When quality indicators are missing

The greatest weakness remains the absence of agreed qualitative indicators. A 2019 survey already showed that teams with a physician—a palliative care physician have more deaths occur in the home setting, use strong opioids more often, perform necessary procedures, and increase access to care. Findings from the React project further revealed that data collection is often not perceived as a natural part of the work. The result is uneven performance: some hospices cared for three patients, others for 180, while receiving comparable funding.

Measurement that changes behavior and helps patients

The solution already exists: structured, ideally digital collection of both clinical and operational data and their regular comparison. Simple clinical monitoring—for example pain, dyspnea, or vomiting with follow-up within 48 hours—can directly serve as a quality indicator. Other measurable parameters include the number of patients per physician and nurse FTE, the share of deaths in a natural setting, or the median length of care. This is not about “better and worse,” but about benchmarking that shows where and how to improve results.

Such data collection, however, needs clear rules: who will set them, what the scope of services will be and the methodology for eligible costs, where to account for medicines or call-outs. It is also important that measurement changes behavior—if 24/7 availability is tracked, services will start planning for it; if the place of death is tracked systematically, the trajectory of care shifts toward the patient’s wishes. Since prices have been regulated by the Ministry of Health since 2022, it is natural for the regulator to set the framework for data collection and reporting. Without this, we risk that further investments will not go where they deliver the greatest benefit for patients.