Le financement des soins infirmiers à domicile en Belgique - KCE

110 Financing of Home Nursing KCE reports 122
Pay for quality
Many participants pleaded that financing should take outcome and quality of care into
account. There was general agreement on the principle that payments should be related
to the objectives care, to the outcome, to quality of care. It was mentioned that the
organisation and collaboration of nurses in nursing practices/services yield merits for
quality of nursing care and that therefore the financing mechanisms should take into
account the type of organisation of home nurses.
• “Financing should take account the necessary (organisational) conditions for
quality of care and the indicators of good quality of care delivery” (participant
23; session 2)
• “Associations of less than 7 self-employed nurses were not eligible for
receiving payments for specific costs of services for home nursing.”
(participant 5; session 1)
It was added that the existing financing of specific costs of services for home nursing
(specific costs were defined as costs for organisation, coordination, programming,
continuity, quality and evaluation; see chapter 2.) is unwieldy due to complex
administrative regulations. A more flexible financing system of practices of home nurses
and differentiation of functions should be implemented. It was argued that simplifying
the administrative work will require that a registry of nursing practices will be installed.
In the context of this discussion, participants mentioned that quite a number of nurses
combine a job in a hospital with some limited nursing activity as a self-employed home
nurse. It was suggested that low activity levels and the limited availability of the parttime
self-employed nurse could affect continuity and coordination of nursing activities.
• “There are cherry-pickers who have via the hospital very easy access to
profitable nomenclature activities”. (participant 22; session 4)
• “A registry of home nurses is required: who is employed full-time in home
nursing? Who is combining employment in a hospital with partial selfemployment
in home nursing? Does full-time employment in home nursing
result in higher quality of care delivery than partial employment?” (participant
16; session 4)
Additionally, it was mentioned that payments related to the objectives of care,
outcome, quality of care will require data registration of sufficiently large patient
populations.
• “Data registration is required on every level of care delivery. Therefore an
adequate data management model will be required” (participant 23; session 2)
Several methods for differentiating payments according to the outcome/quality of care
were mentioned:
• Quality indicators and outcome parameters should be developed: e.g. patient
satisfaction, HbA1c blood levels in diabetic patients.
• The fees were mentioned as a very effective lever to promote the required
nursing interventions: fee for unnecessary interventions should be low
whereas fees for evidence based interventions should be high.
• The use of an instrument (see further) would support the evaluation of
quality of care.
Decision making process on implementation of new nursing acts
Home nurses and representatives of health authorities agreed that the introduction of
nursing interventions in the nomenclature requires a heavy procedure which takes at
least one year, which is too slow. Additionally, home nurses mentioned that the
representatives of home nurses in the Agreement Committee often do not request for
the introduction of new nursing interventions because they know that budgets are
limited. It was also mentioned that recently the Agreement Committee considered a
new method for provisional financing of urgently needed nursing interventions.