[Too thin on the ground? Regional disparities in hospice and palliative care in Germany].

Introduction: Outpatient and inpatient hospice and palliative care services have been significantly expanded in Germany in recent decades and are increasingly being supplemented by day care services. However, the availability of these services varies greatly from region to region. The extent to which the availability of these care structures is matched by a regional need based on local population structures is as yet unknown.

Methods: In four Poisson regression models, the relationship between population indicators from the areas of demographics, employment, income, education and health and the number of offers of outpatient and inpatient hospice work and palliative care is exploratively examined. The cumulated data at district level is drawn from the INKAR database of the Federal Institute for Research on Building, Urban Affairs and Spatial Development on living conditions in Germany and from the guide of the German Association for Palliative Medicine. By means of logistic regression, factors influencing the establishment of day care services will also be identified.

Results: The analysis included 401 districts and cities in Germany. The number of inhabitants, settlement density, and the average age of inhabitants are the strongest predictors of the number of palliative care services. In metropolitan regions, both outpatient palliative care services and palliative care units tend to be more frequently available, while the number of outpatient hospice services and inpatient hospices increases in districts with a higher number of inhabitants regardless of settlement density. The regression model was unable to demonstrate a significant influence on the emergence of semi-inpatient care facilities, neither for the population indicators nor for the existing care structures.

Discussion: Regional population structures can only partially explain the geographically uneven distribution of hospice and palliative care services in districts and cities in Germany. Despite an increase in hospice and palliative care services, fewer hospice and palliative care structures are available in low population density regions that tend to have a higher share of older inhabitants.

Conclusion: Future health care planning should give more consideration to other population characteristics than to population size alone in order to improve care in regions with higher care needs that are, for example, due to a higher proportion of older residents. Subsequent studies should investigate which population characteristics can best describe the actual care needs.