Le financement des soins infirmiers à domicile en Belgique - KCE

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6 Financing of Home Nursing KCE reports 122 Main sources of information were documents and annual reports from NIHDI website (http://www.inami.fgov.be in French; http://www.riziv.fgov.be in Dutch) and a recent NIHDI report on home nursing 2 . Other grey reports provided general overviews and outlines, basic or partial descriptions and analysis of minor topics on organisational and financial aspects of home nursing 3-5 . A lot of the relevant “descriptive” information on the organisation and financing of home nursing in neighbouring countries was obtained through collecting grey literature (official government, websites, research and policy reports). The descriptive information was collected through an incremental search of documents and accessible official websites. Local experts were contacted to complete and/or validate the information found in all documents and websites. 1.1.3 Structure of the report After this introduction, chapter two presents the organisation and financing of home nursing in Belgium. Chapter three compares the organisation and financing of home nursing in 4 European countries. The fourth chapter discusses case-mix tools for home nursing. The fifth chapter makes an overview of opinions and remarks of Belgian stakeholders on the current financing system. The final chapter resumes the acquired knowledge to reflect on alternative financing methods for home nursing.
KCE Report 122 Financing of Home Nursing 7 2 HOME NURSING IN BELGIUM 2.1 THE BELGIAN HEALTHCARE SYSTEM: OVERVIEW The Belgian health system is a Bismarck type of compulsory national health insurance, which covers the whole population and has a very broad benefits package 3 . The Belgian health system is mainly organised on three levels, i.e. federal, regional and community levels. Since 1980, part of the responsibility for health care policy has been devolved from the federal Government to the community levels. The communities are responsible for so-called person-related matters, such as healthcare and welfare. The 1980 Institutional Reform Act defines the person-related matters in the sphere of health care policy as intramural and extramural curative health care and the policy regarding health education, health promotion and preventive health care. In both cases, the law provides important exceptions as a result of which the federal Government has kept important powers. Interministerial Conferences (composed of the ministers responsible for health policy from the federal and regional governments) have to facilitate cooperation between the federal Government and the communities. They have no binding decision-making power. Since the Health Insurance Act of 9 August 1963, compulsory health insurance is combined with a private system of health care delivery, based on independent medical practice, free choice of service provider and predominantly fee-for-service payment. The 1963 law endorsed the financing, reimbursement and organisation principles of Belgian health care. Important elements introduced by this law are: • Introduction of a fee-for-service system of reimbursement through a system of medical nomenclature; • Introduction of a system of conventions and agreements between sickness funds and health care providers, setting the prices for medical services and regulating their financial and administrative relationship. All individuals entitled to health insurance must join or register with a sickness fund: either one of the six sickness funds, including the health insurance fund of the Belgian railway company, or a regional service of the public Auxiliary Fund for Sickness and Disability Insurance 3 . Patients participate in health care financing via co-payments. There are two systems of payment: (i) a reimbursement system, for which the patient pays the full costs of services and then obtains a refund for part of the expense from the sickness fund, which covers ambulatory care; and (ii) a third-party payer system, for which the sickness fund directly pays the provider while the patient only pays the co-insurance or co-payment, which covers inpatient care and pharmaceuticals. The National Institute for Sickness and Disability Insurance (NIHDI) is responsible for the general organisation and financial management of the compulsory health insurance. Its most important tasks are to prepare and implement legislation and regulation, to prepare the budget, to monitor the evolution of health care spending, to control whether legislation and regulation are correctly implemented by health care providers and sickness funds and to organise the consultation between the different actors involved in the compulsory health insurance 3 . Within the NIHDI, besides other stakeholders, home nurses’ professionals’ associations are represented in the Agreement Commission for home nursing. In other agencies they are represented in different advisory bodies dealing with organisational issues.
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Le financement des soins infirmiers à domicile en Belgique - KCE

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