Le financement des soins infirmiers à domicile en Belgique - KCE

KCE Report 122 Financing of Home Nursing 97
These Social and home health services are largely provided by independent, charitable
and private-commercial bodies (social service providers), partly also by municipal
service providers. The state and/or the social benefit funds have a safeguarding mandate
here. A typical Sozialstation employs 8 to 10 nurses, either generalists or nurses
specialized in care for the elderly. Volunteers and nursing aids, who perform basic
nursing procedures and home help services, assist them. The size of the population
served by a Sozialstation varies between 12 000 and 50 000 inhabitants, depending on its
size and the degree of urbanization.
Care support centres are created within the framework of LTC to pool all care-related,
medical and social services and their networking under one roof. Ideally, all actors
involved in care, that is sickness/LTC funds, private long-term care insurers,
municipalities, social welfare bodies and local long-term care providers should be
represented in these centrally located, easy-to-reach centres. Staff for serving people
falling under the long-term care and health insurance schemes, of services and facilities
for old people and of the social assistance funds coordinate their activities and inform
those who are seeking advice and help about the relevant social services. The care
support centres must be independent. Additional to these centers the function of casemanagers
was formally established, aiming at coordination of care around patients.
In order to be accredited, home nursing providers are obliged by law to guarantee to
provide nursing services day and night and during the weekends and bank holidays.
Since the SHI Modernization Act 2003, hospitals may treat ambulatory patients with
diseases requiring highly specialized treatment on an ongoing basis, and thus provide
nursing. Since 2004, hospitals may also provide care in specialties and for patients with
certain rare diseases and special forms of disease progression.
Integrated care is recently identified as a separate sector. Integrated care contracts
concern mainly disease-centered programs at the interface between acute hospital care
and rehabilitative care, involving office-based specialists physiotherapists and family
physicians. Sickness funds negotiate selective contracts with single providers or a
network of providers, i.e. physicians, hospitals, rehabilitative institutions. All these
services need to be accredited within their sector, but may provide services across
sectors within the scope of the integrated care contract, e.g. a hospital may provide
outpatient services if it has a joint contract with an ambulatory physician.
Financing of home nursing
In the outpatient sector, health care services are mainly reimbursed according to a feefor-service
system (Leistungen) with a fixed budget and floating (point) values. Sickness
funds are obliged to collectively contract with all providers of ambulatory
care.
Investments are financed through Länder (comparable to the financing model of
hospitals) and are not part of social contribution budgets.
Home nursing is financed through two main insurance schemes: statutory health
insurance and long term insurance. Complementary money is paid by households and
social services.
For the statutory health insurance, nursing care at home is currently included in the
benefit package. Within this health insurance framework there is a strict hierarchy of
service entitlement, ranging from medical treatment, specialized nursing, basic nursing,
and home help as a supplement to nursing. Specialized nursing (“Behandlungspflege”) is
financed when it is prescribed by the medical profession. The same care, provided by
different categories of personnel, implies a different tariff.