Le financement des soins infirmiers à domicile en Belgique - KCE

KCE Report 122 Financing of Home Nursing 105
Costs and type of nurse
An emerging issue was the difference between self-employed nurses and organisations
employing nurses. Most participants agreed that no different fees for self-employed
nurses and employee-nurses should be introduced. But complementary to this general
statement employee-nurses and self-employed nurses expressed also the opinion that
financing should take into account different cost structures of self-employed and
employee-nurses.
Material cost
With regard to the financing of material costs, nurses and participants from sickness
funds formulated different statements: home nurses remarked that the current fees
were not corrected for the increased costs of transport, materials used, index, … As a
reaction one participant from a sickness fund suggested to disentangle the aspect of
material costs from the fee for a nursing activity. Material and other costs might
fluctuate because of other factors (e.g. discount on prices if nurses order large numbers
of a material, which is more advantageous for large organisations).
Cost and collaboration with hospitals
A particular issue concerned the current practice of nursing assistance in haemodialysis
and peritoneal dialysis at home for which specific arrangements have to be made with
hospitals. Critiques on these arrangements were twofold: first, financing home nursing
delivery via these specific arrangements with hospitals adds to the complexity of the
global financing system of home nursing; secondly, it was stated that payments for
nurses in home nursing are too low.
Cost, workload and use of time
Reflections were also made on the need to take into account workload and use of time
in determining fees: one participant mentioned that time registration shows the time
spent of nurses for activities for particular categories of patients has increased:
• “ in the last 5 years, the average time spent in patients with lump sum level A
payments has increased 5 to 10 minutes per visit“ (participant 17; session 1).
Stakeholders do not request continuous and detailed time studies, but a correct
assessment of the required time to care should be possible/done and connected to the
use of a new patient assessment instrument (see below).
Real cost and informal caregivers
Some participants argued that fees should also take account for the availability and the
involvement of the informal caregivers.
• “The absence of an informal caregiver often leads to an increase of the
workload and the time needed to carry out the nursing care”. (participant 24;
session 1)
Other aspects requiring time of nurses were mentioned too:
• “Time is needed to care, to listen, to involve the family members in the care
delivery” (participant 6; session 3)
Urban areas
Some participants raised the particular issue of nursing in urban environments: urban
areas lead to complaints about time loss in traffic jams and parking problems
• “In urban areas costs of time loss in traffic jams and searching for parking are
immense.” (participant 25; session 4)
Moreover labour shortage of nurses in (big) urban centres is seen as a potential
challenge.
• “Nurses can choose/select the patients they (want to) care for. Therefore, in
urban areas, there is a risk of nurses shortage.” (participant 12; session 4)