Organisation and payment of emergency care services in Belgium : current situation and options for reform - Short Report

58 p.ill.,FOREWORD . 1 -- SHORT REPORT 2 -- 1 INTRODUCTION . 6 -- 1.1 WHAT ARE EMERGENCY CARE SERVICES? . 6 -- 1.2 SCOPE AND OBJECTIVES 7 -- 1.2.1 Objective and scope of the study 8 -- 1.3 METHODS. 8 -- 2 CURRENT ORGANISATION AND ACTIVITY PROFILE OF EMERGENCY DEPARTMENTS IN BELGIUM 10 -- 2.1 ACCESS TO EMERGENCY DEPARTMENTS: (SELF-)REFERRALS OR EMERGENCY CALLS .10 -- 2.2 ROLE AND TYPES OF EMERGENCY DEPARTMENTS . 11 -- 2.3 VAST MAJORITY OF HOSPITAL SITES HAVE SPECIALISED EMERGENCY DEPARTMENTS .12 -- 2.4 ACTIVITY PROFILE OF BELGIAN EMERGENCY DEPARTMENTS.14 -- 2.4.1 A high and increasing number of ED visits, especially ambulatory and self-referred ED visits 14 -- 2.4.2 Activity on EDs peaks during office hours. 15 -- 2.4.3 EDs have a highly variable caseload 16 -- 2.4.4 Not all emergency department visits are emergencies, but are they inappropriate?17 -- 2.5 WORKFORCE. 18 3 ORGANISATION AND ACTIVITY OF OUT-OF-HOURS PRIMARY CARE SERVICES .20 -- 3.1 THE CONTEXT OF PRIMARY CARE IN BELGIUM . 20 -- 3.2 ORGANISATION OF OUT-OF-HOURS PRIMARY CARE SERVICES 20 -- 3.2.1 Shift from local rotation systems to larger GP cooperatives .20 -- 3.2.2 ODCs are bottom-up initiatives mainly initiated to improve working conditions of GPs .21 -- 4 PAYMENT SYSTEMS FOR OUT-OF-HOURS PRIMARY CARE AND EMERGENCY DEPARTMENT SERVICES IN BELGIUM 26 -- 4.1 PUBLIC PAYMENTS FOR THE EMERGENCY DEPARTMENT AND ITS WORKFORCE .26 -- 4.1.1 The hospital budget for emergency departments is increasingly based on ED activity26 -- 4.1.2 Fee-for-service reimbursement is still the predominant payment method for physicians working in an emergency department . 28 -- 4.2 PUBLIC PAYMENTS FOR OUT-OF-HOURS PRIMARY CARE SERVICES.29 -- 4.2.1 Fee-for-service is also the dominant payment method for general practitioners 29 -- 4.2.2 ODC budgets have been streamlined . 30 -- 4.3 PATIENT COST SHARING FOR OUT-OF-HOURS PRIMARY CARE AND EMERGENCY DEPARTMENT SERVICES. 31 -- 5 REFORM PROPOSALS: A MULTI-FACTORIAL APPROACH THAT REQUIRES MONITORING .32 -- 5.1 TELEPHONE TRIAGE TO GUIDE PATIENTS TO THE APPROPRIATE CARE LEVEL AND PLACE, AT THE RIGHT MOMENT . 32 -- 5.2 HARMONIZATION ORGANISATION OF EMERGENCY DEPARTMENTS AND OUT-OF-HOURS GP CARE. 34 -- 5.2.1 Should ODCs decrease the number of ED visits? Stakeholders disagree and a clear policy directive is missing 34 -- 5.2.2 Implementation of ODCs: increased use of out-of-hours GP services did not result in a decreased use of ED attendances 34 -- 5.2.3 Increased collaboration between ODCs and EDs but to what extent?.35 -- 5.3 THE IMPACT OF PUBLIC INFORMATION CAMPAIGNS 37 -- 5.4 CO-PAYMENTS HAVE ONLY LIMITED EFFECT ON STEERING PATIENTS TO THE RIGHT CARE SETTING . 37 -- 5.5 RATIONALISATION OF ACUTE CARE RESOURCES: SMALL CHANGES OR A DRASTIC REFORM? . 37 -- 5.5.1 Belgium has a high (specialised) ED capacity 37 -- 5.5.2 Integrate redesigning of emergency departments in a larger reform of healthcare services38 -- 5.6 INTERVENTIONS THAT FOCUS ON FREQUENT ED USERS AND OTHER SPECIFIC TARGET GROUPS . 40 -- 5.7 GETTING PAYMENTS FOR OUT-OF-HOURS PRIMARY CARE AND EMERGENCY DEPARTMENT SERVICES RIGHT 40 -- 5.7.1 The current mix of ED revenue sources: a drive for production and no incentives for collaboration with primary care . 40 -- 5.7.2 Working in an ODC is rewarding during the day but not at night 44 -- 5.7.3 Comparing budgets and activity of ODCs and EDs: value for money? 44 -- 5.7.4 A larger share of fixed payments to emphasize the availability function of emergency care services . 44 -- 5.7.5 Volume-based payments to allocate resources to where care actually takes place 45 -- 5.7.6 A coordinated payment system across care settings .47 -- 6 CONCLUSION 47 -- REFERENCES 5