EVOLUTIE VAN DAGHOSPITALISATIE: IMPACT VAN DE ... - KCE

KCE Report 192 Evolution of day-care: impact of financing and regulation 3
3.3.2 2002 reform ........................................................................................................................... 44
3.3.3 2007 reform ........................................................................................................................... 45
3.3.4 Current hospital day-care financing modalities ..................................................................... 47
3.4 PRICING OF FIXED LUMP SUMS ...................................................................................................... 48
3.5 ADDITIONAL FINANCING OF HOSPITAL DAY-CARE SERVICES .................................................. 49
3.5.1 Consultation fee .................................................................................................................... 49
3.5.2 Surveillance fee ..................................................................................................................... 49
3.5.3 Fees for in-hospital medical permanence ............................................................................. 49
3.5.4 Lump sums for lab tests ........................................................................................................ 50
3.6 NOMINATIVE LISTS FOR DAY-CARE REIMBURSEMENT CLAIMS ................................................ 50
3.6.1 Brief introduction on nominative lists ..................................................................................... 50
3.6.2 Code shifts in nominative lists ............................................................................................... 50
3.6.3 Relative service code registration with reimbursement claims ............................................. 54
4 DATA SOURCES AND THEIR CONSTRAINTS ................................................................................ 56
4.1 INTRODUCTION ON RIZIV – INAMI SPENDING MONITORING ...................................................... 56
4.2 DOC N ................................................................................................................................................. 56
4.3 DOC FH ............................................................................................................................................... 57
4.4 HOSPITAL MICRO LEVEL DATA ....................................................................................................... 57
4.5 OVERVIEW OF USED DATA SOURCES ........................................................................................... 58
5 EVOLUTION OF DAY-CARE LUMP SUM BUDGETS AND COUNTS .............................................. 60
5.1 DATA PARTICULARITIES .................................................................................................................. 60
5.1.1 Doc N ..................................................................................................................................... 60
5.1.2 Doc FH .................................................................................................................................. 60
5.2 NATIONAL DAY-CARE LUMP SUM REIMBURSEMENTS AND COUNTS ....................................... 62
5.3 NATIONAL REIMBURSEMENTS AND COUNTS PER LUMP SUM CATEGORY ............................. 67
5.3.1 Plaster ward services ............................................................................................................ 67
5.3.2 Mini lump sum services ......................................................................................................... 69
5.3.3 Maxi lump sum services ........................................................................................................ 71
5.3.4 Day-care surgery services ..................................................................................................... 78
5.3.5 Day-care groups 1-7 services ............................................................................................... 82