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

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4 Evolution of day-care: impact of financing and regulation KCE Report 192 5.3.6 Pain clinic services ................................................................................................................ 87 6 SELECTIVE INQUIRY ON SHIFTS IN CARE ..................................................................................... 89 6.1 GENERAL INTRODUCTION TO THE MATTER ................................................................................. 89 6.1.1 Inpatient to day-care shifts .................................................................................................... 89 6.1.2 Shifts from ambulatory to day-care or the reverse. ............................................................... 89 6.2 METHODOLOGICAL CONSIDERATIONS ......................................................................................... 90 6.2.1 Shifts from inpatient to hospital day-care .............................................................................. 90 6.2.2 Shifts between day-care and ambulatory care ...................................................................... 92 6.2.3 Selection of study items ........................................................................................................ 93 6.2.4 Other methodological issues ................................................................................................. 96 6.3 RESULTS OF 16 SELECTED CASE STUDIES .................................................................................. 96 6.3.1 Eye lens surgery .................................................................................................................... 97 6.3.2 Lower GI fibre optic endoscopy ........................................................................................... 105 6.3.3 Dental surgery ..................................................................................................................... 106 6.3.4 Surgical circumcision ........................................................................................................... 110 6.3.5 Carpal tunnel release .......................................................................................................... 112 6.3.6 Meniscectomy of the knee joint ........................................................................................... 115 6.3.7 Inguinal hernia repair ........................................................................................................... 117 6.3.8 Follicle aspiration by laparoscopy or trans-vaginally under ultrasonographic guidance ..... 119 6.3.9 Total hysteroscopic endometrial resection (THER) ............................................................. 120 6.3.10 Extracorporeal shock wave lithotripsy ................................................................................. 123 6.3.11 Tonsillectomy by dissection and related ORL interventions ............................................... 124 6.3.12 Subcutaneous portal system implant for administration of medication ............................... 128 6.3.13 Therapeutic epidural infiltration ........................................................................................... 129 6.3.14 Varicose vein surgery .......................................................................................................... 133 6.3.15 Removal of intra-corporeal osteosynthesis material ........................................................... 138 6.3.16 Cardio-angiography: angiocardio-pneumography and coronarography ............................. 141 6.3.17 Summary appraisal of shifts ................................................................................................ 149 7 INTERNATIONAL COMPARISON ................................................................................................... 151 7.1 INTERNATIONAL OVERVIEW .......................................................................................................... 151
KCE Report 192 Evolution of day-care: impact of financing and regulation 5 7.2 FRANCE ............................................................................................................................................ 153 7.3 ENGLAND.......................................................................................................................................... 155 7.4 DENMARK ......................................................................................................................................... 157 8 EXPLORING MODALITIES FOR A MORE GLOBAL FINANCING OF DAY-CARE ....................... 157 9 CONCLUSION AND DISCUSSION .................................................................................................. 158 9.1 EVOLUTION OF DAY-CARE SERVICES: A MIXED PICTURE OF SHIFTS AND GROWTH ......... 158 9.2 IMPACT OF THE FINANCING SYSTEM AND REGULATION ......................................................... 159 9.3 LIMITATIONS OF THE STUDY ......................................................................................................... 160 9.4 EVALUATION OF CURRENT DAY-CARE FINANCING ................................................................... 160 9.4.1 Lack of transparency ........................................................................................................... 160 9.4.2 Lack of scientific evidence supporting choice of care setting ............................................. 161 9.5 POSSIBLE DIRECTIONS FOR THE FUTURE ................................................................................. 161 9.5.1 A global plan for hospital activities ...................................................................................... 161 9.5.2 Following the international trends in day-care financing ..................................................... 161 REFERENCES .................................................................................................................................. 162
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