Le financement des soins infirmiers à domicile en Belgique - KCE

KCE Report 122 Financing of Home Nursing 19
Patients with a palliative medical certificate receive higher reimbursement on top of
general reimbursement rules for home nursing.
Calculating the tariff
The tariff/honorarium for each nursing intervention is calculated by multiplying a generic
value of the key-letter W with a specific coefficient for that nursing intervention: e.g. for
hygienic care on weekdays at the patients’ home, the coefficient equals 1.167 (see
Appendix 2). The honorarium equals € 4.82 and it was calculated by multiplying
€ 4.13113 (value of W on January 1 st , 2009) with 1.167 (coefficient of hygienic care on
weekdays). The value of the key-letter W depends on the Belgian health index which is
used for adapting the nurse’s wages.
For the years 1995-2005, the evolution of W-value was lower (+17%) than the
evolution of the health index (+18%), which means that the evolution of tariffs was
lower than the evolution of the nurse’s wages. As a consequence, organisations
employing home nurses were confronted with higher personnel cost increases than the
incremental fees-for-service. Since 2006, the evolution of the W-value equals the
evolution of the health index.
The value of the coefficient is determined by the NIHDI agreement committee and is
specific for each activity delivered at a particular moment (week-weekend) and location
(at home, group homes for handicapped persons, …). Using different values of the
coefficient, different tariffs were established for care provision on weekdays and during
the weekend or official holidays.
Honoraria were determined for a limited set of nursing interventions delivered in the
nurse’s practice room or in a temporary or final group homes for handicapped persons.
The honorarium/fee for a single nursing intervention may change by adjusting the
coefficient. For example, in 2007, the tariffs for intravenous injections were re-evaluated
by adjusting the coefficient from 0.484 to 0.532 (+10%).
Limitation and ceilings
In order to limit supply-induced care provision in the fee-for-service financing, a
maximum day-limit was fixed based on the amount of level A lump sum payment.
With regard to costs of materials, there is no general rule. It is assumed that an implicit
consensus exists (in the agreement committee and in NIHDI) that the honorarium/fee
for common technical nursing interventions includes the costs of small disposable
materials needed for administering these nursing interventions (G. Lombaerts, NIHDI,
2009; personal communication). With regard to more expensive materials for specific
technical nursing interventions (e.g. the tube for connecting an intravenous perfusion), a
NIHDI-guideline on the nursing intervention ‘Installation of a permanent catheter or
material/needle for medication administration in an implantable medication infusion
device’, which specifies that the required materials are comprised in the honorarium.
The required average numbers of visits per day in patients in the lump sum financing
system are:
• Level A lump sum financing: 1.15 visits per day on average
• Level B lump sum financing: 1.40 visits per day on average
• Level C lump sum financing: a minimum of 2 visits per day
Linking reimbursement to qualifications
In the past, reimbursement and tariffs were generally not linked to the qualification level
of the nurse: all nurses were authorized to perform most of the nursing interventions of
the nomenclature. Recently there is a growing trend to allow reimbursement of some
nursing interventions only if they are performed by nurses with higher professional
qualifications. For example, self-management education of a diabetic patient is only
reimbursed if performed by a specialist nurse in diabetes.