Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
In the same wway,
an assessmeent
of the economic
impact of thee
after-
hours services makes sense if ambulatory servic ces provided by the GP
are compared wwith
hospital emergency
services. As stated in the sstudy
of
UCL-KULeuvenn
(see 8.1.1.1) hoospital
emergenc cy wards are ofteen
used
for non-seriouss
health problems whilst the cost per p patient is highher.
It is
expected that reallocating patiients
from hospi ital emergency ccare
to
primary care faccilities
may have eeffects
on costs.
6.4.2. Limitaations
of the ODC
description
The economic ddescription
of ODCs
has limitations s:
• The first oone
is that the iniitial
objective of the t financing of tthe
first
ODCs projects
was to solvee
local organizatio onal problems, wwith
little
attention too
economic conseequences
at a larg ger scale. The avaailability
of economic
data is thereforre
limited.
• The data hhave
been gathereed
by the ODCs th hemselves: the acccuracy
and standaardization
(e.g. iteems
classification)
are unknown. TThere
is
no data too
calculate the reeal
costs of the ODCs O and perforrm
their
economic eevaluation.
• The differeences
in the ODC’s
running periods s (the first one haas
been
financed in
2003) make economic comp parisons and syynthesis
complicateed.
• Some ODCCs
benefit from oother
sources of financing f and/or ffacilities
e.g. Cerclees/Kringen,
local AAuthorities,
private e organizations.
• Many factoors
influence the rreal
costs of the ODCs: O urban versus
rural
area, the population coverage,
opening times,
day versus
night
activities, the
proximity of ann
hospital, the sec curity problems faaced
by
the GP.
• The approximation
of the ccovered
populatio on makes matterss
worse
for the estimate
per inhabitaant.
6.4.3. Wayss
for the future
This analysis sshows
the variatioons
between the budgets allocatedd
to the
ODCs, based oon
their self-reporrt.
In England, a survey s has pointeed
out a
gap between thhe
theoretical meeans
allocated to the ODCs and tthe
real
needs measureed
by the actuaal
costs. A sound
evaluation shoould
be
necessary in Beelgium
to estimatte
the real cost to implement an ODDC
and
during the yearss
afterwards.
Affter-Hours
Primaary
Care
There are currenntly
no criteria to evaluate the perttinence
of the finaancial
means necessaryy
to implement thee
after-hours caree.
In the future, a list of
criteria should be used in order to eestimate
the ODCC
budget.
Keypoints – Anaalysis
of available
economic dataa
• Financial infformation
on outt
of hours was avvailable
in 4
countries : TThe
Netherlands,
Denmark, UK, FFrance
and
Switzerland (Zurich). Common
results show:
o Differennt
costs accordinng
to the mode oof
contact: visits are
more exxpensive
than coonsultations
and telephone calls; ;
o That consultations
are mmuch
more expeensive
in emergency
departmments
than in ODDCs
and GP officees
(the less
expensiive
solution);
o That rurrality
is a specificc
factor that deteermines
higher
costs.
• For the yearr
2011, the total bbudget
allocatedd
by the NIHDI waas
€
10.3 Million.
• There is a laack
of informatioon
on economic aaspects
of the ODCs.
More than twwo
thirds of expeenses
are relatedd
to personnel. TThe
major sourcce
of revenues iss
the subventionss
allocated by thhe
NIHDI. The ccurrent
system reelies
on requestss
from the ODCss
but
does not consider
differencees
between (andd
homogeneity
within) rurall
and urban areass.
• In the futuree,
there is a needd
for a sound evaaluation
of the affter
hours system
with an evaluaation
of the activvities
and expensses
to make acccurate
previsionss
for the followinng
years.
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