With Europe’s Beating Cancer Plan (EBCP), the European Commission follows a new approach to cancer prevention, treatment and care. The action ‘OBS-Learning From Progress In Addressing Cancer In Europe’ (OBS-PACE) contributes to this by improving the understanding of the national cancer control situation and policy actions in EU Member States.
OBS-PACE is collecting case studies of innovative actions in cancer research, care, and policy across the cancer care pathway. The case studies mirror the implementation of the EBCP at the national and regional level and can inform new actions to better tackle cancer across Europe. Each case study describes the objective of the new action, its implementation, including enablers and barriers, and its outcomes at the health system level.
07 August 2025 | Case Study
The development of palliative care in Czechia began over three decades ago, with the establishment of the first inpatient palliative medicine ward in 1992 and the creation of the first hospice dedicated to palliative care in 1995. Since, several other hospices were established, followed by palliative home hospices. However, these health facilities and services were at first solely funded through donations and patients’ contributions, resulting in a limited connection between the palliative care and general health and social systems. Furthermore, the availability of palliative care for terminally ill patients remained insufficient, with significant variations in both the range and quality of palliative services across the country.
In response, the Czech Society of Palliative Medicine, the Ministry of Health, and the General Health Insurance Company (VZP CR) launched a joint project in 2015, the “Mobile Specialised Palliative Care (MSPC)”, which lasted three years from 2015 to 2018. This programme aimed at testing the effectiveness of the MSPC, meaning if this new model of care enabled the provision of palliative care at home of similar or higher quality than inpatient care and if it could do so for a similar or lower cost. It also sought to inform its potential reimbursement by the VZP CR. The pilot included eight MSPC/hospice providers from eight regions of Czechia. This model of mobile palliative services consisted of multidisciplinary teams of palliative medicine physicians, nurses, social workers and psychologists, who could provide palliative care services at home and whose services were available 24/7.
In 2017, preliminary results revealed that 93% of enrolled patients in mobile palliative care lived and died at home without emergency room visits, ambulance transfers, or hospitalizations; recorded high satisfaction from patients’ families with their care; and showed that the total cost of care for patients with similar clinical and prognostic characteristics was lower for the group of patients who received the palliative team intervention.
Based on these results, all Czech health insurance companies recognized the cost-effectiveness of the mobile palliative care model and included this service in their benefits basket. A new medical specialization code, “926: home palliative care for terminal patient” was also created to help healthcare organizations providing these services to contract with health insurance companies and subsequently facilitate the reimbursement of home palliative care.
Hence, since 2018, mobile palliative teams have been financed through lump sum payments per bed-day, under the condition that home hospices guarantee the complete takeover of the provision of all necessary medical care for their patients, including a continuous availability of both medical and nursing care (24/7). MSPC care is indicated for patients with a severe functional condition assessed on the Palliative Performance Scale (PPS) as 40% or less, the presence of severe symptoms (assessed by the ESAS questionnaire), and an expected prognosis of survival in the order of weeks or low numbers of months. Currently, 48 MSPC providers have contracted with health insurance companies. In 2023, it represented a total of around 6 800 patients (including 6 200 cancer patients) who benefited from MSPC and around 23% of all patients who died at home.
Enablers: The main drivers of change have been the high enthusiasm of providers for this initiative, combined with the close collaboration between the Czech Society of Palliative Medicine, the Ministry of Health of the Czech Republic and health insurance companies (Governance). Furthermore, the association of all the mobile specialized palliative care providers under an umbrella organization, the Mobile Hospice Forum, further facilitated the multidisciplinary collaboration and coordination both among providers and with other stakeholders (Governance). The creation of binding documents for more standardized MSPC has also been key to the initiative’s success, with clear mobile specialized palliative care standards, methodological instructions from Czechia’s Ministry of Health on the provision of mobile specialized palliative care, and staffing recommendations for the establishment of mobile palliative care multidisciplinary teams (Information, governance). Finally, starting with piloting the implementation of mobile palliative care enabled to first demonstrate the cost-effectiveness of these services and therefore facilitate their adoption and coverage by health insurance funds before scaling (Financing, service delivery).
Barriers: Currently, only 60 to 70% of the total cost of MSPC is covered by public health insurance, requiring providers to rely on donations, grants, municipal funds, and other non-insurance sources to cover the remaining expenses (Financing). Despite the expansion of services, regional disparities persist, with limited provider coverage in some areas (Service delivery). Additionally, efforts to ensure consistent quality and availability of multidisciplinary teams remain ongoing (Resources).
The development of Mobile Specialised Palliative Care (MSPC) in the Czech Republic represents a significant advancement in ensuring dignified end-of-life care at home. Its inclusion in health insurance’s benefits basket also prompted an increase in MSPC providers, therefore ensuring both better access and coverage for terminally ill patients. The creation of binding documents for MSPC delivery also contributed to better quality and safety of care, and further developments are ongoing, for example with the Ministry of Health that is developing the Strategy for the Development of Palliative Care in the Czech Republic until 2035, which aims to establish standards for individual forms of specialized palliative care, including MSPC, a network of palliative care providers, and indicators for the availability of palliative care services (Ministry of Health of the Czech Republic, n.d.). Finally, MSPC also contributes to enhancing efficiency, financial protection, equity, and people-centredness.
Lessons learned: Key lessons from the Czech MSPC experience include the importance of multidisciplinary collaboration, piloting before scaling, and evidence-based advocacy in securing systemic change. Demonstrating cost-effectiveness and high patient satisfaction helped build support among policymakers and insurers. However, sustainable financing beyond insurance reimbursement and equitable regional access remain ongoing priorities. The initiative highlights that while policy alignment and standardization are critical, continuous investment in workforce development and quality monitoring is essential to ensure consistent, patient-centred care.
https://mzd.gov.cz/informace-o-projektu-standardizace-paliativni-pece-v-ceske-republice
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