Financing of home nursing in Belgium

VII 121 p.ill.The main objective of this study is to provide knowledge to assess to what extent an alternative or adapted financing scheme for home nursing in Belgium is needed and possible. An important question is whether the financing principles can be based on a patient case-mix. This study is limited to homecare nursing as currently reimbursed at the Belgian federal level through the National Institute for Health and Disability Insurance (NIHDI). Home help services, social services, general practitioners, occupational therapists, physiotherapists, as well as community nursing activities such as preventive mother and child care, psychiatric care, midwifery, school health nursing and occupational nursing are beyond the scope of this study. Financing is studied from the provider perspective. Patients accessibility and equity are not addressed. This report describes the financing of home nursing in Belgium as in 4 selected European countries. It also discusses measures of patient dependency in Activities of Daily Living, currently used for case-mix financing. Finally, it reports Belgian stakeholder opinions on issues related to the future financing of home nursing in Belgium.Table of contents -- GLOSSARY 3 -- 1 INTRODUCTION 4 -- 1.1 SCOPE OF THE STUDY 4 -- 1.1.1 RESEARCH QUESTIONS 4 -- 1.1.2 Methods 5 -- 1.1.3 Structure of the report 6 -- 2 HOME NURSING IN BELGIUM 7 -- 2.1 THE BELGIAN HEALTHCARE SYSTEM: OVERVIEW 7 -- 2.2 DEVELOPMENTS RELEVANT FOR BELGIAN HOME NURSING 8 -- 2.3 THE NATURE OF HOME NURSING. 11 -- 2.4 THE ORGANISATION OF HOME NURSING IN BELGIUM 11 -- 2.4.1 Self-employed or employee nurses 11 -- 2.4.2 Qualification levels 12 -- 2.4.3 New organisational forms including nursing 13 -- 2.5 THE FINANCING OF HOME NURSING IN BELGIUM 14 -- 2.5.1 Healthcare financing concepts 14 -- 2.5.2 Historical background 16 -- 2.5.3 Current situation 17 -- 2.5.4 Types of home nursing activities financed 24 -- 2.5.5 Discussion 25 -- 3 CROSS-NATIONAL COMPARISON 28 -- 3.1 INTRODUCTION 28 -- 3.2 RESULTS 28 -- 3.2.1 The financing of home nursing 28 -- 3.2.2 The organisation of home nursing 29 -- 4 DEPENDENCY TOOLS FOR CASE-MIX FINANCING IN HOME NURSING 33 -- 4.1 INTRODUCTION 33 -- 4.2 RESULTS 33 -- 4.2.1 Nursing dependency scales 33 -- 5 STAKEHOLDER DIALOGUE 44 -- 5.1 INTRODUCTION 44 -- 5.2 THEMATIC ANALYSIS 44 -- 5.2.1 Theme 1: The current financing system 45 -- 5.2.2 Theme 2: Arguments for reforms 48 -- 5.2.3 Theme 3: Nursing related topics 49 -- 5.2.4 Theme 4: Assessment and registration instruments 51 -- 5.3 SUMMARY. 53 -- 6 OVERALL DISCUSSION 55 -- 6.1 SCOPE AND LIMITATIONS OF THE STUDY 55 -- 6.2 THE FINANCING SYSTEM FOR HOME NURSING 56 -- 6.2.1 Political factors 56 -- 6.2.2 Economical factors 57 -- 6.2.3 Social Factors 58 -- 6.2.4 Technological Factors 58 -- 6.3 BUILDING BLOCKS OF A FINANCING SYSTEM FOR HOME NURSING 59 -- 6.3.1 A mixed financing model 59 -- 6.3.2 Financing nursing interventions 60 -- 6.3.3 Financing per number of patients. 60 -- 6.3.4 Financing according to patient needs 61 -- 6.3.5 Financing and nurses characteristics 63 -- 6.3.6 Adaptation of the current funding system, the readjustment or the calculation of new -- tariffs 64 -- 6.3.7 The organisation 65 -- 6.3.8 The results/ performance 65 -- 7 REFERENCES 67 -- 8 APPENDICES 7