Hospice or community network? Choices in end-of-life care in Jamaica.

AIM: Now considered a subspecialty of medicine and nursing, palliative care is a critical aspect of healthcare at the end of life. National and international healthcare agencies typically attribute its slow or haphazard growth in developing countries to various resource constraints. However, this study provides evidence of the substantial and widening gap between policy advocacy and patient choices in end-of-life care. It does so by establishing the incentives and risks that underlie decision-making by patients and providers against the relative scarcity of palliative care and hospices in these countries. METHODS: Jamaica offers an illustrative case. It shares the socioeconomic conditions and isolated provision of hospice and palliative care that remain prevalent in many developing countries. Empirical information was collected from all Jamaican hospices, along with agency and media reports, for comparative institutional analysis. RESULTS: Financial and infrastructural challenges hamper hospice expansion and integration into formal healthcare systems in developing countries. Yet, other equally vital considerations are too often neglected. These include the high transaction costs of decision-making, which account for limited hospice accessibility, affordability, and efficiency, particularly to underserved populations. Risk and payoff calculations by patients and their families as well as hospices and their providers lead to two strategic options in maximizing hospice value and/or minimizing transaction costs in end-of-life care. CONCLUSION: Policy formulation and advocacy for hospice and palliative care should match aggregate demand. The socio-cultural milieu of care is critical and should be equally considered. Otherwise, providing and expanding free or subsidized palliative care at the end-of-life stage can become cost-inefficient relative to robust family and grassroots community networks.

[Doctors and madmen in south of Brazil: an overview on the São Pedro Hospice in the city of Porto Allgre/RS, its patients and its practices of madness treatment (1884-1924)]. / Médicos e loucos no sul do Brasil: um olhar sobre o Hospício São Pedro de Porto Allegre/RS, seus internos e as práticas de tratamento da loucura (1884-1924).

The São Pedro Hospice was inaugurated on June 29, 1884, and it wa the first psychiatric hospital in Rio Grande do Sul State and one of the first of Brazil, whose history was in a turning point, and it became correlated with the construction of the psychiatry then province. This article presents an abbreviation history of the institution until the decade of 1920, it analyzes the data of the internal population. Moreover, it deals with the medical practices of attendance inside the hospice, which were combined with the development of the "cure" of the subjects, the precepts of the science and the physical and cultural attributes, as well as the experiences of the inpatients' life.