Le financement des soins infirmiers à domicile en Belgique - KCE

4 Financing of Home Nursing KCE reports 122
1 INTRODUCTION
1.1 SCOPE OF THE STUDY
Originally designed as a fee-for-service system in the 1960s, the Belgian public financing
system of home nursing was gradually adapted towards a mixed fee-for-service and
lump sum payment system, complemented with additional financing regulations.
Currently, four payment systems and one special arrangement contribute to the
financing of home nursing at the federal level (see for details chapter 2.5). Arguments
frequently expressed against the current financing system are: the nomenclature is
obsolete and non exhaustive, the financing system lacks clarity, the negotiated tariffs
have little or no relation to real production costs, the current financing does not take
into account new challenges faced by healthcare providers at all levels of the healthcare
system (primary care, secondary care and tertiary care).
The purpose of the study is to provide knowledge to assess to what extent an
alternative or adapted financing scheme for home nursing in Belgium is needed and
possible. An important additional question is whether the financing principles can be
based on a patient case-mix basis.
The scope of this study is limited to homecare nursing that is currently reimbursed at
the Belgian federal level through the National Institute for Health and Disability
Insurance (NIHDI). Professionals providing home care like home help services, social
services, general practitioners, occupational therapists, physiotherapists, etc. and
community nursing activities such as preventive mother and child care, psychiatric care,
midwifery, school health nursing and occupational nursing are beyond the scope of this
study.
The study uses the perspective of financing the providers, even if we acknowledge that
changes to the reimbursement schemes or changes in the provision of services can have
a major impact on equity and accessibility issues for the target populations. The issue of
co-payments both as a societal equity question as well as an element of the financing
regulations is not considered.
1.1.1 RESEARCH QUESTIONS
Situation in Belgium
• How is home nursing currently financed in Belgium?
• Who provides home nursing in Belgium?
Dependency measurement tools for case mix financing
• What is known about the dependency and care profile of the patient
population?
• Which instruments can be applied to take into account case-mix of patients
in home nursing?
Neighbouring countries
• What are the insurance mechanisms to entitle patients to different forms of
care and nursing?
• How is the provision of home nursing organised in each country?
o What type of organisations are involved (public, semi-public, private, self
employed or organised)?
o Are there any relevant issues with regard to nursing and related care
professions to be considered in view of the financing system? (in particular
do qualification structures affect the organisation and financing of home
nursing)?
o If any, what were the major changes and motivations to adapt the
organisational model of health care provision? (e.g. the new roles of
hospitals in post-acute and disease specific chronic care)?