Le financement des soins infirmiers à domicile en Belgique - KCE

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102 Financing of Home Nursing KCE reports 122 The proposition forms, with the scores and written arguments and opinions, were collected after the stakeholder meeting. To analyse the stakeholder-perspective from which some arguments were given, the participants were asked to put their names on the forms, with the guarantee that nobody would be quoted by name. One of the researchers (JP) operated as moderator of the group discussions using a predefined scenario, including support questions 85 . One of the researchers (WS) operated as co-moderator for time-keeping, helping the moderator when necessary 85 . Each session proceeded in the same way: 1. Introduction and welcome 2. Identification of purpose of the study 3. Introduction to the method of the study and stakeholder dialogue 4. Introduction to group discussion 5. Introducing participants’ (name, organisation, role) 6. Reading first proposition aloud + clarification (JP) 7. Scoring the proposition (on paper) + formulating arguments (10’) 8. One hour group discussion per proposition 9. Next proposition… 10. Group discussion 11. Finalizing and thanking for collaboration One month elapsed between the two stakeholders’ sessions. The first session explored opinions on the statements 1 to 4. The second session focused on the statements 5 to 8. The dialogue from the first session was transcribed and analyzed before session 2 in order to detect whether some additional issues should be discussed more in depth during the second stakeholder meeting. Between the first and the second session, a research team meeting (15 June 2009) was organised for an intermediate analysis of the first sessions, checking for saturation or emerging new priority topics. This intermediate analysis did not urge to change or adapt the original propositions 5 to 8. Due to time constraints, two propositions were discussed simultaneously: proposition 3& 4, and proposition 5&6. Analysis and reporting of the stakeholder dialogue: In each stage of the raw data reporting or analysis at least two researchers were involved (MP, CD, LP, WS, ML). The analysis was carried out as follows: 1. Thematic minutes of sessions according to relevant topics (MP, CD, WS, LP). Researcher triangulation of minutes and check for completeness (CD, LP). 2. The arguments of the stakeholders were first thematically grouped by two researchers into summary raw data reports of the respective meetings. The reports were corrected for missing or inaccurate data by two researchers per session (MP, CD, LP), who participated as external observers. 3. This stage was followed by: 4. General Classification of content and control of statements for stakeholder 86, 87 attributes 5. Thematic details coding of topics according to their content (MP, CD, LP, ML). All topics were classified in a classification table.
KCE Report 122 Financing of Home Nursing 103 6. Synthesizing, theorizing, re-contextualizing using inter-participant analysis and analysis of categories (ML, LP). Comparative analysis of parallel stakeholder groups. THEME 1: REMARKS AND COMMENTS ON THE CURRENT FINANCING SYSTEM Topic 1: General Quite a number of participants had comments and remarks that can be labelled as “general” in the sense that hold encompassing issues on health care organisation and policy making. Lack of global vision A recurrent remark was that in the Belgian organisation and financing of health care lacks a global vision on the organisation of health care delivery and, more particularly a vision on how the current financing model can be adapted to deal with the new challenges. • “Currently modifications to the financing system are not based on a global reflection on the financing system, but there are only small case by case adaptations”ff (participant 11). • “A holistic vision is required ... it would be better to adopt a totally new financing system rather than to provide little/partial solutions using separate incremental ad hoc financing mechanisms” (participant 12; session 1). Pleas to adapt the financing model to the organisation model Stakeholders argue that the organisation model of health care (including the role of home nursing) should be well reflected before changing/adapting the financing system. Participants urged to develop a financing system taking into account clearly defined objectives underlying the intended organisation of home nursing: the integration of home nursing with hospital based care delivery and primary care (organisational objective), the promotion of good practice, the promotion of a global view on the patient, etc. ... • “The financing system should promote the integration of home nursing in the global health care delivery” (participant 11; session 2) Remarks on a segmented policy approach of healthcare sectors Participants criticised the fact that the debate on financing and healthcare organisation is currently fragmented. The policies for different healthcare sectors are too segmented, approached as separate boxes: e.g. if the hospital stays become shorter, there are no provisions (there is no plan) for home nursing to take care of higher numbers and technical complexity of patients in a post-acute stage of recovery. Moreover, the increasing number of chronic conditions to care for within home care put pressure on the complexity and severity of nursing. These aspects of changing severity and complexity are expected to be embedded in a vision on the organisation of primary care and home nursing within a more broad health care perspective. • “Healthcare is shifting towards a transmural chronic care model requiring other/higher competencies, specialisation, ... the nomenclature of home nursing is poorly adapted to this new model“ (participant 2; session 1). ff We selected quotes illustrating the issue. Often more quotes are made by more participants on the same issue. Of course we translated the original quotes of the participants, trying to stick as close as possible to the original one.
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Le financement des soins infirmiers à domicile en Belgique - KCE

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