Étude de faisabilité de l’introduction en Belgique d’un système de financement hospitalier «all-in» par pathologie [printed text] / Stefaan Van de Sande  , Author ; Dorien De Ryck, Author ; Kristel De Gauquier , Author ; Rebecca Hilderson, Author ; Mattias Neyt , Author ; Gert Peeters, Author ; Nathalie Swartenbroekx, Author ; W Tambeur, Author ; G Vanden Boer, Author ; Carine Van de Voorde, Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2010 . - vii, 143 p. : ill. ; 30 cm.. - ( KCE Reports B. Health Services Research (HSR); 121B) . ISSN : D/2010/10.273/02 : 0 € Etude n° 2007-21 Languages : English ( eng) French ( fre)
| Descriptors: |
Classification
WX 157 Financial administration. Business management. Cost accounting
Indexation
2007-21 ; Cost Allocation ; Diagnosis-Related Groups ; Health Care Reform ; R121 ; Reimbursement Mechanisms
|
| Abstract: |
Le Centre fédéral d’expertise des soins de santé (KCE) a examiné, en collaboration avec des chercheurs de l’UZ Leuven, la faisabilité et l’impact éventuel de l’introduction d’un système de financement “all-in” des hôpitaux en Belgique. Il s’agit d’un mode de rémunération dans lequel les hôpitaux recevraient un montant forfaitaire en fonction du nombre et de la nature des pathologies qu’ils prennent en charge. Plusieurs pays voisins appliquent déjà un tel système dans le but de responsabiliser financièrement les hôpitaux et d’accroître leur efficience. Le “All-in” est praticable en Belgique et préférable aux réformes fragmentaires et compliquées introduites jusqu’à présent. Cependant, le KCE recommande de rechercher un consensus préalable entre les parties prenantes et de n’introduire ensuite le système que de façon progressive. |
| Contents note: |
INTRODUCTION . 5 - - 1.1 GENERAL BACKGROUND OF THE STUDY . 5 - - 1.2 AIMS, SCOPE AND METHODS . 6 - - 1.3 STRUCTURE OF THE REPORT . 6 - - 2 A BRIEF INTRODUCTION TO HOSPITAL REIMBURSEMENT SYSTEMS AND - - COSTING METHODOLOGIES . 7 - - 2.1 HOSPITAL REIMBURSEMENT SYSTEMS . 7 - - 2.1.1 Principal objectives of a health care system . 7 - - 2.1.2 Typology of hospital reimbursement systems . 9 - - 2.2 DEVELOPING AND RATING DRGS FOR PROSPECTIVE HOSPITAL PAYMENTS . 15 - - 2.2.1 DRGs: definition, types and weights . 15 - - 2.2.2 Costing methodology . 20 - - 2.2.3 Conclusion . 22 - - 3 STRUCTURE OF THE HOSPITAL SECTOR AND HOSPITAL REIMBURSEMENT - - IN BELGIUM . 23 - - 3.1 FINANCIAL FLOWS AND RESPONSIBILITIES IN THE BELGIAN HEALTH CARE SECTOR 23 - - 3.2 HEALTH CARE PROVIDERS IN BELGIUM . 26 - - 3.2.1 Typology of hospitals . 27 - - 3.2.2 Typology of health care professionals. 28 - - 3.3 REGULATORY FRAMEWORK FOR HOSPITALS . 28 - - 3.3.1 Planning and programming . 28 - - 3.3.2 Recognition . 29 - - 3.3.3 Accreditation . 30 - - 3.3.4 Supply restrictions on the number of health care professionals . 30 - - 3.4 FINANCING OF HOSPITAL ACTIVITIES: PRICE REGULATION AND PROSPECTIVE - - PAYMENTS . 31 - - 3.4.1 Remuneration of health care professionals in hospitals . 31 - - 3.4.2 Hospital reimbursement for non-medical activities . 32 - - 3.4.3 Prospective payments for a selection of hospital activities . 37 - - 3.4.4 Other sources of hospital financing . 41 - - 3.4.5 Capital financing . 43 - - 3.4.6 Other financial resources . 44 - - 3.4.7 Hospital financing in numbers . 45 - - 3.5 DISCUSSION AND CONCLUSION . 45 - - 4 ACTIVITY-BASED HOSPITAL FINANCING: A REVIEW OF ENGLAND, - - GERMANY, FRANCE, DENMARK AND AUSTRALIA (VICTORIA) . 48 - - 4.1 RATIONALE AND SCOPE . 48 - - 4.1.1 Rationale . 48 - - 4.1.2 Scope . 48 - - 4.2 METHODOLOGY . 49 - - 4.3 RESULTS . 49 - - 4.3.1 General information on healthcare system . 49 - - 4.3.2 DRG classification system . 50 - - 4.3.3 Calculation of costs . 51 - - 4.3.4 Outliers . 52 - - 4.3.5 Determining the DRG tariff . 53 - - 4.3.6 Funding characteristics of specific hospital activities . 54 - - 5 BELGIAN HOSPITAL ACTIVITY AND THE APR-DRG GROUPER: DATA AND - - METHODOLOGICAL ISSUES . 71 - - 5.1 DEFINING HOSPITAL SAMPLES . 72 - - 5.2 DATA SOURCES: HOSPITAL CASE-MIX, BILLING AND ACCOUNTING DATA . 73 - - 5.2.1 Minimal Clinical Data (MCD) . 73 - - 5.2.2 Hospital billing Data (HBD) . 74 - - 5.2.3 MCD-HBD linkage . 74 - - 5.2.4 Minimal Nursing Data (MND) . 74 - - 5.2.5 Day care Billing Data (DBD) . 75 - - 5.2.6 Accounting data: Finhosta. 75 - - 5.3 THE PRICE MODEL . 76 - - 5.3.1 Introduction . 76 - - 5.3.2 Initial selection of hospital stays . 76 - - 5.3.3 Construction of variables . 78 - - 5.3.4 Adjustments to lump sum reimbursements . 78 - - 5.3.5 Budget of financial means (BFM): inpatient fraction and primary/secondary exclusions . 80 - - 5.3.6 Data cleaning . 82 - - 5.3.7 Final representativeness of the database used for the price model . 82 - - 5.3.8 Hospital severity scoring . 83 - - 5.3.9 The homogeneity challenge . 83 - - 5.3.10 Small cell size . 86 - - 5.3.11 APR-DRG sub-grouping . 87 - - 5.3.12 Separation of (excessively) distorting price components . 89 - - 5.3.13 Conclusions on the price model . 90 - - 5.4 THE COST MODEL . 92 - - 5.4.1 Activity Centre-Care Programme model (AC-CP) . 92 - - 5.4.2 Data and methodological issues in the cost model . 101 - - 5.4.3 The homogeneity challenge and variability . 105 - - 5.5 APR-DRG-SOI BASED HOSPITAL ALLOCATIONS . 108 - - 5.5.1 APR-DRG weighing . 108 - - 5.5.2 Nominator - denominator rule . 109 - - 5.5.3 APR-DRG level allocations . 109 - - 5.5.4 Hospital level allocations . 110 - - 5.6 HOSPITAL TYPOLOGIES . 110 - - 5.6.1 Objective . 110 - - 5.6.2 Selection of descriptive variables and their correlation . 111 - - 5.6.3 Dimensioning hospital characteristics . 111 - - 5.6.4 Conclusions . 114 - - 6 BUILDING BLOCKS AND MACRO SIMULATION . 115 - - 6.1 DEFINING FRAMEWORK AND DATA SET . 115 - - 6.1.1 Objectives and assumptions . 115 - - 6.1.2 Framework . 116 - - 6.2 RESULTS OF THE MACRO SIMULATIONS . 121 - - 6.2.1 An all-inclusive case-based financing model . 121 - - 6.2.2 Scenario implementation . 124 - - 6.3 CONCLUSIONS . 130 - - 7 CONCLUSIONS AND DISCUSSION . 132 - - 7.1 BUILDING BLOCKS OF CASE-BASED FUNDING . 132 - - 7.1.1 Case-based funding: principles and objectives. 132 - - 7.1.2 Data and methodological issues . 133 - - 7.2 FINANCIAL IMPACT OF AN ALL-INCLUSIVE CASE-BASED FINANCING SYSTEM . 134 - - 7.3 IMPLEMENTATION ISSUES . 135 - - 7.3.1 Impact of hospital financing reform on the hospital revenue structure and on the - - relationship between hospital management and providers of health care . 135 - - 7.3.2 Impact of hospital financing reform at the macro level of the hospital sector. 136 - - 7.3.3 A selection of specific implementation issues . 136 - - 8 REFERENCES . 139 |
| Link for e-copy: |
https://kce.fgov.be/sites/default/files/page_documents/d20101027302.pdf |
| Format of e-copy: |
PDF (2,16 MB) |
| Record link: |
https://kce.docressources.info/index.php?lvl=notice_display&id=1835 |
|  |
Add the result to your basket Make a suggestion Refine your search Apply to external sourcesEssays on risk adjustment in health insurance / Leuven [Belgium] : Katholieke Universiteit Leuven (KUL) (2010)
