Le financement des soins infirmiers à domicile en Belgique - KCE

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118 Financing of Home Nursing KCE reports 122 However, advantages of RAI were emphasized too: it is seen as a complete and adequate assessment and it offers an integrated approach enabling to serve several purposes simultaneously: quality indicators, financing, support for plan of care, outcome measurement, etc ... Stakeholders from home nurses pleaded that, before RAI would be implemented, health care authorities should decide in advance which of the applications will be used in home nursing. On the question whether the same instrument should be used for planning and financing of nursing care, some participants agreed, others disagreed. Opinions on this matter were not linked to characteristics of the stakeholders. Participants also requested a shorter screening instrument for detecting those patients who need a full RAI-assessment. It was also mentioned, both by home nurses and by representatives of sickness funds, that if RAI is used only for those patients requiring complex nursing care and/or multidisciplinary consultation, the time and effort which will be required for carrying out the assessment should be reimbursed. A new instrument should enable external control and self-control by means of quality indicators (see earlier themes: quality of care and control). Home nurses requested that, simultaneous with the implementation of a new instrument, there would be opportunities to receive sufficient training from NIHDI and that patients will also be informed about the instrument/method used for financing nursing care delivery. Time needed for registration Use of time for the RAI-assessment was a major counter-argument to implement and use the instrument. However, opinions diverged between stakeholders. On the one hand, representatives of health authorities, self-employed home nurses and representatives of the larger home nursing organisations disagreed on the proposition that costs and efforts for registration of care dependency are too high for an adaptation of the financing system. The participants raised issues such as: • The cost of additional time spent in a more encompassing registration should be weighed against the cost of abuse of the current system. • When it was argued that better data and information will be required for achieving higher quality and outcome of home nursing, it was mentioned that time investments will be needed for data registration. • The registration cost should be financed. • The work load of assessment and registration might be shared with other disciplines. • ICT support will be required for efficient use of RAI. • It is part of professional nursing to carry out a comprehensive data and information collection in order to formulate nursing diagnoses/problems. On the other hand, self-employed nurses and employee-nurses agreed with the proposition that costs and efforts for registration of care dependency are too high. They argued that: • RAI-assessment takes too much time. • Nurses are reluctant to spend much time in administrative tasks. • Administrative tasks should be limited. The scoring of propositions and written comments The stakeholders’ scores for the propositions are listed further and summarized as averages scores per stakeholder group in Figure 3. These scores confirm the issues which emerged during the dialogue. The written documents do not present any additional information on arguments used as compared to the discussion sessions.
KCE Report 122 Financing of Home Nursing 119 Most stakeholders agreed that the changing role of home nursing required that the financing mechanisms would change (proposition 1). Two participants from financing authorities disagreed. One of them did not repeat this different opinion in the group discussion, although she used her written arguments in her contribution to the discussion. The other disagreeing stakeholder argued that the nurses’ changing role did not require a change of the financing mechanisms, but that some of the instruments used within the financing mechanisms needed modification, more precisely the evaluation instrument. Most stakeholders agreed that the principles for financing home nursing in Belgium must change fundamentally (proposition 2). However, mixed opinions on the word ‘fundamentally’ emerged on the scope of the required change: incremental changes versus fundamental changes. All participants agreed that the financing system should be a mixed system, existing of partly fee-for-service payments and partly lump sum payments. There was quasi unanimous disagreement with the proposition that financing sufficiently takes into account new nursing activities (proposition 3). The only stakeholder who agreed with the proposition, argued that financing does already account for many ‘new’ nursing interventions. Similar disagreement is found with the proposition that financing is sufficiently adapted to allow for differentiation of tasks and functions between different types of nurses (proposition 4). Major concern was that there was no financing for the consequences. There was general agreement with the proposition that the current nomenclature list of nursing interventions is incomplete and insufficiently adapted to the current nursing reality in home care (proposition 5). While all nurse stakeholders from home nurses agreed with the proposition that tariffs for home nursing interventions should be based on real costs of suppliers of home nursing care (proposition 6), a majority of stakeholders from health authorities mentioned that they had no opinion on this proposition. There was agreement with the proposition that other instruments for care dependency are needed in order to create opportunities for an appropriate financing system for home nursing. However, a minority of the stakeholders disagreed with or had no opinion on the proposition. There was only one extreme score (2 = I strongly agree), which might be an indication that stakeholders were cautious on the issue. There was no consensus in the opinions on the proposition which stated that costs and efforts for registration of care dependency are too high for an adaptation of the financing system. Within each stakeholder group (financing authorities, self-employed nurses and employee nurses) there were two opinions: agreement and disagreement with the proposition. From Figure 1 it can be concluded that for each separate proposition, average scores of the three stakeholder groups (employee-nurses, self employed nurses and financing authorities) were similar (agreement or disagreement) except for the 8 th proposition which stated that costs and efforts for registration of care dependency are too high for an adaptation of the financing system: employee-nurses and financing authorities disagreed with the proposition; self employed nurses agreed with the proposition. For the first six propositions, the financing authorities demonstrated more moderate opinions (closer to the ‘no opinion’ score) than the nurses, who formulated more explicit agreement and disagreement scores. For the 7 th and 8 th proposition, the financing authorities formulated more extreme scores than self employed nurses and employee-nurses.
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Le financement des soins infirmiers à domicile en Belgique - KCE

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