Le financement des soins infirmiers à domicile en Belgique - KCE

8 Financing of Home Nursing KCE reports 122
Key points
• The Belgian health system is a Bismarck-type of compulsory national health
insurance.
• The Belgian health system is organised on three levels, i.e. federal, regional and
community levels impacting on the complexity in the organisation of home
care.
• Patients in Belgium participate in health care financing via co-payments.
2.2 DEVELOPMENTS RELEVANT FOR BELGIAN HOME
NURSING
The current debate on home care financing in Belgium is strongly embedded in the
discussions on an adequate tackling of future healthcare needs of the ageing population,
the changing complexity of home nursing and the development of new organisational
models in providing home nursing services. One of the societal and policy objectives for
the future is aiming at substituting institutional healthcare as much as possible by
alternatives, among which home care, and home nursing will be an important
component. This policy shift is necessary because of demographic changes (including
expected changes in available workforce), in issues of long term dependency and social
participation, and not to be forgotten issues of an efficient allocation of public
resources. Recent reports forecasted an increase of expenditures for nursing home
care in order to adequately tackle health problems of the ageing Belgian population and
to provide a supply of nursing care as an alternative for institutionalisation 2,5 . For the
period 1971 to 2000, the yearly increase of public healthcare expenses due to the
ageing of the population was estimated to be around 0.5% 6 . This yearly increase of
public expenses in health care could be as high as 0.7% for the years 2001 to 2030 7 . This
is mainly due to some chronic diseases which are associated to higher age such
hypertension, diabetes, osteoporosis, cataract, and glaucoma 3, 8 .
In recent years, the organisational context and the complexity of care provided in home
nursing has changed due to shorter lengths of hospital stays, increased importance of
day hospital admissions, higher demands for collaboration between nurses, higher need
for integration of nursing care in primary care and increased interest of home nurses to
participate in shared care provision with hospitals as we see in a higher use of care
pathways 9 .
The Belgian public financing system of home nursing seems not to be fully adapted to
these evolutions and challenges. Since 1998, yearly expenditures for home nursing make
up 4.1% to 4.5% of total health care expenditures by the NIHDI (Table 1). Since 1999,
the yearly proportional increase of home nursing expenditures averaged 6.9%,
compared to the 5.9% average increase of total health care expenditures.