year. It was the result of assessments done across 24 points in four broad categories – quality, availability, the basic health-care environment and the cost of end-of-life care.
Taking the top spot on the overall tablewas Britain. It was followed by Australia and then New Zealand.
It was clear from the overall score – in the West as well as in Asia – that rich nations are lagging despite a tacit assumption that richer states would have the resources to grow their end-of-life healthcare sectors.
Dr Cynthia Goh, who co-chairs the Worldwide Palliative Care Alliance, said: “Much depends on how palliative care servicesare organised and funded, and if these are easily accessible to those who need them.”
In Asia, Singapore is pipped only by Taiwan, which, even then, made it to only No. 14 in the world.
Singapore’s strengths in the field, according to the report, include Medisave, its national medical savings account system, its high number of volunteers caring for the terminally ill and its efforts to train doctors in palliative medicine, although this was a recognised sub-speciality only from 2007.
So why didn’t it do better than No. 18? The report accompanying the rankings offered three reasons: One is that the country spends a relatively low 3.3 per cent of its gross domestic product (GDP) on health care; another is its relatively low number of hospital beds per capita; the third is that it is still taboo to talk about death – or preparation for it.
The Ministry of Health (MOH), asked to respond, said it found it “perplexing” that Singapore’s relatively low healthcare spending and number of hospital beds per capita could weigh negatively against it, since these factors reflect “the affordability and efficiency of health-care services in Singapore, which are major strengths of our system”.
Its spokesman said: “We are satisfied with the development of palliative care, but there is scope to go further. There are more patients and their families who can benefit from good end-of-life care.”
He noted that seven providers of in-patient hospice and home palliative care now serve more than 5,000 patients a year, and that practically all public hospitals now have palliative care units.
On the affordability front, patients can use Medisave for in-patient hospice care, and by year’s end, probably for home palliative care too. Training has been stepped up to raise the number of palliative physicians from the current 17 to 25 by 2012. The MOH spokesman said the ministry is also promoting more open dialogue among patients, families and health-care professionals on end-of-life care and treatment decisions.
Most of these changes have come in the last three years. With the population here fast ageing, end-of-life care has been forced into the spotlight.
Dr Angel Lee, the medical director of the Dover Park Hospice, said that although the quality-of-death ranking was useful, what really mattered was whether patients were getting the end-of-life care they needed and expected to have.
“This scale, unfortunately, does not allude to that, so we will still need to look into such aspects.”
Britain takes top spot, India at bottom
THE Quality of Death Index measures the environment for end-of-life care services in 40 countries and territories.
It scores them on 24 points in four categories: basic end-of-life health-care environment; availability of end-of-life care; cost of end-of-life care; and quality of end-of-life care.
The largest weighting of 40 per cent is accorded to quality, and cost accounts for the lowest at 15 per cent. Availability is given the weighting of 25 per cent, while the basic end-of-life health-care environment category has 20 per cent.
Experts carrying out the report say it is unsurprising that Britain comes out tops. Its health-care system is far from perfect but it has a headstart in the field.
Dr Sheila Payne, a professor in hospice studies at Lancaster University, says the UK “has perhaps had the longest period of sustained charitable development of hospices and, more recently, limited statutory involvement and investment”.
Its first modern hospice was St Christopher’s, founded in 1967 by Dame Cicely Saunders. Each year it cares for 2,000 dying people 24 hours a day, seven days a week.
In the quality of end-of-life care category, which includes public awareness, training availability, accessto painkillers and doctor-patient transparency, Britain gets the highest score of 9.8 out of 10.
However, in the basic end-of-life health-care environment category, Britain falls to 28th position – faring relatively badly on life expectancy, the number of hospital beds per 1,000 non-accidental deaths, the number of doctors and national spending on health care.
At the other end of the scale is India, despite the notable excellence of Kerala. The south-western state accounts for only 3 per cent of India’s population but provides two-thirds of the country’s palliative care services.
India, as a whole, lacks the funding for end-of-life care and has no formal palliative care policy in place. Its laws on drugs do not permit the use of morphine by palliative care providers.
In all four categories, India is in the bottom five with scores of between 1 and 2.9. As a result, it sits at the bottom of the table.
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