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Going abroad for —

Palliative Care Quality

Palliative and hospice care quality

A fuller editorial guide to palliative care quality is coming soon. For now, the ranking below compares every country we have assessed on it — open a country's report for the cited detail behind its score.

The country comparison

Which countries are best for palliative care quality

The destinations ranked high→low under this lens — each with the reasoning behind its score, the cited evidence one click down, and its full report. The verdict is free; the report is the depth.

19 / 19 Countries ranked

Researched and assessed by the Epidaurus editorial pipeline against our published scale. A country below the rule is not yet assessed enough — never ranked last.

  1. 1 United States US 4.0/5 Good The United States demonstrates a well-developed palliative care system with extensive infrastructure (4,400+ accredited facilities, ~6 specialists per 100,000 population), established national quality standards, 24/7 ... Full report
    The evidence behind this score 5 cited points
    • 83.6% of U.S. hospitals with 50+ beds have specialty palliative care services; 96.2% with 300+ beds; 4,400+ programs accredited by The Joint Commission
    • Approximately 19,920 specialists with hospice and palliative care certification (~6 per 100,000 population), all required to complete 12-month ACGME-accredited fellowship since 2014
    • 50% of hospice providers received 4-5 stars on CAHPS survey; only 50% meet high-quality thresholds despite national quality standards
    • Rural hospitals at 34.5% palliative care availability vs. urban; regional disparities from 88% (New England) to 42% (East South Central); no state achieved 5 stars on Serious Illness Scorecard
    • Opioid crisis regulations created unintended barriers to pain medications despite CDC guidelines explicitly exempting palliative care from restrictions; 55% of pediatric facilities lack hospice access, 79% lack respite care

    Read the full United States report →

  2. 2 United Kingdom GB 4.0/5 Good The UK demonstrates well-developed palliative care with comprehensive national quality standards (NICE QS13/QS144, CQC framework), a highly qualified specialist workforce (910+ palliative medicine doctors, representin... Full report
    The evidence behind this score 5 cited points
    • 910+ FTE palliative medicine doctors in NHS England plus 650 in hospices (~2.3 per 100,000 population) with formal specialty training and CCT certification
    • NICE Quality Standards QS13/QS144 and Clinical Guideline CG140 provide comprehensive national quality frameworks; CQC inspects all hospices using five-domain assessment
    • 54% of hospice activity delivered at home with 590,000+ specialist nurse and doctor home visits annually; 28.4% of deaths occurring at home
    • Marie Curie Better End of Life 2024 report: one-third of patients severely or overwhelmingly affected by pain in final week of life; ~100,000 people die annually needing but not receiving palliative care
    • No structured international patient palliative care services; NHS charges overseas visitors; report documents 'complex journey' for international patients requiring end-of-life care in UK

    Read the full United Kingdom report →

  3. 3 Singapore SG 4.0/5 Good Singapore demonstrates a well-developed palliative care system with comprehensive infrastructure (300 inpatient beds, 3,600 home care places by end-2025), formalized specialist training since 2006, a government-backed... Full report
    The evidence behind this score 5 cited points
    • Infrastructure: ~300 inpatient beds, 3,600 home places, 140 day-hospice places targeted by end-2025, with 9 home care providers and palliative services at all major public hospitals
    • Quality Standards: 2023 National Strategy for Palliative Care with 11 specific recommendations; 2015 National Guidelines; National Palliative Care Quality Improvement Committee overseeing benchmarking and minimum data sets
    • Professional Training: Palliative Medicine recognized subspecialty since 2006; 2-3 year advanced specialist training under APMES framework; PalC trained 2,521 professionals since 2017
    • Pain Management: Morphine and oral opioids available under Health Sciences Authority; separate palliative prescribing guidelines with fewer bureaucratic barriers; interventional pain services (nerve blocks, intrathecal catheters) available at major hospitals
    • International Access: Five to six JCI-accredited private hospitals (Mount Elizabeth, Gleneagles, Raffles, Parkway Cancer Centre) with dedicated International Patient Service Centres; multilingual clinical services; seamless transition from curative to palliative care within same institutions

    Read the full Singapore report →

  4. 4 Germany DE 4.0/5 Good Germany operates a well-developed, legally-mandated palliative care system with exceptional specialist physician density (~16 per 100,000), evidence-based S3 quality guidelines, comprehensive pain medication access, a... Full report
    The evidence behind this score 7 cited points
    • ~13,188 physicians hold Zusatzbezeichnung Palliativmedizin (approximately 16 per 100,000 population), among Europe's highest specialist densities
    • S3 guideline on palliative cancer care with 11 measurable quality indicators, developed by 150+ experts across 60 institutions
    • Comprehensive opioid availability: hydromorphone (99%), morphine (98%), fentanyl (96%) in inpatient hospices with minimal regulatory barriers
    • 403 SAPV (specialized outpatient palliative care) teams legally mandated for 24/7 home-based care nationwide
    • 95% of hospital-based palliative care units include social work, 93.6% physiotherapy, 87.2% chaplaincy services
    • Only 35.3% of facilities offer regular staff diversity training and 57.8% provide information exclusively in German, limiting access for international patients
    • Bed capacity of 34.1 per million inhabitants falls below EAPC recommended 50 per million; 27.4% of districts lack any specialist palliative service

    Read the full Germany report →

  5. 5 United Arab Emirates AE 3.5/5 Moderate The UAE demonstrates moderate palliative care quality concentrated in a small number of world-class urban centers, offset by systemic limitations in specialist training, home-based care, and medication access. Burjeel... Full report
    The evidence behind this score 5 cited points
    • Four established hospital-based palliative care centers by 2022 (Tawam, American Hospital Dubai, Mediclinic Dubai, Burjeel Medical City Abu Dhabi) with no standalone hospice facility
    • Burjeel Medical City employs 10 fellowship-trained palliative physicians and 14 specialized nurses; 92% of oncology patients report ≥30% pain reduction within 48 hours of admission
    • No dedicated palliative care fellowship training program exists in UAE; no formal curricula in internal medicine or emergency medicine residencies
    • Historical morphine consumption at 0.38 mg/capita (6.4% of global mean); institutional access improved at leading centers but injectable opioids restricted to hospital settings
    • Tawam Hospital achieved 85% patient recommendation rate; first national Palliative Care Conference held October 2024 with government endorsement, signaling emerging momentum

    Read the full United Arab Emirates report →

  6. 6 Spain ES 3.5/5 Moderate Spain demonstrates moderately well-developed palliative care with solid infrastructure, particularly in Catalonia and major urban centers, 21 JCI-accredited facilities, adequate opioid access, and growing pediatric se... Full report
    The evidence behind this score 5 cited points
    • Palliative medicine is NOT a formal specialty in Spain—SECPAL identifies this as the primary structural deficit
    • Spain has 21 JCI-accredited organizations but lacks national definitions for palliative care unit standards, creating absence of uniform benchmarks across regions
    • Infrastructure varies sharply: Catalonia operates 742 dedicated beds, 72 home care teams, and 29 psychosocial teams, while rural areas face documented shortfalls in 24/7 coverage and home care
    • Opioid accessibility is broadly adequate, typical of Western European systems, with fentanyl and morphine readily available; advanced interventional pain management available at private hospital pain units
    • International patient services concentrated in JCI-accredited private sector (Quirónsalud, FJD, Hospital Teknon); public sector palliative care restricted to residents and registered EU nationals

    Read the full Spain report →

  7. 7 Israel IL 3.5/5 Moderate Israel has well-developed physical infrastructure with 5 ESMO-accredited integrated oncology-palliative centers and excellent opioid accessibility without bureaucratic barriers, exceeding Score 3 thresholds. However, ... Full report
    The evidence behind this score 5 cited points
    • Five ESMO-accredited integrated oncology and palliative care centers with JCI accreditation at major hubs (Sheba, Rambam with 97.5% JCI score)
    • Patient satisfaction mean of 57.2 on QODD instrument; nearly 50% of bereaved caregivers rated overall dying quality as poor (2014 study)
    • Palliative care coverage reaches only estimated 10–15% of those clinically eligible despite 2005 Dying Patient Law making it a legal entitlement
    • Excellent opioid accessibility: injectable morphine available in all Israeli hospitals; any licensed physician can prescribe opioids without specialized permits
    • 190 certified palliative care nurse practitioners by 2024; palliative medicine recognized subspecialty since 2012

    Read the full Israel report →

  8. 8 Japan JP 3.5/5 Moderate Japan has excellent institutional infrastructure (462 PCUs, high family satisfaction of 5.0/6.0) and mandatory quality standards with sophisticated monitoring, but critical clinical gaps prevent a higher rating. Speci... Full report
    The evidence behind this score 7 cited points
    • Opioid adequacy at only 74-78% of WHO recommended levels with 38.2% of end-stage cancer patients experiencing severe-to-intolerable pain in final 30 days
    • Specialist density of 0.42 per 100,000 population (530 certified physicians / 125 million) falls below even the 'Moderate' threshold of 1-2 per 100,000
    • Family satisfaction consistently 5.0/6.0 (83%) across J-HOPE studies, exceeding Score 4 threshold of >80%
    • Nationally mandated quality standards under 2007 Cancer Control Act with systematic J-HOPE monitoring across 153+ facilities
    • Three ESMO Designated Centres of Integrated Oncology and Palliative Care (world-class accreditation) plus multiple ISO certifications
    • Insurance-based PCU access restricted to cancer and HIV patients; only 15.2% of PCUs admitted any non-cancer patients in 2020
    • Language support and international patient coordination concentrated in Tokyo and Osaka; limited outside major urban centers

    Read the full Japan report →

  9. 9 India IN 3.0/5 Moderate India demonstrates basic palliative care infrastructure with significant regional disparities. While policy frameworks exist (NPPC 2012, National Health Policy 2017) and specialist training is available in 17 teaching... Full report
    The evidence behind this score 5 cited points
    • Only 1-2% of 7-10 million people needing palliative care have access; Kerala accounts for majority of services with 60%+ coverage in some areas
    • MD Palliative Medicine training available in 17 teaching hospitals as of 2023, representing approximately 1-2 specialists per 100,000 population
    • NDPS Amendment (2014) improved morphine access but persistent barriers remain: no state essential medicines list includes all recommended formulations; potent opioids initiated in only 16% of advanced cancer patients
    • 55 JCI-accredited hospitals with language support and international patient services, but palliative care integration within these facilities varies significantly
    • Home-based palliative care accessible to only one-third of patients across cancer hospitals surveyed; 92.3% of centers provide home care services but availability limited to major cities

    Read the full India report →

  10. 10 South Korea KR 3.0/5 Moderate South Korea demonstrates a moderate level of palliative care quality with established legal framework and government oversight through the Act on Hospice and Palliative Care, but falls short of well-developed services... Full report
    The evidence behind this score 6 cited points
    • Only ~100 designated hospice institutions nationwide with 30 beds per 1,000,000 population as of 2020, representing modest infrastructure development
    • Inpatient hospice care eligibility restricted to terminally ill cancer patients only, limiting access for patients with other terminal conditions such as heart failure or neurological diseases
    • Palliative care not recognized as a government specialty but operates under voluntary KSHPC certification system requiring 18 hours training (established 2019)
    • Hospice utilization rate among eligible cancer patients only 23-24%, with median care duration of just 14 days, indicating late referrals and underutilization
    • Opioid medications available with insurance coverage but methadone, buprenorphine, and naltrexone not readily available; historical barriers to morphine access (oral and injectable) indicate persistent restrictions
    • Strong medical tourism infrastructure with JCI-accredited facilities and international patient accommodation through universal healthcare coverage for foreign residents enrolled in NHIS

    Read the full South Korea report →

  11. 11 Poland PL 3.0/5 Moderate Poland has developed a strong home hospice network exceeding European benchmarks and maintains formal national quality standards with substantial nursing specialization, but critical deficiencies prevent a higher scor... Full report
    The evidence behind this score 10 cited points
    • Home hospice network operates 1.06 teams per 100,000 inhabitants (2019), exceeding EAPC benchmark; 522 entities under 1,125 NFZ contracts serving ~105,000 patients annually
    • Zero JCI-accredited facilities specifically for palliative care services; 2024 NIK audit documented facility deficiencies including expired medications and inadequate infrastructure
    • Critical specialist physician shortage: only 30–40 new palliative medicine doctors complete specialty annually; National Consultant estimates workforce needs to more than double to meet patient needs
    • Mean waiting time for urgent inpatient admission is 43 days; patients documented to die on waiting lists
    • Access restricted to only 8 qualifying diagnoses under public funding; 28 documented cases of care refusal due to eligibility restrictions
    • No dedicated international patient coordinators, transparent pricing, repatriation assistance, or interpretation services in palliative care facilities
    • Hospital-based palliative consultation teams declined from 9 (2012) to 3 (2019), eliminating natural care transition point for curative-to-palliative shifts
    • Formal national organizational standards via 2021 Delphi methodology; NFZ staffing regulations (2023); comprehensive nursing specialization (8,100+ trained nurses)
    • Opioid medication availability improved (15 formulations, threefold consumption increase 2000–2015) but opiophobia persists among non-specialists; 2024 amendment requires personal examination for strong opioid prescriptions, adding procedural barriers
    • Social workers notably absent from many home palliative care teams since 2008 regulatory changes; no formal coordination with social/long-term care services

    Read the full Poland report →

  12. 12 Colombia CO 3.0/5 Moderate Colombia demonstrates moderate palliative care capacity with strong legal frameworks and excellent flagship urban programs, but is held back by systemic gaps in opioid accessibility and geographic coverage. The countr... Full report
    The evidence behind this score 5 cited points
    • 6 JCI-accredited hospitals offering palliative care (Fundación Santa Fe, Fundación Cardioinfantil, Fundación Clínica Shaio, Hospital Pablo Tobón Uribe, Fundación Valle del Lili, Hospital Internacional de Colombia)
    • Law 1733 of 2014 mandates all EPS and IPS maintain palliative care network capacity; national clinical practice guidelines published by Ministry of Health
    • 64.92% of prescribers report limited morphine availability; extended-release oral morphine unavailable in Colombian market despite being on IAHPC essential medications list
    • 41% average national population coverage with 504 identified services; six departments (Amazonas, Guainía, Putumayo, Vaupés, Vichada, San Andrés) have zero services
    • Home-based palliative care described as 'very scarce' and concentrated in three cities; no standalone hospice facilities exist; most teams lack interdisciplinary composition beyond physicians and nurses

    Read the full Colombia report →

  13. 13 Thailand TH 3.0/5 Moderate Thailand demonstrates moderate palliative care infrastructure with strengths in government commitment and international private hospital capacity, but significant limitations in specialist availability and medication ... Full report
    The evidence behind this score 5 cited points
    • 62 JCI-accredited medical facilities as of July 2024; 85% of government hospitals have palliative care committees
    • Only 10.3% of hospitals report doctors with at least 1 month palliative care training; ~1-2 palliative medicine specialists per 100,000 population; WHO categorizes Thailand at Level 4a (preliminary stage of integration)
    • Injectable morphine 96.9% available but oral morphine limited (32.2% immediate-release, 51% controlled-release); government policy restricts opioid prescriptions due to drug trafficking concerns; only 4 kg morphine consumed annually vs. 1000 kg needed for cancer pain
    • Major private hospitals (Bumrungrad, Bangkok Hospital) with 14 JCI locations provide multilingual international patient services and palliative care integration; limited government subsidies require international patients to pay out-of-pocket
    • National palliative care policy established 2014; MOPH set Key Performance Indicators; Ramathibodi Hospital and Cheewabhibaln Center serve as model facilities; but most care delivered through hospital consultation rather than dedicated hospice units

    Read the full Thailand report →

  14. 14 Turkey TR 3.0/5 Moderate Turkey demonstrates moderate palliative care quality with established regulatory frameworks (2015 Directive), more than 50 JCI-accredited hospitals, and multiple ESMO Designated Centers for integrated oncology and pal... Full report
    The evidence behind this score 5 cited points
    • Over 50 JCI-certified hospitals across Turkey with 3 ESMO Designated Centers for integrated oncology and palliative care (Anadolu, Hacettepe, Dokuz Eylül)
    • Established legal framework via 2015 Directive on Implementation Procedures and Principles of Palliative Care identifying essentials in seven areas (physical environment, staff, roles, scope, admission, training, supervision)
    • Bed capacity of 30.4 per million inhabitants, significantly below European recommendation of 80-100 per million
    • Opioid consumption improved to 26.7% of PC patients by 2017 after Pallia-Turk project, but remains lower than global average; historical restrictions on specialist prescribing
    • Services concentrated in major cities (Istanbul, Ankara, Izmir) with acknowledged need to disseminate across less developed regions; multidisciplinary teams available at leading centers but limited rural access

    Read the full Turkey report →

  15. 15 Jordan JO 2.5/5 Moderate Jordan has one internationally accredited palliative care center (KHCC) with evidence-based care and a supportive national policy framework, but the system suffers from severe structural limitations: comprehensive pal... Full report
    The evidence behind this score 5 cited points
    • KHCC is Jordan's sole comprehensive palliative provider with inpatient, outpatient, and home care; palliative care is not formally available at most MOH, Royal Medical Services, or private hospitals [Jordan Palliative Care Initiative - Shamieh & Jazieh - 2007]
    • 31% of cancer patients with pain receive no treatment; opioid consumption is 34× lower than high-income countries [National Palliative Care Strategy - JPASM - 2024]
    • Estimated 185-235 FTE palliative specialists needed versus current supply far below 1 per 100,000 population [Gaining Palliative Medicine Subspecialty Recognition - Shamieh et al. - 2020]
    • 97.5% of medical students have never taken formal palliative care course; ICU nurses average 8.88/24 on palliative care knowledge assessment [Medical Students' Knowledge - PMC - 2024; Palliative Care Knowledge ICU Nurses - Acute Critical Care - 2023]
    • National Palliative and Home Care Strategic Framework endorsed 2018, with 2023-2025 MoH and 2026-2030 Cancer Control strategies explicitly prioritizing palliative care [National Palliative Care Strategy - JPASM - 2024]

    Read the full Jordan report →

  16. 16 Brazil BR 2.5/5 Moderate Brazil's palliative care system is poorly developed, with critical deficiencies in specialist density (0.18 per 100,000 vs. the Score 3 minimum of 1-2), severe opioid access restrictions, limited accredited facilities... Full report
    The evidence behind this score 7 cited points
    • Only 389 palliative medicine physicians for 215 million population (0.18 per 100,000), far below the 1-2 per 100,000 required for Score 3
    • 65% of 423 palliative care services fail minimum quality standards; ranked 79th of 81 countries in international end-of-life care quality survey
    • Opioid access classified as 'highly restricted' in Latin America with ANVISA restrictions including 30-day supply caps and special registration requirements
    • Only 14.3% of palliative care services provide home-based care; 80% of cancer deaths occur in hospitals rather than hospice settings
    • 78.6% of palliative care services lack dedicated palliative nurses; some services operate with physicians only
    • National Palliative Care Policy (Portaria GM/MS 3.681) established May 2024, mandating multidisciplinary teams and 180-hour professional training
    • Hospital Israelita Albert Einstein in São Paulo holds JCI accreditation and Planetree designation with international patient center; Hospital Mont Serrat opened January 2025 as first dedicated public palliative hospital with 70 beds and 41 specialists

    Read the full Brazil report →

  17. 17 Hungary HU 2.5/5 Moderate Hungary has established a functional basic framework with national quality standards, universal free coverage, and a well-developed home care network (87 teams). However, the system is undermined by serious implementa... Full report
    The evidence behind this score 5 cited points
    • 33% decline in opioid use for oncological pain 2006–2020 despite rising cancer incidence, indicating systemic under-treatment
    • Only 215 hospice beds nationally vs. WHO recommendation of 500 for ~10 million population
    • Average home hospice stay 26.7 days vs. 8.5 months ideal benchmark, reflecting cultural barriers and late referral
    • No JCI-accredited palliative facilities; national Ministerial standards exist (2003/2004) but lack international accreditation
    • Zero dedicated international patient coordinators, repatriation support, or formal medical tourism integration for end-of-life care

    Read the full Hungary report →

  18. 18 Malaysia MY 2.5/5 Moderate Malaysia has a national policy framework and world-class private hospital palliative care in Kuala Lumpur (Sunway's ESMO integrated oncology/palliative designation is rare regionally), but faces critical barriers: spe... Full report
    The evidence behind this score 5 cited points
    • Opioid access critically restricted: oral morphine available in only 10–30% of urban primary clinics and <10% of rural clinics; only 24% of cancer pain patients receive regular opioid analgesia; 34.2% of physicians believe morphine causes addiction [APHN Atlas 2025; Knowledge, Perception and Barriers - PMC 2023]
    • Severe specialist workforce shortage: approximately 21 trained specialists at 2019 policy launch; by 2025 ~46 hospitals offer services but many share specialists with internal medicine duties = approximately 0.15–0.20 specialists per 100,000 population, far below Score 3's 1–2 range [CodeBlue April 2025; Malaysia Launches Policy - APHN 2019]
    • National policy framework and institutional commitment: National Palliative Care Policy and Strategic Plan 2019–2030; MOH-led coordinating committee; 31 expert-endorsed quality indicators developed by NIH Malaysia 2025; MSQH and JCI accreditations present [MOH 2019; BMC Palliative Care 2025]
    • World-class private hospital care concentrated in Kuala Lumpur: Sunway Medical Centre holds JCI Gold and unique ESMO Designated Centre of Integrated Oncology and Palliative Care status (2025–2027); Subang Jaya Medical Centre offers JCI accreditation and 24-hour TeleConnect consultations [ESMO 2025; CodeBlue August 2024]
    • System reach and geographic equity severely limited: only ~10% of Malaysians needing palliative care receive it; extreme access disparities (Klang Valley 3.7 km median distance vs. Pahang 45–79 km vs. Sabah/Sarawak 82+ km vs. Labuan requiring 4.5-hour ferry); Perlis and Labuan had zero registered facilities as of 2021; home-based domiciliary care available in only 4 states [Mapping Palliative Care - PMC/NIH 2024]

    Read the full Malaysia report →

  19. 19 Mexico MX 2.0/5 Poor Mexico has progressive legislation (2009 law, NOM-011-SSA3-2014 standard) but implementation remains severely limited. With only one 24/7 palliative care hospital in the entire country, fewer than 1 trained specialist... Full report
    The evidence behind this score 5 cited points
    • Only one 24/7 palliative care hospital (Juntos Contra el Dolor) in entire country, located in Jalisco state
    • Palliative care unavailable in 7 of 32 states; 17 states have only capital-city services
    • Opioid analgesics access meets only 36% of population need per International Narcotics Control Board
    • Only 6 of 102 medical schools teach palliative care; few formally trained palliative medicine physicians
    • National standard NOM-011-SSA3-2014 exists but implementation gap is substantial; few people know law exists

    Read the full Mexico report →

See the full ranking, the 1–5 rubric and the reports →