Le financement des soins infirmiers à domicile en Belgique - KCE

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.