Le financement des soins infirmiers à domicile en Belgique - KCE

KCE Report 122 Financing of Home Nursing 59
Key points
• A political reflection is needed on the intended role of health services functions
within an overall vision of health services provision. One of the challenging
issues in Belgian home-care and nursing will require structured negotiations
between the different Ministers at different political levels.
• Two major societal shifts should be considered. 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.
• Little is currently known on the cost structure of home nursing. It is thus very
difficult to assess objectively to what extent the current financing is covering
the real costs of home nursing provision.
• An issue closely connected to the financing of the home care sector are labour
market issues.
• The financing mechanisms should be assessed against the background of
intended objectives. For chronic patients the emphasis could be set on self-care
support, increasing the abilities of patients and their families rather than
getting support for punctual technical nursing acts. The latter could be more
appropriate for post acute care (e.g. as a result of early discharge or specialised
nursing acts that can be provided in a home care setting).
• Developments in tele-monitoring, patient support tools, independent living
technology are considered as key factors in the future development of home
care. One of the future challenges will be to assess to what extent these new
technologies will affect on how nursing care and support could be organised and
financed
6.3 BUILDING BLOCKS OF A FINANCING SYSTEM FOR
HOME NURSING
6.3.1 A mixed financing model
The financing system for Belgian home nursing responds to the characteristics of a
hybrid system. A hybrid system consists of a variety of payment systems which are used
simultaneously for financing care in a certain treatment setting 13 . This is in line with the
systems found in the neighbouring countries studied where also hybrid systems are
installed. Most of our Belgian stakeholders wanted to maintain this hybrid, mixed model,
but also agreed on the fact that the current financing system is not well adapted to the
changing needs of our healthcare system. Many issues should be dealt with such as:
• In most countries studied a difference is made between acute home care
following an acute onset requiring hospital stay and long term care for
patients with chronic conditions and high levels of dependency.
• Many countries make the distinction in the way they finance basic nursing and
specialised, technical nursing. The former is mostly paid by a global budget
based on an assessment of dependency. The latter is mostly paid on a fee-forservice
basis.
• Many countries integrate home nursing and home care in one overall
approach.
• In general, basic care is mostly given by caregivers with a lower qualification.
Patient responsibility is taking and specialised care is giving by qualified nurses.
• The correspondence between tariffs and costs.