Le financement des soins infirmiers à domicile en Belgique - KCE
Le financement des soins infirmiers à domicile en Belgique - KCE
Le financement des soins infirmiers à domicile en Belgique - KCE
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<strong>KCE</strong> Report 122 Financing of Home Nursing 31<br />
Health insurance type<br />
and coverage<br />
Home nursing<br />
providers<br />
Table 10: Comparison of home nursing in four countries<br />
France The Netherlands Germany UK (England)<br />
• Compulsory social insurance<br />
(professional categories and<br />
resid<strong>en</strong>ce).<br />
• B<strong>en</strong>eficiaries : persons with<br />
gainful employm<strong>en</strong>t or with<br />
perman<strong>en</strong>t resid<strong>en</strong>ce in France.<br />
• Since 2004, the sickness funds<br />
are responsible for the financial<br />
stewardship of the health care<br />
system, the definition of the<br />
health care package and the<br />
regulation of prices and tariffs,<br />
the negotiation of collective<br />
agreem<strong>en</strong>ts with the providers.<br />
• Low level of copaym<strong>en</strong>t.<br />
• Differ<strong>en</strong>t types:<br />
1. hospital at home to<br />
provide hospital-level<br />
nursing for pati<strong>en</strong>ts at<br />
home;<br />
2. nursing home care<br />
services (SSIADs) for<br />
• Since 2006, a standard health<br />
care insurance package was<br />
introduced, besi<strong>des</strong> long term<br />
care (AWBZ) and social support<br />
regime (WMO).<br />
• All Dutch resid<strong>en</strong>ts are obliged<br />
to take out health insurance,<br />
paying a nominal premium,<br />
irrespective of income, age or<br />
health status.<br />
• Private health insurers (since<br />
2006).<br />
• Freedom of choice and to change<br />
health insurance.<br />
• Health insured pay an incomerelated<br />
contribution (basic<br />
premium) and a flat rate fee<br />
(supplem<strong>en</strong>tary premium).<br />
• Insurance companies are not<br />
allowed to have co-paym<strong>en</strong>ts or<br />
deductibles. They cannot d<strong>en</strong>y<br />
coverage to any person or to<br />
charge anything other than their<br />
nationally set and published<br />
standard premiums.<br />
• Private - not for profit local and<br />
regional home care<br />
organisations, operating under<br />
nationally organised umbrella<br />
organisations (kruisver<strong>en</strong>iging<strong>en</strong>).<br />
• Rec<strong>en</strong>tly indep<strong>en</strong>d<strong>en</strong>t or small<br />
scale nursing initiatives<br />
• The federal governm<strong>en</strong>t deci<strong>des</strong> the<br />
global budget and which procedures<br />
to include in the b<strong>en</strong>efit package.<br />
• The National Association of Sickness<br />
Funds and the National Association of<br />
Physicians negotiate and co-decide<br />
which b<strong>en</strong>efits are included in the<br />
sickness fund b<strong>en</strong>efit package.<br />
• Dec<strong>en</strong>tralized federal organisation.<br />
• Social insurance model. Statutory<br />
sickness funds and private insurance<br />
cover the <strong>en</strong>tire population.<br />
• Private health insurers: Freedom of<br />
insurer choice.<br />
• Separate long term care insurance<br />
(1995).<br />
• Until rec<strong>en</strong>tly, there have be<strong>en</strong> almost<br />
no co-paym<strong>en</strong>ts or deductibles.<br />
Rec<strong>en</strong>tly, copaym<strong>en</strong>ts for prescription<br />
drugs, doctors visits, and hospital<br />
stays, not for home nursing.<br />
• Social-profit organisations, (municipal<br />
services)<br />
• Private nursing services<br />
• Important differ<strong>en</strong>ce betwe<strong>en</strong> basic<br />
nursing (grundpflege) and technical<br />
nursing (behandlungspflege) regulations<br />
• G<strong>en</strong>eral taxation based<br />
model.<br />
• Publicly funded healthcare<br />
system that provi<strong>des</strong><br />
coverage to everyone<br />
normally resid<strong>en</strong>t in the<br />
UK.<br />
• It is not strictly an insurance<br />
system because (a) there<br />
are no premiums collected,<br />
(b) costs are not charged at<br />
the pati<strong>en</strong>t level<br />
• Dec<strong>en</strong>tralised model with<br />
important role of strategic<br />
health authorities.<br />
• NHS model with private<br />
trusts contracting for<br />
treatm<strong>en</strong>t and care.<br />
• Mainly through primary<br />
care trusts<br />
• Exceptionally by private<br />
indep<strong>en</strong>d<strong>en</strong>t providers
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