Le financement des soins infirmiers à domicile en Belgique - KCE

48 Financing of Home Nursing KCE reports 122
5.2.1.7 Topic 7: Critique on lump sum financing
The main critique on the current lump sum financing of nursing care is the lack of
transparency. Especially the fact that only minimal criteria are used for registration of
‘pseudocodes’, is questioned. Because registration of ‘pseudocodes’ is often lacking, it is
insufficiently known which nursing activities are performed for patients falling under the
rules of lump sum payments.
5.2.1.8 Topic 8: Out-of-pocket payments for patients
Some persons reflected on the patient’s out of pocket payments in home nursing. Two
participants from self-employed nurses mentioned that many home nurses, employeenurses
as well as self-employed nurses, did not charge for the co-payment part of the
patient. They argued that it should be mandatory to ask patients to pay the personal
contribution in order to hold them responsible, to take into account their personal
contribution for the MAB (‘maximum billing’) and to avoid abuse.
The patient in the role of manager of his budget for nursing care, such as the personal
assistance budget (PAB) for handicapped persons in the Flemish community, was not
considered as a good model, because many patients would experience difficulties to
describe their need and choose appropriate nursing care and support.
Key points
• Stakeholders had a general critique on the lack of a global vision on health care
organisation. They explained it partly as a result of the division of political
competencies on health care in Belgium.
• Stakeholders formulated detailed critiques on the fee-for service as it is
currently applied via the nomenclature of home nursing: the incompleteness for
financing different types of activities; the complexity resulting from application
of different financing mechanisms and complex rules for financing of combined
nursing activities; tariffs that insufficiently cover operational costs of workload
and time, material cost, the absence vs. availability of family caregivers, time
loss in urban traffic.
• Many stakeholders also emphasized the (potential) merits of the current
system.
5.2.2 Theme 2: Arguments for reforms
5.2.2.1 Topic 9: The extent of required change: radical or fundamental?
Reflecting on the reform process to implement new financing mechanisms, two
dominant opinions emerged: the good parts of the current system should be kept and
incremental changes would be made for solving the critiques on the system. The latter
participants agreed that the financing system should be a mixed system, partly fee-forservice
and partly lump sum payments.
5.2.2.2 Topic 10: Principles of financing
Practically all stakeholders agreed on their preference for a mixed system of fee-forservice
payments for discrete nursing activities and lump sum payments for patient
groups with higher case-mix levels. Some stakeholders expressed their preference to
limit fee-for-service financing for simple and well defined care situations, and not to use
it for complex and long term care.
Many participants pleaded that financing should take outcome and quality of care into
account. It was mentioned that the organisation and collaboration of nurses in nursing
practices/services yield merits for quality of nursing care and that therefore the financing
mechanisms should take into account the type of organisation of home nurses.