Le financement des soins infirmiers à domicile en Belgique - KCE

KCE Report 122 Financing of Home Nursing 93
In addition, the regulatory powers of the G-BA encompass recommendations on
requirements regarding the content of disease management programs. The aim of these
programs is to improve the treatment and the quality of medical provision for
chronically ill patients.
The reform of 2006 y focuses on the structure of health insurance funds, also induced by
the fact that employers contributions have been raised. At the same time, the new
reform aims to simplify health benefits, provide more choices, increase transparency
and create competition among providers.
In 2008, The National Association of Statutory Health Insurance Funds (GKVspitzenverand)
was created as the central coordinating organisation for all statutory
health insurance funds. The National Association of Statutory Health Insurance Funds
also acts as the National Association of Long-Term Care Funds. Representing the
interests of statutory health insurance at federal level, it plays an important role in
concluding framework contracts and remuneration agreements in all health care
sectors. The contracts concluded apply to all health insurance funds and their
associations at sub national level z .
The 2006 health care policy reforms culminated in 2009 in the introduction of the
health care fund (Gesundheitsfonds) introduced as a new organisation for centrally
collecting and distributing the money from social security contributions and taxes to the
several health insurance funds. Statutory health insurance funds will receive a flat
amount for each insured person. The sickness funds may raise an additional premium to
cover excess funds. But the government aims at more competition between the
sickness funds.
In relation to home nursing the most important reform was the introduction of the long
term care insurance. The health care system developed historically very much as a
hospital-centred health care model. Until the introduction of the Pflegeversicherung in
1995, home care relied a lot on the role of informal family care, more than professional
home care. The strong medically oriented health care model has for a long time
hampered a structural development of home nursing and care. Nursing as a profession
has mainly developed as an extension of the role of physicians. Home nursing developed
as an extension of hospital care.
The 2006 reforms promote integration and cooperation through start-up financing for
integrated care contracts within and between together long-term care and non-medical
health care professions (such as speech therapists, occupational therapists, etc.). The
main objectives of the 2007 reform of the German long-term care system include
establishment of local LTC support centres and case managers who help organise and
coordinate care; increasing benefits; development of evidence-based care standards and
regular quality inspections.
Insurance framework
In this part, we focus on Statutory Health Insurance (SHI) and long term care insurance,
and pay less attention to the private insurance. About 85% of the population is covered
by a basic health insurance plan providing a standard level of coverage. The remainder
opt for private health insurance, which frequently offers additional benefits.
Statutory health insurance aa
Statutory health insurance is the major source of financing health care.
The sickness funds are responsible for collecting contributions, purchasing benefits on
an in-kind basis and paying providers. Sickness funds collect the contributions directly
from the employers or public agencies. Since 2009, money is allocated and redistributed
through this Gesundheitsfonds.
y http://www.allhealth.org/BriefingMaterials/BertelsmannStiftung-BigBang-1171.pdf
z http://www.gkv-spitzenverband.de/About_us.gkvnet
aa http://www.deutsche-sozialversicherung.de/en/health/index.html