Hospices provide care and accommodation to people with a life expectancy of less than three months. They are an important link in palliative care and a great example of close collaboration between informal and formal care. The care need at admission to a hospice is usually similar across patients. Our research nevertheless finds significant variation in organization and funding. We observe that there is limited insight into the accessibility, quality and affordability of hospices. It is unclear who should ensure there is sufficient capacity, even though parties in the field expect that significantly more hospice places will be needed in the coming years.

Gupta finds that the funding structure does not support hospices in the right way. Hospices depend on various income sources and have little long-term certainty. The current funding structure is a patchwork of solutions that creates diverging — and potentially undesirable — incentives. It is also difficult to explain why one patient has to contribute much more towards the cost of admission than another.

The core of our recommendation is to make a clear distinction between two types of hospices based on their function. There are hospices for people who, based on their care need, require 24-hour presence of formal care, and hospices for people who do not need this, but who also cannot die at home.

Hospices providing 24-hour formal care with accommodation are needed. The legal framework for care providers safeguards quality, safety and transparency for this form of care, which is funded through health insurers and long-term care offices. Health insurers and long-term care offices have a duty of care and are therefore responsible for availability and capacity.

In addition, hospices are needed for people who do not require 24-hour formal care presence, but for whom it is not possible or desirable to die at their place of residence. These hospices provide a place to stay with informal care. A third party provides formal care on-site (as it would at home). We propose placing this form of hospice in the social domain, making local government explicitly responsible for this regional infrastructure that supports vulnerable residents.

This report sketches a development direction. Only together can parties ensure that, in the future, there is sufficient hospice capacity for people who need it in their final phase of life.