Who pays for palliative care, by country

Teams work across public hospitals, the national retirees' insurer, other insurers and prepaid plans. Unpaid family care is the largest end-of-life cost, and a modeled provincial home care program was cost-saving.^242,239

OpenHow do public, social security and prepaid insurers cover palliative services and medicines?

Early service development relied on Global Fund and Open Society funding, and funding remained the central challenge once pilots ended.^155,156

OpenIs there a state budget line or insurance mechanism for palliative care?

Palliative care is funded mainly through Medicare, the universal insurance scheme. Most opioid analgesics are subsidized through the national medicines scheme, which has a dedicated palliative care section; prescriptions outside its rules are paid privately. A rural nurse practitioner-led model cost more than fee-for-service income covered.^{165,159,160,164}

OpenHow is specialist palliative care funded between the Commonwealth and the states?

Families pay most palliative care costs in Bangladesh. At two Dhaka inpatient centers the average cost was 41 170 BDT (about 339 USD), and out-of-pocket spending made up 73.5% of the total. A hospital-led children's home care program in Korail slum was free to families, including medicines, and its team names financial sustainability as a challenge.^372,373

OpenDoes any government scheme or insurance cover palliative care or morphine outside these pilot and urban programs?

The national program ran through a ministry partnership with philanthropic hospitals. Patients pay out of pocket for opioid prescriptions at a meaningful share of the minimum wage.^235,232

OpenHow are palliative services reimbursed in the public system versus private plans?

The Canada Health Act funds hospital and physician services publicly, while home care coverage varies by province and most public plans exclude outpatient drugs for people under 65. Ontario's drug benefit covers most drug costs in end-of-life home care. Palliative fee codes differ across jurisdictions.^217,219

OpenHow does palliative drug and home care coverage differ outside Ontario for people under 65?

• 0.47 percent of national health expenditure Cost of extending the essential palliative package to all in need, Chile, 2019¹⁰⁶

The guarantee is funded through the public insurer, which covers most of the population at no charge for guaranteed care, and through private insurers with capped co-payment. Central public procurement held down drug price growth.^106,109

OpenHow is the 2022 to 2026 rollout of the universal law funded?

No dedicated insurance payment scheme exists for hospice care, so fee-for-service leaves many services unreimbursed. Programs have relied on philanthropy or patient payment, and later pilot plans moved toward bed-based payment.^182,181

OpenHas bed-based hospice payment spread beyond local pilots, and who pays for home care?

Both the contributory and the subsidised regime cover benefit-plan medicines, opioids included, for a small co-payment. Professionals still report insurer-imposed barriers, especially for poorer patients.^86,84

OpenHow much palliative care is delivered under each regime, and is any of it donor funded?

Costa Rica's national pediatric palliative care program is supported by the Costa Rican Social Security System and by a non-governmental foundation, Fundacion Unidad Pro-Cuidados Paliativos, which hires staff, funds home visit supplies and gives aid to the poorest families. This describes the pediatric program only.³¹⁹

OpenHow is adult palliative care in the 23 Ministry of Health accredited clinics financed, and what do patients pay out of pocket?

The regional expert survey reports palliative care funded through the national health budget.⁴⁹

OpenDoes the universal health insurance benefit package, rolled out by governorate since 2019, name palliative care? Secondary accounts disagree.

Services are largely donor-dependent, private home care is unaffordable for most, and community-based health insurance helps access where patients are enrolled.¹³⁸

OpenDoes community-based health insurance cover opioids and palliative visits?

A dedicated state programme funds palliative care from the annual budget, covering opioids in full and part of inpatient and outpatient costs, at reimbursement rates set in 2004 and never updated. It funds only a doctor and a nurse per service and covers only terminal-stage patients.¹⁵⁴

OpenWhat is the programme's total annual budget?

Statutory and private insurers fully cover specialist home care through regional contracts. Insurance covers most of an inpatient hospice bed and donations the rest, and uninsured residents have poor access. Since 2022, insurers can co-fund regional network coordination if the municipality matches.^{174,176,175,177}

OpenDo varied regional reimbursement schemes produce differences in access or quality?

Palliative care associations report poor allocation and use of government funds and little insurance cover for home and outpatient palliative care. Patients at a national cancer centre called for palliative care to be added to the national insurance benefit packages.^118,120

OpenWho pays for morphine procurement at recognised medical institutions, and what does the national programme spend?

The 2023 Health Law mandates palliative care, but the 2024 presidential regulation on national health insurance set no palliative benefits package, eligibility or tariff. The policy brief calls this a mandate without a mechanism, and community services lean on charity and volunteers.⁶⁹

OpenDoes the national formulary reimburse oral morphine, and at which facility levels?

Palliative care is paid through private insurance and direct payments to health centres or NGOs, not a national budget line.⁴⁹

OpenWhat do the public insurance organisations cover for palliative care drugs and visits?

Where palliative care is funded, it comes from private insurance and direct payment to health centres or NGOs, not a national budget line.⁴⁹

OpenDoes the public system provide palliative care or opioids free of charge?

A 2018 insurance incentive for team-based palliative care in heart failure was rarely adopted and did not change end-of-life care. Palliative unit leaders report that non-cancer admissions are not covered on equal terms with cancer.^204,205

OpenHow does insurance pay for home palliative care and hospital consultations outside cancer?

Palliative care is included in the basic package and in the national health budget, with private insurance cover recorded alongside.⁴⁸

Health has been devolved to counties since 2013. Sources report high variation between counties and counties reluctant to release staff for palliative training.^60,62

OpenDoes devolution help or fragment palliative funding on balance, and what does the Social Health Authority actually cover? No primary document on the new scheme was read.

Palliative care has a line in the national health budget, yet lack of reimbursement remains a barrier, and the post-2019 crisis cut health financing and drove health workers abroad.^49,141

OpenHow has the mix of public, out-of-pocket and NGO funding shifted since 2019?

Public clinics provide palliative care and essential opioids free of charge. Centres of excellence and scale-up programmes depend heavily on donors, and family costs remain catastrophic.^105,103

OpenWhat share of palliative spending is government rather than donor?

Hospital and primary care palliative services are funded through the subsidised public system. Community palliative care is free to patients but delivered by NGOs dependent on donations.⁴⁷

OpenWhat budget does the 2019 to 2030 national palliative care strategy commit?

Seguro Popular added opioid coverage around the time of the reform. It was closed in 2020 and replaced, with disruption to coverage that followed.^95,97

OpenIs opioid coverage for palliative use continued under the successor public scheme?

Palliative care is named in the Health Insurance Law, which makes national insurance a formal payment channel.⁹⁴

OpenWhat does insurance pay for: drugs, inpatient days, home visits?

The national health budget carries no line for palliative care.⁴⁹

OpenSince the transfer of the medical assistance scheme into mandatory health insurance in 2022, does the benefit package name palliative care or opioid medicines?

• 855 US dollars, approximate Government one-time treatment support for a cancer patient, Nepal, 2021⁵³
• 500 Nepalese rupees per day Health Insurance Board allowance for a patient receiving palliative care, Nepal, 2021⁵³
• 73 percent Essential palliative care medicines on the government insurance medicines list, Nepal, 2024⁵⁵
• 46 percent Available essential palliative care medicines judged affordable, Nepal, 2024⁵⁵

Care is funded mainly out of pocket, with a one-time government cancer treatment payment and a daily palliative care allowance under the Health Insurance Board. Opioids were on neither the free nor the fixed-price medicines list as of the 2024 study, despite the 2017 national strategy.^53,55

OpenWhat share of palliative patients is enrolled with the Health Insurance Board?

Care is paid largely out of pocket. Palliative medicines were outside the national health insurance benefit package and the national budget carried no palliative line, with donors supporting training and morphine access.⁶⁵

OpenHas the National Health Insurance Authority added palliative medicines or services since the 2022 act?

The Universal Health Care Act entitles every citizen to palliative services through the national insurer, but without a dedicated law financing is described as fragmented and dependent on administrative priorities. Extension of cover to home and community care is still being urged.^79,83

OpenWhat does the national insurer reimburse for palliative and hospice care, and at what rate?

Health insurance funds gained a mechanism to reimburse palliative care, and the national strategy is partly funded by a World Bank loan. A costing framework supported the case for consistent payment, but charities still provide much of the care.^189,192,193

OpenWhat share of palliative spending comes from insurance rather than NGOs or loans?

• 97 percent Population with community-based health insurance, Rwanda, 2020⁵⁹

Community-based health insurance covers most of the population and most of the cost of essential medicines, with Partners In Health supporting district services alongside the ministry. The evidence concerns chronic disease drugs, not opioids.⁵⁹

OpenWhat share of morphine production, procurement and palliative workforce cost is domestic rather than donor funded?

Palliative care is funded through the national health budget. Out-of-pocket costs and private insurance still shape who reaches care.^49,89

OpenWhat share of the health budget goes to palliative care?

Funding mixes NGO fundraising, donor grants and limited government lines. A major academic hospital's palliative unit runs on a foundation grant with no provincial budget, after an earlier project collapsed when donor funds ran out. The Western Cape funds NGO beds per bed-day.^131,130

OpenWhat has donor withdrawal done to hospice services nationally?

National Health Insurance funds hospice care under the act and began covering home-based hospice in September 2020, after which more cancer patients died at home.^211,79

OpenHow does insurance pay for consultative and pediatric hospice programs?

Care is free at the point of access. Hospital palliative services are paid per day and community services by capitation that is not weighted for rural areas, and unreliable public payment has pushed services toward charity.^225,228

OpenIs the funding picture, last described in 2015, still current?

The tax-funded state sector provides care free at the point of use and delivers most inpatient care. Patients and families still report travel cost and lost income as the main barrier to clinic attendance.^77,76

OpenIs there a budget line for opioid procurement, and was it cut during the 2022 crisis?

As of 2021 the government had not committed to publicly funded palliative care, unlike Kenya and Rwanda.¹⁰¹

OpenDoes the National Health Insurance Fund cover any palliative care or oral morphine?

• 72 percent Population covered by the Universal Coverage Scheme, Thailand, 2002¹¹⁴

The tax-funded Universal Coverage Scheme covers most of the population, and the National Health Security Office has funded district palliative networks directly with a dedicated grant.^114,115

OpenWhat does the scheme now pay for a home palliative visit and for morphine dispensing?

Inpatient palliative care has been reimbursed by the Social Security Institution since 2014, through the healthcare implementation notification rather than a dedicated statute.⁴⁰

OpenIs outpatient opioid analgesia reimbursed on the same footing?

• 94 percent Stand-alone service donations from external sources, Uganda, 2019³⁶

Government support to stand-alone services arrives as medicines, training and tax exemption rather than cash.³⁶

OpenWhat changed in donor funding after 2025?

The national purchaser pays mobile palliative teams at base rates judged below actual costs, and many services carry high out-of-pocket payments. In wartime the health system depends on international grants and loans.^197,195,194

OpenHow much palliative care depends on national purchaser contracts versus donors and out-of-pocket payment?

Much care is delivered by charitable providers reliant on donations, a model described as possibly unsustainable. In England, statutory palliative spending per death varied widely by area and providers were largely paid through historically based block contracts.^249,228

OpenWhat is the current split between NHS and charitable funding for hospices?

Medicare pays for most hospice care and requires a certified prognosis of six months or less. Audits from 2014 and a 2016 two-tier payment did not shorten stays, and hospice remains carved out of private Medicare plans after a test of including it ended in 2024.^263,264,265

OpenHow are non-hospice palliative services paid for across Medicaid and private insurers?

Community-based palliative care was not covered by government health insurance and was therefore almost unavailable, and a project was testing whether insurance coverage of home care would pay off.¹⁴⁷

OpenHas health insurance since covered home palliative care or opioids?

Donor funding carried much of the early growth, and the national palliative care association stopped operating when that funding ran short. In the hospital program, hospitals paid staffing while the program paid for training.^184,186,57

OpenDoes the government budget for palliative care or morphine, and do patients pay out of pocket?