Le financement des soins infirmiers à domicile en Belgique - KCE

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76 Financing of Home Nursing KCE reports 122 4 Hygien Specific hygienic care in preparation of medical examination or treatment B1 / Hygienic care in patients with ADL dysfunction 5 Fysical protection B1 425110 Transport of patients requiring permanent supervision Measures for prevention or physical laesions: physical B1 / restraints, isolation, supervision B1 / Measures for prevention of infections B1 / Measures for prevention of pressure ulcers 6 Nursing activities with regard to the medical diagnosis and treatment B1 / Measurement of parameters of different biological functions B1 Preparation and assistance in invasive medical intervention / for diagnosis B2 / Using devices for observation of different functions B2 / Sampling and collection of secretions en excretions Blood sampling B2 / - by venous and capillar punction B2 / - by an arterial catheter which is in place Carrying out and reading out cutaneous and intradermo B2 / tests 7. Assistance in medical treatments B2 / Management of surgical equipment and equipment for anaesthesia Preparation of the patient for anaesthesia and surgical B1 / interventions B1 / Participation, assistance and supervision during anaesthesia Preparation, assistance and instrumentation during medical B2 / and surgical interventions B2 /
KCE Report 122 Financing of Home Nursing 77 APPENDIX 4: CROSS-NATIONAL COMPARISON FRANCE Introduction The French health care system is based on a social insurance model in which contributions are based on income. All citizens and legal foreign residents are covered. In addition, 90% of the population subscribes to supplementary health insurance to cover other benefits not covered under NHI. Responsibilities are divided between the state (the parliament, the government and various ministries), the statutory health insurance funds and, after the reforms of 1996, regional and departmental authorities (DRASS [Regional health and social affairs services] and DDASS [Health and social affairs services at the department level]). The Social Security Funding Act of 2000 gave the state responsibility for the whole hospital sector, including private for-profit hospitals that previously were regulated by the insurance funds 75 . The Ministry of health, among other tasks, divides the budgets over different health care sectors (and if hospitals are concerned over regions). The health insurance schemes are under the supervision of the Social Security Directorate of the Ministry of Social Security. It has the responsibility for the financial and operational management of health insurance too. The health system is dominated by solo-based, fee-for-service private practices for ambulatory care and public hospitals for acute institutional care. Patients are free to consult each level of care and be reimbursed under NHI 76 . Insurance framework Three main health insurance schemes provide a uniform package of benefits: the general health insurance scheme (Régime Général), the agricultural scheme (Mutuelle Sociale Agricole, MSA) and the national insurance fund for self-employed non-agricultural workers (Régime Social des Indépendants, RSI). In addition, there remain several insurance systems for some professional groups who already had insurance coverage in 1945, including civil servants, mariners, miners, railway-workers, and employees of the national bank 75 . In 2000 the Universal Health Coverage Act (Couverture Maladie Universelle, CMU) was introduced, opening up the right to statutory health insurance coverage on the basis of legal residence in France and for persons below a certain income level 75 . Reimbursement is regulated through uniform rates. The financing is supported by employers, employee contributions, and personal income taxes. Major reforms were adopted in 2004: the Public Health Policy Act and the Health Insurance Reform Act, followed in 2005 by new agreements between the national health insurance funds and medical trade unions on rules governing private practice. The Public Health Policy and Health Insurance Reform Act insist on the role of the state and parliament in priority setting in the health sector. They give more power to local and/or dedicated structures for implementation. The Health Insurance Reform Act also renewed the governance of national health insurance by reinforcing still further the position of the government in national insurance fund management. A new branch (the fifth) of the social security system was created in 2005 to provide support to people living with disabilities 75 . The three main insurance funds (Régime Général, MSA and RSI) are federated in a National Union of Health Insurance Funds (Union Nationale des Caisses d’Assurance Maladie, UNCAM). This new federation has become the sole representative of the insured in negotiations with the state and health care providers. In order to regulate ambulatory health care expenditure, the director-general of UNCAM now has more power than the health insurance funds had previously, to negotiate with the doctors’ unions and other professionals in private practice.
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Le financement des soins infirmiers à domicile en Belgique - KCE

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