Access to inpatient palliative care services in France: Inequalities across regions

Objectives. - This study aimed to measure geographical inequalities across regions in the provision of inpatient palliative care services, while taking into account the needs for palliative care at the regional level. Methods. - Use of aggregated administrative data informing the geographical distribution of palliative care services in France in 2012, in relation with the need-adjusted number of inhabitants in each region. We computed ``density ratios'' by comparing the ratio of inpatient palliative care beds per 100,000 need-adjusted inhabitants in each region to the average ratio in France. Results. - While adjusting for the palliative care needs of the population, the number of beds in palliative care units per 100,000 inhabitants varied from 0.4 in the region of Pays-de-la-Loire to 5.4 in Ile-de-France. The number of beds dedicated to palliative care in acute and rehabilitation care units varied from 5.4 per 100,000 need-adjusted inhabitants in the region of Provence-Alpes-Cote-D'azur to 13.4 in Limousin. Although the number of inpatients admitted in palliative care units accounts for 3.8% of all deaths in France, in fact this proportion varies from 1.9% in Haute-Normandie to 10.6% in Nord-Pas-de-Calais. When we computed the ``density ratios'' of palliative care beds, several regions appeared to have not only a lessthan-average number of palliative care units' beds per 100,000 need-adjusted inhabitants, but also a less-than-average number of beds dedicated to palliative care in hospital wards (e.g. Haute-Normandie and Aquitaine). Conclusion. - Our study highlights considerable inequalities across regions in the accessibility of and in the access to inpatient palliative care services in France. (C) 2015 Elsevier Masson SAS. All rights reserved.