Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE

8 Maternal Intensive Care in Belgium KCE Reports 94
To help them work together in this context a list of maternal pathologies was made for
which procedures of consultation were considered necessary concerning conditions and
circumstances for intra-uterine transfer.
I. Given the Belgian context it is recommended that any mother has the freedom to
choose the accredited MIC-service she wants if she needs maternal intensive care as
well as to choose the accredited NIC-service where she wants her child(ren) who
need(s) neonatal intensive care, to be treated.
In other words, it is not allowed that any M, N* en P* makes exclusive contracts for
transferring these patients among each other.
1.3.3 NIC-services in Belgium (1996)
A few years after the publication of the WENZ-report, a new Royal Decree changed
the existing accreditation criteria of the n-service into the N*-function, while the Nservice
were replaced by the NIC-service. At the same time, the new P*-function
(regional perinatology) was created. This new function combines the NIC-service and
MIC-service which is both located at the same hospital campus.
The new Royal Decree implements almost all recommendations proposed by the
WENZ-commission. The most important exception is that this R.D. does not specify
the list of maternal pathologies for which written procedures concerning consultation
between the chief-clinicians of M-service, the N*-function and the P*-function is deemed
necessary.
The Royal Decree of August 1996 also specifies, as recommended, that the MIC-service
should be staffed at all times with at least 2 FTE midwives, who are trained on a regular
basis in the care of high-risk pregnancies.
Since then, the hospital budget is adjusted for the extra personnel costs in the Mservices
with an accredited MIC-service.
1.3.4 Perinatal Hospital Care (1996)
Hospitals with accredited MIC and NIC-services treat patients that need more intensive
care than hospitals with accredited M and N*-services only. They need to be
reimbursed separately for these intensive care treatments. This assumes that
parameters are found that measure differences in workload and other cost-drivers. This
assumes also that mothers and newborns can be classified between those who need
intensive care and those who don’t.
The Belgian Federal Science Policy Office (previously known as the Federal Office for
Scientific, Technical and Cultural Affairs) has financed a research project to develop a
more appropriate financing system for perinatal hospital care in Belgium that promotes
efficiency and equity in this field. The study (promoters: L. Cannoodt and A. Vleugels)
focussed primarily on the financing of neonatal services. In one chapter of this study
efforts were made to classify patients that need maternal intensive care versus other
maternal care. The list of high-risk pregnancies, developed by the WENZ-commission,
(see above 1.2. H.) was translated into codes of ICD-9-CM. As it turned out, it was not
possible to determine from the ICD-9-CM codes only whether the patient needed to
be transferred to a MIC-service or could be treated in a regular M-service facility. The
same analysis was attempted using the minimal nursing data-set ( M.V.G. – R.I.M.) and
the physician reimbursement fee schedule (nomenclature). It was concluded that these
two classification systems were also not useful to distinguish between MIC– and Mpatients.
Therefore, the Obstetrical experts of the FPZ-commission recommended that the Chief
Obstetrician of each M-Service should make written agreements with the Chief
Obstetrician of at least one MIC-service about the conditions and circumstances where
consultation and/or transfer of patients to a MIC-service is recommended, based on the
following (translated) classification: