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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46 Financing of Home Nursing <strong>KCE</strong> reports 122<br />
Participants urged to develop a financing system taking into account clearly defined<br />
objectives underlying the int<strong>en</strong>ded organisation of home nursing: the integration of<br />
home nursing with hospital based care delivery and primary care (organisational<br />
objective), the promotion of good practice, the promotion of a global view on the<br />
pati<strong>en</strong>t, etc. ...<br />
5.2.1.2 Topic 2: The Belgian political compet<strong>en</strong>cies<br />
All participants were aware that the division of political compet<strong>en</strong>cies makes the<br />
organisation of home care and home nursing quite particular in Belgium: participants felt<br />
there is an issue with regard to a clear demarcation of home nursing (federal<br />
compet<strong>en</strong>cy) and family help/social care and services (compet<strong>en</strong>cy of the communities).<br />
Some participants argued to develop a regulating mechanism for making a clear<br />
distinction betwe<strong>en</strong> health care delivery and social care delivery (financing should follow<br />
the organisational model). In the curr<strong>en</strong>t situation, pati<strong>en</strong>ts can opt for the federal<br />
health care approach or for the community care for similar care. In the grey zone<br />
betwe<strong>en</strong> health care and social services, curr<strong>en</strong>tly financing is an argum<strong>en</strong>t for the<br />
pati<strong>en</strong>t to choose for health care for their basic care.<br />
5.2.1.3 Topic 3: Critiques on the complexity of curr<strong>en</strong>t financing mechanisms<br />
All participants seemed to agree on the problematic complexity of the curr<strong>en</strong>t financing<br />
mechanisms. Stakeholders disapproved of the fact that curr<strong>en</strong>tly too many differ<strong>en</strong>t<br />
mechanisms and financing sources contribute to the financing of home nursing. They<br />
m<strong>en</strong>tioned: the nom<strong>en</strong>clature, specific costs of services for home nursing, social tax<br />
reductions, subsidies for software, specific arrangem<strong>en</strong>ts with hospitals. The complexity<br />
was <strong>des</strong>cribed a consequ<strong>en</strong>ce of differ<strong>en</strong>t policy measures to substitute for the<br />
shortcomings within the basic financing mechanism (the nom<strong>en</strong>clature). Many<br />
participants urged for a simple (straightforward) financing mechanism which would offer<br />
suffici<strong>en</strong>t financing without additional ”patchwork” systems.<br />
5.2.1.4 Topic 4: Critique on curr<strong>en</strong>t fees<br />
The curr<strong>en</strong>t fees were g<strong>en</strong>erally criticized because they do not cover the real costs of<br />
home nursing. There was a cons<strong>en</strong>sus betwe<strong>en</strong> home nurses that fees should account<br />
for real costs and include differ<strong>en</strong>t cost aspects: personnel costs, material costs, travel<br />
costs, … Repres<strong>en</strong>tatives of health authorities agreed less with this statem<strong>en</strong>t. It was<br />
also m<strong>en</strong>tioned that in a society with an increasing number of persons with chronic<br />
diseases, the fee-for-service financing mechanism is not adequate if it is used to finance<br />
new tasks such as support and counselling, assessm<strong>en</strong>t, education of pati<strong>en</strong>ts,<br />
coordination, communication… These types of tasks should be integrated in a more<br />
global financing mechanism (or lump sum) of holistic nursing care of pati<strong>en</strong>ts with a<br />
chronic disease and not a separate fees for separate activities.<br />
Most participants agreed that no differ<strong>en</strong>t fees for self-employed nurses and employe<strong>en</strong>urses<br />
should be introduced. However, financing should take into account differ<strong>en</strong>t cost<br />
structures of self-employed and employee-nurses.<br />
A particular issue concerned the curr<strong>en</strong>t practice of nursing assistance in haemodialysis<br />
and peritoneal dialysis at home for which specific arrangem<strong>en</strong>ts have to be made with<br />
hospitals. Critiques on these arrangem<strong>en</strong>ts were twofold: first, financing home nursing<br />
delivery via these specific arrangem<strong>en</strong>ts with hospitals adds to the complexity of the<br />
global financing system of home nursing; secondly, it was stated that paym<strong>en</strong>ts for<br />
nurses in home nursing are too low.