Le financement des soins infirmiers à domicile en Belgique - KCE

56 Financing of Home Nursing KCE reports 122
A methodological difficulty of the study is that the review of scientific articles yielded in
just a small number of studies. Most of the information on financing of nursing and the
place of home nursing in the health care system is found in grey literature, unpublished
reports, policy documents and websites. We did not find any studies in which a formal
evaluation of the financing approach leads to a conclusion of the effect or impact of
financing mechanisms with regard to home nursing.
The search on evaluation scales was contractually limited to the BESADL-scale, APAscale,
AGGIR, RAI, and SMAF. Only few papers about case-mix funding for home care
are found. Moreover, conflict of interests are frequent because the authors who publish
are often linked with conception or implementation of the tool assessed. The difficulty
to find independent authors and validation research explains why this research area is a
field of controversy and debate. The levels of evidence are frequently low, few studies
using random samples.
Key points
• This report uses a rather narrow approach on the concept of home nursing
determined by the existing financing framework of home nursing at the federal
level in Belgium. On many issues the delineation between home nursing and
home care is difficult to make.
• The study uses the perspective of financing the providers. It did not address the
question of patients’ accessibility and equity. The economic literature clearly
indicates that each financing mechanism has direct and indirect consequences
for the patients.
• The search on evaluation scales was limited.
6.2 THE FINANCING OF HOME NURSING
In this section, we use the framework of PEST-analysis to discuss some developments
and considerations surrounding the debate on the financing of home nursing. The
framework focuses on four dimensions to asses the macro-environment in which policy
discussions evolve: political (P), economical (E), Social (S) and Technological (T) factors
6.2.1 Political factors
During the stakeholder discussions, it was often mentioned that a more elaborated
vision and perspective on the organisation of Belgian health services in general and
home nursing in particular is needed. The lack of a global and integrated vision on the
positioning of different health services within the societal developments has a potential
negative impact on positioning of home nursing in the health care field. Some of the
countries studied (e.g. Germany and the Netherlands) have introduced health insurance
reforms (and thus financing) based on a debate of the role of different health service
functions within a changing health care field. One of the challenging future issues in
Belgian home-nursing will therefore consist of positioning the different functions of care
and nursing in an organisational framework. In a Belgian context this will necessary
require structured negotiations between the different Ministers at different political
levels. It is currently observed that home nursing and family support services are visiting
the same patients and families and sometimes offer overlapping activities, while both are
financed according to different financing mechanisms. A political reform will require a
clear assessment of the evolutions and choices made on the overall priorities in
organising health care for a population. For home care and home nursing this will
require to consider two major societal shifts. On the one hand, the length of stay
reduction in hospitals going hand in hand with transfer of a number of technical and
specialised nursing activities and skills between sectors. On the other hand, there are
major demographic changes and a growing need for chronic care provision at home.