The quality and availability of palliative care has increased, but the Ministry of Health has failed to plan for new hospice beds
Press release on audit No 22/30 – 16 October 2023
Between 2017 and 2021, EU and state funds earmarked for palliative care in the Czech Republic, i.e. care for terminally ill patients, have led to an improvement in the availability of home palliative care, palliative care in hospitals and hospices, and to an increase in its quality. Awareness of the professional and general public has increased and the facilities providing this type of care have improved. However, the Ministry of Health (MoH) failed to plan an investment programme whose main objective was to increase the capacity of hospice beds. Due to the unrealistic plan of the MoH, this objective has not been achieved yet and some of the funds available for support have remained unused in the years mentioned above. This was revealed by the SAO audit focused on the use of subsidies intended to support palliative care in the Czech Republic in the period from 2017 to 2021. In addition to the MoH, the SAO audited 12 selected palliative care providers.
CZK 98.7 million was allocated for projects co-financed by the EU through the Operational Programme "Employment" and focused on mobile specialised palliative care (home care) and the activities of palliative teams in acute and follow-up care hospitals. The SAO also audited the distribution of subsidies from the state budget in the amount of CZK 82.6 million for investment and non-investment projects of the MoH's subsidy programmes.
The Ministry failed in planning the investment programme. It intended to support the acquisition of 40 new hospice beds with the amount of CZK 67.5 million. It reduced this plan by half in 2021 - already during the programme - but kept the price at the original level. When preparing the programme, the MoH did not properly analyse the expected costs of creating one new hospice bed and significantly underestimated these costs. Moreover, the MoH postponed the implementation of the programme from the end of 2022 to mid-June 2024. In addition to 20 new hospice beds at a cost of CZK 67.5 million, 40 positioning beds, 16 hoists for immobile patients and 4 transport vehicles are to be purchased by the middle of next year. The original plan also envisaged the purchase of 40 anti-disability mattresses and 20 infusion pumps, but the MoH abandoned this intention at the end of 2022. In total, the state budget is to contribute CZK 80.5 million to the investment programme. However, in the period audited by the SAO from 2017 to 2021, only CZK 5.1 million was spent, i.e. only 6.3% of this planned amount.
In addition to the unused 93.7% of the state budget funds earmarked for investments, more than 30% of the subsidies co-financed from the EU budget earmarked for home palliative care projects (CZK 21 million) and more than 10% of the funds for hospital palliative care projects (CZK 5.7 million unused) also remained unused by the Ministry.
The auditors also found that the MoH did not always distribute subsidies transparently and made errors in the administration of projects co-financed from the EU budget and in the provision of subsidies. As a result of the errors of the MoH, a part of the expenditure was not reimbursed from the EU budget due to ineligibility and more than CZK 200,000 had to be paid from the state budget. This is despite the fact that - as we have mentioned - even in the projects supported by EU funds, a significant part of the funds remained unspent.
Between 2017 and 2021, the MoH carried out only a minimal number of inspections on the use of subsidies provided from the state budget. In the audited period, only 3 out of 198 supported projects were inspected in this way. Thus, the Ministry inspected the use of CZK 0.5 million of the total amount of CZK 34.1 million granted. On the other hand, in the case of projects co-financed from the EU budget, the MoH inspected all beneficiaries, found deficiencies and imposed corrective measures.
In some cases, the SAO found less serious violations of the conditions under which the subsidies were granted. The audited projects, which focused on mobile specialised palliative care and the activities of hospital palliative care teams, met their objectives.
Palliative care is an area of health services that is dynamically developing and growing in importance, including financially. According to available information, more than 70,000 patients need palliative care in the Czech Republic every year and it can be assumed that this number will increase as the population ages. For example, the cost of home palliative care to health insurers alone increased almost tenfold between 2018 and 2022. In 2018, insurers paid CZK 22.8 million for this type of care. Four years later, it was already more than CZK 218 million. The cost of beds in special hospice-type inpatient facilities covered by public health insurance was CZK 198.8 million in 2017. In 2022, however, they already reached CZK 362 million. Nevertheless, the operation of hospices remains largely covered by donations, collections, etc. The Czech Republic still lacks a comprehensive concept of palliative care, in which the MoH would clearly define how this area should be developed, including a financial and time plan. The MoH has so far only partially addressed this area and defined only partial tasks.
Supreme Audit Office