Improving palliative care in Germany: Summative evaluation from experts' reports in Lower Saxony and Brandenburg

The German Health Care System is in substantial change. New structuring of services and processes of care are necessary, particularly to meet the complex requirements of the ever-increasing chronic illness and multimorbidity. The main deficits and strategies of improvement can be pointed out clearly by illustrating the situation of palliative care, which is more and more in the focus of experts and public. However, current statements are only slightly based on scientific data. Therefore, policymakers and self-governing bodies in the federal states of Lower Saxony and Brandenburg have commissioned reports from a multidisciplinary study group of health system research. This article describes the cumulative evaluation of both reports, referring to literature findings, specific empirical surveys and expert discussions. The main findings include a high level of emotion among the involved caregivers and social groups, resulting in difficulties in rational discussions; furthermore, a large multiplicity of viewpoints on the assessment of the current situation and on the appropriate needs for improvement was shown. The current deficits are significantly caused by inadequate structuring of care processes. Therefore, better integration of the large and diverse number of involved services and professions is necessary, including new specialised services. Health policy has created legal conditions, but up to now, fulfilment is low. Other improvement strategies should focus on working conditions of personnel in the basic services, such as family doctors and nurses, because the current conditions seem not to meet the patient or caregiver needs. Furthermore, a debate on principles regarding responsibilities of the health care system is needed: What should be covered by social health insurances, and what should be part of other areas of public welfare? © Springer-Verlag 2006.