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Organisation of paediatric hospital care in Belgium: current situation and options for reform / Mélanie Lefevre / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2022)  

Organisation of paediatric hospital care in Belgium: current situation and options for reform [printed text] / Mélanie Lefevre , Author ; Nicolas Bouckaert, Author ; Jens Detollenaere , Author ; Joan Vlayen , Author ; Llenalia García Fernández, Author ; Hilde Pincé, Author ; Koen Van Den Heede , Author ; Renate Zeevaert, 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, 2022 . - 359 p. : ill., ; A4. - (KCE Reports. Health Services Research (HSR); 358C) . ISSN : D/2022/10.273/48 : € 0,00 Languages : English (eng) Descriptors: Indexation 2019-50-02 ; Child, Hospitalized ; Continuity of Patient Care ; Health Care Reform ; Home Care Services, Hospital-Based ; Hospital Bed Capacity ; R358 Classification WX 100 Hospitals and Other Health Facilities -- General works Contents note: LIST OF FIGURES 10 -- LIST OF TABLES 15 -- LIST OF ABBREVIATIONS .17 -- SCIENTIFIC REPORT 23 -- 1 INTRODUCTION .23 -- 1.1 THE CHANGING ROLE OF HOSPITAL CARE FOR CHILDREN .23 -- 1.2 OBJECTIVE AND SCOPE OF THE REPORT .24 -- 1.3 RESEARCH OBJECTIVES AND METHODS 25 -- PART I: THE ORGANISATION AND ACTIVITY PROFILE OF PAEDIATRIC SERVICES IN BELGIUM 27 -- 2 THE LEGAL FRAMEWORK OF PAEDIATRIC HOSPITAL CARE IN BELGIUM 27 -- 2.1 THE SYSTEM OF PAEDIATRIC CARE IN BELGIUM .28 -- 2.2 THE LEGAL FRAMEWORK OF PAEDIATRIC HOSPITAL CARE 28 -- 2.2.1 Paediatric service .29 -- 2.2.2 Care programme for children (2006) 30 -- 2.2.3 Care programme for children (2014) 31 -- 2.2.4 The specialised care programme for paediatric haemato-oncology 35 -- 2.2.5 Paediatric liaison function 37 -- 2.2.6 Paediatric network 38 -- 2.2.7 Intensive care for children 39 -- 2.2.8 Conventions 39 -- 2.3 FINANCING 39 -- 2.3.1 Paediatric service and paediatric intensive care 39 -- 2.3.2 Paediatric liaison function 41 -- 2.3.3 Conventions 41 -- 3 LANDSCAPE AND ACTIVITY PROFILE OF SERVICES PROVIDING PAEDIATRIC CARE IN BELGIAN HOSPITALS 41 -- 3.1 INTRODUCTION .43 -- 3.2 METHODS 43 -- 3.3 CURRENT LANDSCAPE OF PAEDIATRIC SERVICES IN BELGIAN HOSPITALS 44 -- 3.4 DAY CARE FOR CHILDREN 51 -- 3.4.1 Selection of stays .51 -- 3.4.2 Distribution of day-care stays .51 -- 3.4.3 Age profile of patients 54 -- 3.4.4 Clinical profile of patients .54 -- 3.5 INPATIENT PAEDIATRIC SERVICES .56 -- 3.5.1 Selection of stays .56 -- 3.5.2 Children and paediatric services 57 -- 3.5.3 Age profile of patients in paediatric services .63 -- 3.5.4 Length of stay for patients in paediatric services .64 -- 3.5.5 Clinical profile of patients .66 -- 3.5.6 Respiratory syncytial virus (RSV) 75 -- 3.6 PAEDIATRIC INTENSIVE CARE UNITS 79 -- 3.6.1 Selection of stays .79 -- 3.6.2 Children in intensive care units .79 -- 3.6.3 Adolescents in intensive care units .82 -- 3.6.4 Age profile of patients 84 -- 3.6.5 Clinical profile of patients .84 -- 4 OCCUPANCY RATE IN SERVICES PROVIDING PAEDIATRIC CARE IN BELGIAN HOSPITALS 87 -- 4.1 OBJECTIVE 87 -- 4.2 METHODS 88 -- 4.2.1 Selection of stays .88 -- 4.2.2 Computation of bed occupancy rates in paediatric services and bed use in other inpatient units .88 -- 4.3 BED OCCUPANCY RATE AND BED USE AT THE NATIONAL LEVEL 90 -- 4.3.1 Daily average bed occupancy rate for 2017 and 2018 .90 -- 4.3.2 Bed occupancy rate in 2018 subdivided by age groups 92 -- 4.3.3 Bed occupancy rate in 2018 subdivided by clinical profile of the patients 95 -- 4.3.4 Bed use outside paediatric services 99 -- 4.4 BED OCCUPANCY RATE AT THE SITE LEVEL 101 -- 4.4.1 Mean, minimum and maximum occupancy rate 101 -- 4.4.2 Number of days with high occupancy rates .107 -- 4.4.3 Number of days with low occupancy rates 108 -- 4.5 BED OCCUPANCY RATE AT THE NETWORK LEVEL 110 -- 4.5.1 Daily average bed occupancy rate for 2018 110 -- 4.5.2 Number of days with high and low occupancy rates 115 -- 4.6 LINK BETWEEN BED OCCUPANCY RATE AND SURVEY RESPONSES .118 -- 5 IMPACT AND MANAGEMENT OF SEASONAL PEAKS: RESULTS FROM AN ONLINE SURVEY 123 -- 5.1 OBJECTIVE .125 -- 5.2 METHODS 125 -- 5.2.1 Data collection process 125 -- 5.2.2 Data collection tool and questionnaire 125 -- 5.2.3 Analysis 126 -- 5.3 RESULTS .127 -- 5.3.1 Response rate .127 -- 5.3.2 Characteristics of hospitals and paediatric services 128 -- 5.3.3 Impact of seasonal peaks in paediatric services 132 -- 5.3.4 Hospital level measures to cope with seasonal peaks in paediatric services 137 -- 5.3.5 General policy measures to cope with seasonal peaks in paediatric services 140 -- 5.3.6 Loco-regional networks 147 -- 5.3.7 Impact of future trends 148 -- PART II: TRANSMURAL CARE FOR CHILDREN IN BELGIUM .151 -- 6 TRANSMURAL CARE MODEL OF THE PAEDIATRIC LIAISON TEAMS IN BELGIUM .151 -- 6.1 OBJECTIVE .153 -- 6.2 METHODS 153 -- 6.2.1 Data collection tool 153 -- 6.2.2 Data collection process 153 -- 6.2.3 Analysis 153 -- 6.3 RESULTS .154 -- 6.3.1 How does a paediatric liaison team work? 154 -- 6.3.2 Target population 157 -- 6.3.3 Type of transmural care .161 -- 6.3.4 Staff numbers, qualifications and roles 168 -- 6.3.5 Funding of paediatric liaison teams .169 -- 6.3.6 Limitations and problems indicated by the paediatric liaison teams 169 -- 6.3.7 The paediatric liaison function as a model for transmural care .172 -- 7 FACTORS INFLUENCING THE IMPLEMENTATION OF TRANSMURAL PAEDIATRIC CARE AND POINT OF VIEW OF STAKEHOLDERS IN BELGIUM 174 -- 7.1 OBJECTIVE .174 -- 7.2 METHODS 174 -- 7.3 GENERAL OPINIONS AND ATTITUDES TOWARDS PAEDIATRIC CARE .175 -- 7.4 OPINIONS AND ATTITUDES TOWARDS TRANSMURAL PAEDIATRIC CARE 176 -- 7.4.1 Terminology to describe transmural paediatric care 176 -- 7.4.2 Target population 177 -- 7.4.3 Transmural paediatric care will further erode paediatric hospital care in Belgium 177 -- 7.4.4 Impact on costs 177 -- 7.5 FACTORS INFLUENCING THE IMPLEMENTATION OF TRANSMURAL PAEDIATRIC CARE 178 -- 7.5.1 Financing 178 -- 7.5.2 Human resources 180 -- 7.5.3 Other factors to consider in the context of transmural paediatric care 183 -- 7.6 LESSONS FROM OTHER INITIATIVES 183 -- 7.6.1 Conventions .184 -- 7.6.2 Lessons from initiatives for transmural care (for adults) 186 -- 7.7 DESIGN AND EVALUATION OF FUTURE PAEDIATRIC PILOT PROJECTS 190 -- 7.7.1 Target population for transmural paediatric care 190 -- 7.7.2 Coordination .192 -- 7.7.3 Funding 193 -- 7.7.4 Distribution of medicines 195 -- 7.7.5 Setting .196 -- 7.7.6 Role of the patient and his family 196 -- 7.7.7 Uniform communication across healthcare providers and/or organisations 198 -- 7.7.8 Other aspects to consider when designing transmural paediatric care .198 -- PART III: INTERNATIONAL COMPARISON OF TRANSMURAL CARE MODELS FOR CHILDREN .200 -- 8 HOSPITAL AT HOME FOR CHILDREN IN FRANCE 202 -- 8.1 OVERVIEW OF HOSPITAL-AT-HOME SERVICES IN FRANCE 203 -- 8.1.1 Historic perspective 203 -- 8.1.2 Current legal framework .204 -- 8.1.3 HAH structures 206 -- 8.1.4 Activity volume 206 -- 8.1.5 Workforce 207 -- 8.1.6 HAH episode 207 -- 8.1.7 Types of care activities 208 -- 8.1.8 Selection of patients .209 -- 8.1.9 Financing 210 -- 8.1.10 Coordination with home nursing care services 212 -- 8.1.11 Evaluation / quality indicators .212 -- 8.1.12 Ongoing reform 213 -- 8.2 PAEDIATRIC ACTIVITY IN HAH IN FRANCE 215 -- 8.3 OVERVIEW OF SELECTED CASE STUDIES .219 -- 8.3.1 Semi-structured interviews with a selection of organisations .219 -- 8.3.2 Brief overview of selected HAH structures 220 -- 8.3.3 Transversal analysis of key topics 229 -- 9 HOSPITAL IN THE HOME FOR CHILDREN IN AUSTRALIA .238 -- 9.1 OVERVIEW OF HOSPITAL IN THE HOME SERVICES IN THE STATE OF VICTORIA (AUSTRALIA) .239 -- 9.1.1 Historic perspective 239 -- 9.1.2 Legal framework .240 -- 9.1.3 HITH structures 241 -- 9.1.4 Workforce 244 -- 9.1.5 HITH episode 245 -- 9.1.6 Types of care 246 -- 9.1.7 Selection of patients .247 -- 9.1.8 Financing 248 -- 9.1.9 Coordination with home nursing care .249 -- 9.1.10 Evaluation / quality indicators .249 -- 9.2 OVERVIEW OF HOSPITAL IN THE HOME SERVICES IN THE STATE OF NEW SOUTH WALES (AUSTRALIA) 250 -- 9.2.1 Historic perspective 250 -- 9.2.2 Legal framework .251 -- 9.2.3 HITH structures 251 -- 9.2.4 Workforce 252 -- 9.2.5 HITH episode 253 -- 9.2.6 Types of care 254 -- 9.2.7 Selection of patients .255 -- 9.2.8 Financing 255 -- 9.2.9 Coordination with home nursing care .256 -- 9.2.10 Evaluation / quality indicators .256 -- 9.3 OVERVIEW OF SELECTED CASE STUDIES .257 -- 9.3.1 Semi-structured interviews with a selection of organisations .257 -- 9.3.2 Brief overview of the selected paediatric HITH programmes .258 -- 9.3.3 Transversal analysis of key topics 260 -- 10 TRANSMURAL PAEDIATRIC CARE IN THE NETHERLANDS 268 -- 10.1 TWO REFORMS SHAPED THE CURRENT HEALTHCARE SYSTEM IN THE NETHERLANDS 269 -- 10.1.1 Main characteristics of the 2006 health insurance reform 269 -- 10.1.2 Main characteristics of the 2015 long-term care reform 269 -- 10.2 HISTORICAL PERSPECTIVE OF TRANSMURAL CARE FOR ADULTS 270 -- 10.2.1 From temporary projects to a clear policy objective 271 -- 10.2.2 Organisation of transmural care for adults 272 -- 10.3 TRANSMURAL CARE FOR CHILDREN 273 -- 10.3.1 From a fragmented policy context to a comprehensive approach for transmural care for children 273 -- 10.3.2 Strategies to ensure quality of care .279 -- 10.3.3 Funding of transmural care for children .280 -- 10.3.4 Education and training of paediatric nurses .282 -- 10.4 OVERVIEW OF SELECTED CASE STUDIES .283 -- 10.4.1 Semi-structured interviews with a selection of organisations .283 -- 10.4.2 ExpertCare 283 -- 10.4.3 KinderThuisZorg .285 -- PART IV: REVIEW OF THE LITERATURE ON PAEDIATRIC HOME THERAPY 287 -- 11 REVIEW OF THE LITERATURE ON PAEDIATRIC HOME THERAPY .287 -- 11.1 INTRODUCTION 287 -- 11.2 METHODS 287 -- 11.2.1 Research question 287 -- 11.3 LITERATURE SEARCH AND SELECTION 289 -- 11.3.1 Quality appraisal and data extraction 289 -- 11.3.2 Statistical analysis .290 -- 11.3.3 GRADE 290 -- 11.4 RESULTS .290 -- 11.4.1 Overview of selected studies 290 -- 11.4.2 Characteristics of home care 302 -- 11.4.3 Effect on outcomes by type of intervention 314 -- 11.5 DISCUSSION .329 -- APPENDICES 332 -- REFERENCES 339 Link for e-copy: http://doi.org/10.57598/R358C Format of e-copy: PDF (13 MB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4856

Organisation of paediatric hospital care in Belgium: current situation and options for reform / Mélanie Lefevre / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2022)  

Organisation of paediatric hospital care in Belgium: current situation and options for reform ; - Short report [printed text] / Mélanie Lefevre , Author ; Nicolas Bouckaert, Author ; Jens Detollenaere , Author ; Joan Vlayen , Author ; Llenalia García Fernández, Author ; Hilde Pincé, Author ; Koen Van Den Heede , Author ; Renate Zeevaert, 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, 2022 . - 81 : ill., ; A4. - (KCE Reports. Health Services Research (HSR); 358CS) . ISSN : D/2022/10.273/47 : € 0,00 Languages : English (eng) Descriptors: Indexation 2019-50-02 ; Child, Hospitalized ; Continuity of Patient Care ; Health Care Reform ; Home Care Services, Hospital-Based ; Hospital Bed Capacity ; R358 Classification WX 100 Hospitals and Other Health Facilities -- General works Contents note: FOREWORD 1 -- SHORT REPORT 2 -- 1. INTRODUCTION 5 -- 1.1. THE CHANGING ROLE OF HOSPITAL CARE FOR CHILDREN 5 -- 1.2. OBJECTIVE AND SCOPE OF THE REPORT 6 -- 1.3. METHODS 7 -- 2. CURRENT ORGANISATION AND ACTIVITY PROFILE OF PAEDIATRIC SERVICES IN BELGIAN -- HOSPITALS 8 -- 2.1. THE LEGAL FRAMEWORK OF PAEDIATRIC HOSPITAL CARE 8 -- 2.1.1. Paediatric service 8 -- 2.1.2. Care programme for children 9 -- 2.2. CURRENT LANDSCAPE OF PAEDIATRIC SERVICES IN BELGIAN HOSPITALS 10 -- 2.3. ACTIVITY PROFILE OF HOSPITAL SERVICES PROVIDING CARE FOR CHILDREN 11 -- 2.3.1. Regional differences in activity profile 12 -- 2.3.2. Age and clinical profile of patients 13 -- 2.3.3. Length of stay and readmissions 14 -- 3. HOW DO HOSPITALS RESPOND TO VARIABILITY IN BED DEMAND? 16 -- 3.1. NUMBER OF HOSPITAL BEDS OCCUPIED BY CHILDREN AT THE NATIONAL LEVEL 18 -- 3.2. BED OCCUPANCY RATE AT THE HOSPITAL SITE LEVEL 19 -- 3.3. CHALLENGES OF AND SOLUTIONS FOR SEASONAL PRESSURES ON HOSPITAL RESOURCES 21 -- 3.3.1. Shortage of beds and nursing staff are the main culprits 21 -- 3.3.2. How do hospitals deal with seasonal peaks in hospital admissions? 22 -- 3.3.3. Which policy measures could help hospitals to deal with seasonal peaks? 22 -- 3.4. OPPORTUNITIES AND LIMITS OF HOSPITAL NETWORKS FOR MANAGING SEASONAL DEMAND PRESSURES 25 -- 3.4.1. The introduction of loco-regional networks to get competing hospitals to collaborate 25 -- 3.4.2. Mixed picture among hospitals of the potential impact of hospital networks 25 -- 3.4.3. Collaboration within and between networks to absorb peaks in bed demand 26 -- 4. TRANSMURAL CARE FOR CHILDREN: LESSONS FROM INTERNATIONAL EXPERIENCE 28 -- 4.1.1. A shift from pilot projects for adults to everyday practice for adults and children 28 -- 4.1.2. A broad range of programmes and structures to provide transmural care for children 29 -- 4.1.3. Key features of a paediatric transmural care episode 30 -- 4.1.4. Range of services provided in transmural care programmes 32 -- 4.1.5. Range of clinical conditions treated in transmural care programmes 33 -- 4.1.6. Exclusion criteria for providing transmural paediatric care 34 -- 4.1.7. Workforce requirements 34 -- 4.1.8. Funding systems for transmural paediatric care 36 -- 4.1.9. Public reporting of quality indicators and financial incentives to promote the quality of care 39 -- 5. EFFECTIVENESS AND SAFETY OF HOME-BASED CARE FOR CHILDREN 40 -- 6. TRANSMURAL CARE FOR CHILDREN IN BELGIUM 42 -- 6.1. TRANSMURAL CARE PROVIDED AND SUPPORTED BY THE PAEDIATRIC LIAISON TEAMS 42 -- 6.1.1. How does a paediatric liaison team work? 42 -- 6.1.2. Licensing standards define staff numbers and qualifications 43 -- 6.1.3. Profile of children cared for by the paediatric liaison teams 44 -- 6.1.4. Paediatric liaison teams provide a broad range of support and care 44 -- 6.1.5. Obstacles in daily practice and barriers to growth 47 -- 6.2. THE VIEWS OF BELGIAN STAKEHOLDERS ON THE (FURTHER) DEVELOPMENT OF TRANSMURAL CARE FOR CHILDREN 48 -- 6.2.1. General opinions and attitudes towards transmural paediatric care 48 -- 6.2.2. Preconditions for a further development of transmural care for children in Belgium 50 -- 6.2.3. Key lessons on the organisation of transmural care from pilot projects in Belgium 53 -- 6.2.4. Preconditions for the design and evaluation of pilot projects 55 -- 7. KEY ELEMENTS FOR A NEW BALANCE BETWEEN CURRENT AND NEW MODELS OF CARE FOR CHILDREN IN BELGIUM 56 -- 7.1. NUMBER AND SIZE OF PAEDIATRIC SERVICES 57 -- 7.2. LEVELS OF PAEDIATRIC HOSPITAL CARE 57 -- 7.3. MANAGEMENT OF SEASONAL PEAKS AT THE LEVEL OF THE LOCO-REGIONAL NETWORKS 58 -- 7.4. WHY SHOULD WE (OR NOT) DEVELOP TRANSMURAL CARE FOR CHILDREN IN BELGIUM? 59 -- 7.5. TOO MANY UNANSWERED QUESTIONS TO CHOOSE BETWEEN TRANSMURAL CARE MODELS 59 -- RECOMMENDATIONS 61 -- REFERENCES 66 Link for e-copy: http://doi.org/10.57598/R358CS Format of e-copy: PDF (2,6 MB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4857

Organisation des soins hospitaliers pédiatriques en Belgique : situation actuelle et possibilités de réforme / Mélanie Lefevre / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2022)  

Organisation des soins hospitaliers pédiatriques en Belgique : situation actuelle et possibilités de réforme : Synthèse [printed text] / Mélanie Lefevre , Author ; Nicolas Bouckaert, Author ; Jens Detollenaere , Author ; Joan Vlayen , Author ; Llenalia García Fernández, Author ; Hilde Pincé, Author ; Koen Van Den Heede , Author ; Renate Zeevaert, 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, 2022 . - 52 p. : ill., ; A4. - (KCE Reports B. Health Services Research (HSR); 358BS) . € 0,00 Languages : French (fre) Descriptors: Indexation 2019-50-02 ; Child, Hospitalized ; Continuity of Patient Care ; Health Care Reform ; Home Care Services, Hospital-Based ; Hospital Bed Capacity ; R358 Classification WX 100 Hospitals and Other Health Facilities -- General works Abstract: La place d’un enfant malade est-elle vraiment à l’hôpital ? D’autres pays que le nôtre ont mis en place des soins pédiatriques « transmuraux », qui permettent de prendre en charge à domicile des enfants qui auraient normalement été traités à l’hôpital. Il a été demandé au Centre fédéral d’Expertise des Soins de Santé (KCE) d’analyser la manière dont la pédiatrie est organisée et financée au sein des hôpitaux belges et d’examiner dans quelle mesure et selon quelles modalités les soins transmuraux pourraient – en partie – éviter des séjours à l’hôpital ou les raccourcir. Contents note: PRÉFACE 1 -- MESSAGES CLÉS 2 -- SYNTHÈSE 5 -- 1. INTRODUCTION 7 -- 1.1. VERS DE NOUVEAUX MODELES DE SOINS EN PEDIATRIE ? 7 -- 1.2. À PROPOS DE CETTE ETUDE DU KCE : OBJECTIFS ET METHODES 8 -- 2. LES SOINS HOSPITALIERS PÉDIATRIQUES EN BELGIQUE 10 -- 2.1. LE PROGRAMME DE SOINS POUR ENFANTS – CADRE LEGISLATIF 10 -- 2.2. DE NOMBREUX SERVICES, LA PLUPART DE PETITE TAILLE 11 -- 2.3. PROFIL D’ACTIVITE DES SERVICES DE PEDIATRIE 12 -- 2.3.1. L’hôpital de jour 12 -- 2.3.2. Hospitalisations classiques avec séjour 12 -- 2.3.3. Taux d’occupation national – d’importantes variations saisonnières 13 -- 2.3.4. Taux d’occupation local – d’importantes variations d’un hôpital à l’autre 13 -- 2.4. GERER LES PICS SAISONNIERS 15 -- 2.4.1. Un manque de lits, d’infirmiers et parfois de pédiatres 15 -- 2.4.2. Comment les hôpitaux gèrent les pics 15 -- 2.4.3. Mesures politiques possibles pour une meilleure gestion des pics saisonniers 16 -- 2.4.4. Quel rôle pour les réseaux hospitaliers ? 16 -- 3. LES SOINS PÉDIATRIQUES TRANSMURAUX 19 -- 3.1. LES SOINS TRANSMURAUX (POUR ENFANTS) EN BELGIQUE 19 -- 3.1.1. Les équipes de liaison pédiatriques 19 -- 3.1.2. Projets pilotes d’hospitalisation à domicile chez l’adulte 20 -- 3.1.3. Onco@Home 21 -- 3.2. QUELQUES EXEMPLES EN FRANCE, AUX PAYS-BAS ET EN AUSTRALIE 21 -- 3.2.1. Beaucoup de points communs… 21 -- 3.2.2. … mais aussi des différences majeures 22 -- 3.3. LES SOINS TRANSMURAUX POUR ENFANTS SONT-ILS SURS ET EFFICACES ? QUE DIT LA LITTERATURE ? 27 -- 3.4. LEÇONS TIREES DES MODELES INTERNATIONAUX ET NATIONAUX, DES INTERVIEWS AVEC LES ACTEURS CONCERNES ET DE LA LITTERATURE SCIENTIFIQUE 27 -- 3.4.1. Soins pédiatriques transmuraux : pour qui, dans quels contextes et avec quels effets ? 28 -- 3.4.2. Points d’attention pour le déploiement plus large des soins pédiatriques transmuraux 29 -- 3.4.3. Conditions pour la mise en place et l’évaluation de projets pilotes 32 -- 4. CLÉS POUR UN NOUVEL ÉQUILIBRE ENTRE SOINS PÉDIATRIQUES À L’HOSPITAL ET À DOMICILE 34 -- 4.1. OPTIMISER L’ORGANISATION DES SERVICES DE PEDIATRIE 34 -- 4.1.1. Nombre et taille des services de pédiatrie 34 -- 4.1.2. Niveaux de soins hospitaliers pédiatriques 34 -- 4.1.3. Gestion des pics saisonniers 35 -- 4.2. DEVELOPPER LES SOINS TRANSMURAUX POUR ENFANTS EN BELGIQUE 36 -- 4.2.1. Les soins transmuraux peuvent permettre d’éviter que des enfants ne restent (trop) longtemps à l’hôpital, mais ils ne conviennent pas pour tous les patients 36 -- 4.2.2. Les hôpitaux sont divisés sur la question des soins transmuraux pour enfants 36 -- 4.2.3. Trop de questions sans réponse pour privilégier un modèle spécifique 36 -- RECOMMANDATIONS 39 -- RÉFÉRENCES 44 Link for e-copy: http://doi.org/10.57598/R358BS Format of e-copy: PDF (2 MB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4859

Patient socioeconomic determinants for the choice of the cheapest molecule within a cluster / France Vrijens in European Journal of Health Economics (The), 13(2012)3 ([07/01/2012])  

[article] Patient socioeconomic determinants for the choice of the cheapest molecule within a cluster : evidence from Belgian prescription data [printed text] / France Vrijens , Author ; Carine Van de Voorde, Author ; Maria-Isabel Farfan-Portet, Author ; Robert H. Vander Stichele, Author . - 2012 . - 315-325. Languages : English (eng) in European Journal of Health Economics (The) > 13(2012)3 [07/01/2012] . - 315-325 Descriptors: Classification W 1 Serials. Periodicals Indexation 2008-08 ; Belgium ; Cost-sharing ; Journal Article ; Peer Review ; R126 ; Socioeconomic Factors Abstract: Reference pricing is a common cost-sharing mechanism, with the financial penalty for the use of costly drugs shifted from the third-party payer to the patient. Unintended distributional consequences might arise, if the weakest socioeconomic groups face a relatively higher financial burden. This study analyzed for a sample of Belgian individual prescription data for 4 clusters of commonly used drugs (proton pump inhibitors, statins and two groups of antihypertensives [drugs acting on renin-angiotensin system and dihydropyridine derivatives]) whether the probability to receive the least expensive molecule within a cluster was linked to the socioeconomic status of the patient. Logistic regression models included individual demographic, working, chronic illness and financial status and small area education data for 906,543 prescriptions from 1,280 prescribing general practitioners and specialists. For the 4 clusters, results show that patients with lower socioeconomic status consistently use slightly more the least expensive drugs than other patients. Larger effects are observed for patients residing in a nursing home for the elderly, patients entitled to increased reimbursement of co-payments, unemployed, patients treated in a primary care center financed per capita (and not fee-for-service) and patients having a chronic illness. Also, patients residing in neighborhoods with low education status use more less expensive drugs. The findings of the study suggest that although equity considerations were not explicitly taken into account in the design of the reference price system, there is no real equity problem, as the costly drugs with supplement are not prescribed more often in patients from lower socioeconomic classes. Link for e-copy: http://link.springer.com/article/10.1007/s10198-011-0367-2 Format of e-copy: PDF [Open Access] Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3790 [article]

Patient socioeconomic determinants of the choice of generic versus brand name drugs in the context of a reference price system / Maria-Isabel Farfan-Portet in European Journal of Health Economics (The), 13(2012)3 ([07/01/2012])  

[article] Patient socioeconomic determinants of the choice of generic versus brand name drugs in the context of a reference price system : a reference price system: evidence from Belgian prescription data [printed text] / Maria-Isabel Farfan-Portet, Author ; Carine Van de Voorde, Author ; France Vrijens , Author ; Robert H. Vander Stichele, Author . - 2012 . - p.301-313. Languages : English (eng) in European Journal of Health Economics (The) > 13(2012)3 [07/01/2012] . - p.301-313 Descriptors: Classification W 1 Serials. Periodicals Indexation Adolescent ; Adult ; Aged ; Belgium ; Choice Behavior ; Cost-sharing ; Drugs, Generic ; Evidence-Based Practice ; Insurance, Health, Reimbursement ; Journal Article ; Odds Ratio ; Peer Review ; Pharmaceutical Services ; Prescription Drugs ; Socioeconomic Factors ; statistics and numerical data [Subheading] Abstract: The generic reference price system (RPS) can impose a financial penalty for patients using a brand name drug instead of its generic alternative. Previous studies on the impact of the RPS have not considered the potentially differential effect of using generic alternatives for individuals with a different socioeconomic background. However, patients' characteristics might determine their overall knowledge of the existence of the system and thus of the financial burden to which they may be confronted. The association between patients' characteristics and the use of generic drugs versus brand name drugs was analyzed for ten highly prescribed pharmaceutical molecules included in the Belgian generic reference price system. Prescriptions were obtained from a 10% sample of all general practitioners in 2008 (corresponding to 120,670 adult patients and 368,101 prescriptions). For each pharmaceutical molecule, logistic regression models were performed, with independent variables for patient socioeconomic background at the individual level (work status, having a guaranteed income and being entitled to increased reimbursement of co-payments) and at the level of the neighborhood (education). The percentage of generic prescriptions ranged from 24.7 to 76.4%, and the mean reference supplement in 2008 ranged from euro4.3 to euro37.8. For seven molecules, higher use of a generic alternative was associated with either having a guaranteed income, with receiving increased reimbursement of co-payments or with living in areas with the lowest levels of education. Globally, results provided evidence that the generic RPS in Belgium does not lead to a higher financial burden on individuals from a low socioeconomic background. Link for e-copy: https://doi.org/10.1007/s10198-012-0377-8 Format of e-copy: PDF [Open Access] Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4083 [article]

Payment methods for hospital stays with a large variability in the care process / Victor Stephani / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2018)  

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Payment methods for hospital stays with a large variability in the care process / Victor Stephani / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2018)  

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Performance of the Belgian Health System. Report 2012 / France Vrijens / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)  

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Performance of the Belgian Health System. Report 2012 / France Vrijens / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)  

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Performance of the Belgian Health System. Report 2012 / France Vrijens / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)  

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Performance of the Belgian Health System. Report 2012 / France Vrijens / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)  

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Performance of the Belgian Health System / France Vrijens / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2016)  

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Performance of the Belgian Health System / France Vrijens / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2016)  

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Performance du système de santé belge / Nicolas Bouckaert / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2020)  

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La performance du système de santé Belge / France Vrijens / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)  

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