Economic impact of hospitalisations among patients in the last year of life: An observational study

Background: Hospital admissions among patients at the end of life have a significant economic impact. Avoiding unnecessary hospitalisations has the potential for significant cost savings and is often in line with patient preference. Objective: To determine the extent of potentially avoidable hospital admissions among patients admitted to hospital in the last year of life and to cost these accordingly. Design: An observational retrospective case note review with economic impact assessment. Setting: Two large acute hospitals in the North of England, serving contrasting socio-demographic populations. Patients: A total of 483 patients who died within 1 year of admission to hospital. Measurements: Data were collected across a range of clinical, demographic, economic and service use variables and were collected from hospital case notes and routinely collected sources. Palliative medicine consultants identified admissions that were potentially avoidable. Results: Of 483 admissions, 35 were classified as potentially avoidable. Avoiding these admissions and caring for the patients in alternative locations would save the two hospitals £5.9 million per year. Reducing length of stay in all 483 patients by 14% has the potential to save the two hospitals £47.5 million per year; however, this cost would have to be offset against increased community care costs. Limitations: A lack of accurate cost data on alternative care provision in the community limits the accuracy of economic estimates. Conclusions: Reducing length of hospital stay in palliative care patients may offer the potential to achieve higher hospital cost savings than preventing avoidable admissions. Further research is required to determine both the feasibility of reducing length of hospital stay for patients with palliative care needs and the economic impact of doing so

Reconciling Work and Family in a Multi-Active Society

The feminisation of the labour market and the persisting inequalities between men and women; precarisation at work; flexibilisation of work and working hours; the geographic movement of people; the diversification of family models, of parenthood and parenting systems; the aging population; the narrowing of intra-familial and community support networks; individualism and the quest for personal fulfilment; the value of children’s well-being; the reconfiguration of spatial and temporal borders by information and communication technologies — these are among the wide-ranging factors that make work-family interface not only a problem faced by many people, but also a challenge that today’s societies must find a way to surmount. Institutions and governments are aware of this. Already, in the 1990s, the European Commission placed on its agenda the topic of ‘reconciliation of work and family life’. The European Directive on parental leave adopted in 1996 — first formulated in 1983 — constituted a strong signal in the countries of the European Union . In Belgium, many policies were pursued, including — among others — measures regarding leave of absences for family (parental, paternity, caring for seriously ill relatives, etc.) or time entitlement/career pause reasons, and those involving support structures for early childhood or services titles that enable externalising certain domestic tasks. Still, we must acknowledge that these measures are ultimately corrections to concrete problems with work-family interface, but do not manage to provide a satisfactory, lasting overall solution. Why? Our argument is that these measures do not address the problem’s root causes, that is, the way that productive functions (production of goods and services necessary to existence) and reproductive functions (the biological reproduction of humanity and its workforce) are societally given shape and direction, which we call the work-family regime. At present, we are not only witnessing the erosion of labour society but a related crisis in the work-family regime