Author details
Author Natalie Baier |
Available item(s) by this author (5)
Add the result to your basket Make a suggestion Refine your search Apply to external sourcesOrganisatie en financiering van spoeddiensten in België / Koen Van Den Heede / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2016)
ISSN : D/2016/10.273/21 : € 0,00
Studie 2014-08
Languages : Dutch (nla)
Descriptors: Indexation
2014-08 ; After-Hours Care ; Emergency Medical Services ; Emergency Service, Hospital ; Health Care Reform ; R263
Classification
WX 215 - Emergency serviceAbstract: In ons land heeft elk ziekenhuis een spoed, sommige zelfs meer dan één, die zich dan op verschillende locaties bevinden. Dit komt neer op 1,24 spoeddiensten per 100 000 inwoners, wat uitzonderlijk hoog is in vergelijking met andere landen. De helft van deze spoeddiensten heeft op 24u tijd echter gemiddeld minder dan 55 contacten, en nog geen 6 contacten per nacht. Ook de spreiding over het grondgebied is niet steeds rationeel. Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) beveelt daarom aan om het aantal spoeddiensten te beperken. Bovendien kan een groot deel van de patiënten die zich op de spoed aanbieden even goed door een huisarts geholpen worden. De 70 huisartswachtposten die de laatste jaren werden opgericht, doen echter het aantal spoedcontacten niet dalen. Daarom beveelt het KCE aan om naast de spoeddiensten, op de ziekenhuissite, ook een 24/7 huisartspermanentie onder te brengen. Deze moet wel autonoom van het ziekenhuis kunnen functioneren, onder de coördinatie van de lokale huisartsenkringen. Spoeddienst en huisartspermanentie vormen samen een ‘centrum voor ongeplande zorg’, dat één centrale toegangspoort met een triage-zone heeft. Het klinisch geschoolde triage-team onthaalt de patiënt en stuurt deze dan door naar de huisartspermanentie of naar de spoed, afhankelijk van zijn medische situatie. Contents note: VOORWOORD 1 -- KERNBOODSCHAPPEN. 2 -- SYNTHESE . 4 -- 1. INLEIDING 6 -- 1.1. SPOEDAFDELINGEN, SPOEDDIENSTEN OF KORTWEG ‘DE SPOED’. 6 -- 1.2. STIJGEND AANTAL CONTACTEN OP SPOEDDIENSTEN. 7 -- 1.3. WAAROM DEZE STUDIE? . 7 -- 1.4. ONDERZOEKSAANPAK 8 -- 2. SPOEDAFDELINGEN: HUIDIGE ORGANISATIE EN VOORSTELLEN TOT HERVORMING 9 -- 2.1. GESPECIALISEERDE SPOEDGEVALLENZORG IN BIJNA ALLE ZIEKENHUIZEN 9 -- 2.2. GROTE TOEGANKELIJKHEID, MAAR OOK VERSNIPPERING VAN BUDGET EN PERSONEEL.10 -- 2.3. AANTAL SPOEDCONTACTEN PER ZIEKENHUIS IS ZEER VARIABEL 10 -- 3. EERSTELIJNSZORG: HUIDIGE ORGANISATIE EN VOORSTELLEN TOT HERVORMING.15 -- 3.1. ORGANISATIE VAN DE EERSTELIJNSZORG BUITEN DE KANTOORUREN 15 -- 3.1.1. Klein deel van de huisartsenactiviteit, maar met een potentiële impact op het gebruik van de spoed. 15 -- 3.1.2. Evolutie van lokale rotatiesystemen naar wachtposten 15 -- 3.1.3. Wachtposten: bottom-up initiatieven om de werkomstandigheden van huisartsen te verbeteren 17 -- 3.2. VELE SPOEDCONTACTEN KUNNEN EVEN GOED DOOR DE HUISARTS WORDEN BEHANDELD 17 -- 4. HUIDIGE FINANCIERING EN VOORSTELLEN TOT HERVORMING .23 -- 4.1. HOE WORDEN DE SPOEDDIENSTEN EN DE ARTSEN DIE ER WERKEN GEFINANCIERD? 23 -- 4.1.1. Het ziekenhuisbudget voor spoeddiensten wordt meer en meer gebaseerd op hun activiteiten 23 -- 4.1.2. Vergoeding van de artsen 25 -- 4.1.3. Uitgaven voor het personeel op de spoeddienst 26 -- 4.2. HOE WORDT EERSTELIJNSZORG BUITEN DE KANTOORUREN GEFINANCIERD?.26 -- 4.2.1. Betaling per prestatie blijft ook daar de belangrijkste inkomensbron 26 -- 4.2.2. In een wachtpost werken loont overdag maar niet ‘s nachts 27 -- 4.2.3. RIZIV-budget voor de wachtposten 27 -- 4.3. REMGELD VOOR EERSTELIJNSZORG EN SPOEDDIENSTEN IS ONVOLDOENDE OP ELKAAR AFGESTEMD 29 -- REFERENTIES 34 Link for e-copy: http://kce.fgov.be/sites/default/files/page_documents/KCE_263_As_Organisatie_en_ [...] Format of e-copy: PDF (1 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3825
ISSN : D/2016/10.273/24 : € 0,00
Study 2014-08
Languages : English (eng)
Descriptors: Indexation
2014-08 ; After-Hours Care ; Emergency Medical Services ; Emergency Service, Hospital ; Health Care Reform ; R263
Classification
WX 215 - Emergency serviceContents note: 1 INTRODUCTION AND SCOPE 13 -- 1.1 WHAT ARE EMERGENCY CARE SERVICES? 13 -- 1.2 WHY THIS REPORT? 15 -- 1.2.1 Objective of the study .15 -- 1.2.2 Scope of the study 15 -- 1.3 ORGANISATION OF THE REPORT16 -- 2 SCOPE AND METHODS 17 -- 2.1 INTRODUCTION17 -- 2.2 METHODS17 -- 2.2.1 Legal documents and text books .17 -- 2.2.2 Belgian data 17 -- 2.2.3 Literature 18 -- 2.2.4 Review of the literature and Belgian reports .18 -- 2.2.5 Qualitative study design18 -- 3 BELGIAN EMERGENCY DEPARTMENTS: ORGANISATION AND ACTIVITY 20 -- 3.1 EMERGENCY DEPARTMENTS IN BELGIUM: PROFILE AND ACTIVITY.20 -- 3.1.1 Specialised and non-specialised emergency departments 20 -- 3.1.2 Geographical distribution 21 -- 3.1.3 Activity profile .22 -- 3.2 CRITICAL APPRAISAL: A RELATIVELY HIGH NUMBER OF EMERGENCY DEPARTMENTS WITH LARGE DIFFERENCES BETWEEN URBAN AND RURAL AREAS.37 -- 3.2.1 Current capacity is a consequence of (not always harmonized) policy measures: programming, recognition, financing .37 -- 3.2.2 Advantages and disadvantages of the current ED capacity 38 -- 3.3 CRITICAL APPRAISAL: ARE EMERGENCY DEPARTMENTS THE MOST APPROPRIATE ORGANISATIONAL LEVEL FOR ALL CURRENT ACTIVITY? .39 -- 3.3.1 Not all emergency department visits are urgent, but are they inappropriate? A uniform definition is lacking 39 -- 3.3.2 Throughput and outflow problems are also burdening emergency departments 44 -- 3.4 SOLUTION ELEMENTS .45 -- 3.4.1 Planning of the required number of emergency departments in the larger spectrum of acute care services 45 -- 3.4.2 Reduction of emergency department capacity 47 -- 3.4.3 Concentration of highly-specialised services in reference centres51 -- 4 EMERGENCY DEPARTMENT WORKFORCE 55 -- 4.1 PHYSICIANS AND NURSES SPECIALISED IN EMERGENCY CARE .55 -- 4.1.1 Physicians working in Belgian emergency departments.55 -- 4.1.2 Nurses with a special title in intensive and emergency care .59 -- 4.2 CRITICAL APPRAISAL: THE ED IS A DEMANDING WORKPLACE AND STAFFING SHORTAGES ARE REPORTED .60 -- 4.2.1 Emergency physician shortage: need for evaluation in larger policy context .60 -- 4.2.2 A stressful work environment with high levels of burnout for physicians and nurses 61 -- 4.2.3 Are the current policy measures sufficient to tackle the shortage? .63 -- 4.3 SOLUTION ELEMENTS .66 -- 4.3.1 Focus on emergency care .66 -- 4.3.2 Adequate remuneration 66 -- 4.3.3 New roles and workforce innovations in the emergency department.66 -- 5 OUT-OF-HOURS SERVICES FOR ACUTE CARE: THE ROLE OF PRIMARY CARE SERVICES 69 -- 5.1 OUT-OF-HOURS PRIMARY CARE SERVICES 69 -- 5.1.1 The context of primary care and out-of-hours services in Belgium .69 -- 5.1.2 Payment system for general practitioners 74 -- 5.2 CRITICAL APPRAISAL OF ORGANISED DUTY CENTRES 78 -- 5.2.1 Rationale for ODC implementation: isolated focus on better working conditions for GPs or part of a larger vision?78 -- 5.2.2 Implementation of ODCs: increased use of out-of-hours GP services did not result in a decreased use of ED attendances .80 -- 5.2.3 ODCs are geographically well dispersed but is their location well chosen?.91 -- 5.2.4 Paying for ODCs: are the budgets covering investments and operational costs and the fee-forservice payments for GPs well-balanced? 97 -- 5.3 SOLUTION ELEMENTS .99 -- 5.3.1 Integration of EDs and ODCs .99 -- 5.3.2 Payment and organisation of acute care requires one general approach 102 -- 5.3.3 The role of primary care services during office hours in acute care .103 -- 6 TELEPHONE TRIAGE FOR PATIENTS WITH NON-EMERGENCY MEDICAL CONDITIONS .106 -- 6.1 ACCESS TO THE EMERGENCY CARE SYSTEM: REFERRALS, SELF-REFERRALS OR CONTACTING THE EMERGENCY CALL CENTRE 106 -- 6.2 CRITICAL ANALYSIS.107 -- 6.3 SOLUTION ELEMENTS 109 -- 7 THE ROLE OF PATIENT COST SHARING IN PROVIDER CHOICE .115 -- 7.1 PATIENT COST SHARING FOR GP AND EMERGENCY DEPARTMENT SERVICES .116 -- 7.1.1 Patient cost sharing for emergency department services 116 -- 7.1.2 Patient cost sharing for GP services .117 -- 7.1.3 Direct payment versus third-party payer system 119 -- 7.2 CRITICAL APPRAISAL OF THE ROLE OF PATIENT COST SHARING IN THE CHOICE BETWEEN GP AND EMERGENCY DEPARTMENT SERVICES 120 -- 7.3 SOLUTION ELEMENTS 121 -- 8 PAYMENT MODELS FOR THE EMERGENCY DEPARTMENT AND ITS WORKFORCE 123 -- 8.1 THE BUDGET OF FINANCIAL MEANS 123 -- 8.1.1 Components of the closed-end hospital budget .123 -- 8.1.2 Calculation of the B2-budget for clinical costs .124 -- 8.1.3 The B2-budget for the emergency department 127 -- 8.2 THE REMUNERATION SYSTEM OF MEDICAL SPECIALISTS PROVIDING SERVICES IN AN EMERGENCY DEPARTMENT .139 -- 8.2.1 How are physician fees determined? 139 -- 8.2.2 The fee schedule for emergency physicians and other medical specialists providing services at the emergency department 140 -- 8.2.3 Fees for physicians providing services in the ED: evolution of reimbursements and cases142 -- 8.2.4 Combination of one A-fee and one or more C-fees per emergency department visit .142 -- 8.2.5 A-fees by type of emergency physician .142 -- 8.3 PERFORMANCE MEASUREMENT AND PAY FOR PERFORMANCE .147 -- 8.3.1 Quality of care in emergency departments traditionally relies on a policy of recognition norms .147 -- 8.4 CRITICAL APPRAISAL OF THE OLD CALCULATION METHOD OF THE B2 BUDGET FOR THE EMERGENCY DEPARTMENT .147 -- 8.4.1 The B2 budget is not sufficient to guarantee minimum staffing ratios 147 -- 8.4.2 Distribution of the budget among hospitals: parameters are insufficiently related to ED activity and favour large hospitals148 -- 8.4.3 The old emergency department payment system better reflected the case-mix of the hospital .149 -- 8.4.4 Hospital responses.149 -- 8.5 CRITICAL APPRAISAL OF THE NEW CALCULATION METHOD OF THE B2 BUDGET FOR THE EMERGENCY DEPARTMENT .150 -- 8.5.1 New rules did not solve the structural underpayment but only changed the distribution of the closed-end budget 150 -- 8.5.2 Emergency department caseload and workload is better reflected 150 -- 8.5.3 The pros and cons of a patient classification system for emergency department payments150 -- 8.5.4 Hospital responses.151 -- 8.6 CRITICAL APPRAISAL OF THE REMUNERATION SYSTEM OF MEDICAL SPECIALISTS PROVIDING SERVICES AT THE EMERGENCY DEPARTMENT 151 -- 8.6.1 A fee-for-service payment system contributes to a productive workforce but incentivizes the quantity of services a physician provides .151 -- 8.6.2 The fee schedule helps us to keep track of what happens within the system.152 -- 8.6.3 The fee schedule for physians working in the ED: amount of the fee 153 -- 8.6.4 Large differences between hospitals in the share of ED visits for which a C-fee is charged 155 -- 8.6.5 A system of salaried emergency physicians: less appropriate for a flexible workforce and more expensive for society 156 -- 8.6.6 The fee schedule of emergency physicians: redundant or too restricted? .156 -- 8.6.7 The size of the hospital determines the budget available for physicans on duty in the ED.157 -- 8.7 CRITICAL APPRAISAL OF THE DEVELOPMENT AND IMPLEMENTATION OF QUALITY INDICATORS FOR EMERGENCY CARE .158 -- 8.8 SOLUTION ELEMENTS 159 -- 8.8.1 The ED budget should be sufficient to cover minimum staffing levels 159 -- 8.8.2 The new calculation method for the ED budget should be evaluated regularly 159 -- 8.8.3 A mix of fixed and variable payments 160 -- 8.8.4 Variable payments reflecting the ED caseload and patient case-mix .162 -- 8.8.5 Funding for sparsely populated and remote areas 163 -- 8.8.6 A payment system to support the development of an emergency care network 163 -- 9 ORGANISATION AND PAYMENT OF EMERGENCY CARE SERVICES IN SELECTED COUNTRIES .165 -- 9.1 INTRODUCTION 165 -- 9.1.1 Background 165 -- 9.1.2 Methodology.165 -- 9.1.3 Overview of emergency care services across countries .167 -- 9.2 ORGANISATION OF EMERGENCY CARE SERVICES 170 -- 9.2.1 Framework 170 -- 9.2.2 Organisation and planning .172 -- 9.3 PAYMENT OF EMERGENCY CARE SERVICES 185 -- 9.3.1 Framework 185 -- 9.3.2 Payment of Providers 187 -- 9.4 REFORMS AND DEBATES.194 -- 9.4.1 Overview .194 -- 9.4.2 Improved availability of urgent primary care services and better coordination with emergency care .194 -- 9.4.3 Rationalizing and concentrating emergency care .197 -- 9.5 CONCLUSIONS .200 -- 9.5.1 Guiding patients through the system 200 -- 9.5.2 Reconfiguring urgent primary and emergency care.201 -- 9.5.3 Supporting integrated emergency and urgent care structures through payment .201 -- 10 INTERVENTIONS TO REDUCE EMERGENCY DEPARTMENT UTILIZATION204 -- 10.1 OBJECTIVE.204 -- 10.2 METHOD 204 -- 10.3 RESULTS .206 -- 10.3.1 Search and inclusion 206 -- 10.3.2 Methodological assessment 207 -- 10.3.3 Type of target populations included in systematic reviews212 -- 10.3.4 Type of interventions and scope of reviews 212 -- 10.4 DISCUSSION AND CONCLUSION .223 Link for e-copy: http://kce.fgov.be/sites/default/files/page_documents/KCE_263_Organisation_and_p [...] Format of e-copy: PDF (4,8 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3821
ISSN : D/2016/10.273/23 : € 0,00
Study 2014-08
Languages : English (eng)
Descriptors: Indexation
2014-08 ; After-Hours Care ; Emergency Medical Services ; Emergency Service, Hospital ; Health Care Reform ; R263
Classification
WX 215 - Emergency serviceContents note: 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 50 Link for e-copy: http://kce.fgov.be/sites/default/files/page_documents/KCE_263_Cs_Organisation_an [...] Format of e-copy: PDF (2 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3822
ISSN : D/2016/10.273/25 : € 0,00
Study 2014-08
Languages : English (eng)
Descriptors: Indexation
2014-08 ; After-Hours Care ; Emergency Medical Services ; Emergency Service, Hospital ; Health Care Reform ; R263
Classification
WX 215 - Emergency serviceContents note: 1 ANNEX TO CHAPTER 2 3 -- 2 ANNEX TO CHAPTER 3 7 -- 2.1 INAPPROPRIATE USE OF EMERGENCY DEPARTMENT: DEFINITION AND PREVALENCE7 -- 2.2 ECONOMIES OF SCALE 7 -- 2.3 IMPACT OF EMERGENCY DEPARTMENT CLOSURES8 -- 3 ANNEX TO CHAPTER 4 11 -- 3.1 SYSTEMATIC REVIEWS ON EMERGENCY CARE WORKFORCE ISSUES11 -- 4 ANNEX TO CHAPTER 6 12 -- 4.1 SYSTEMATIC REVIEWS ON TELEPHONE TRIAGE.12 -- 5 ANNEX TO CHAPTER 10 .13 -- 5.1 LIST OF EXPERTS13 -- 5.2 EXPERT SURVEY ON EMERGENCY CARE SERVICES IN SELECTED COUNTRIES.14 -- 5.2.1 Introduction .14 -- 5.2.2 Context 14 -- 5.2.3 Questionnaire.17 -- 6 ANNEX TO CHAPTER 10 .20 -- 6.1 SEARCH STRATEGY 20 -- 6.2 FULL AMSTAR EVALUATION.22 -- 6.3 EXTRACTION TABLES 24 Link for e-copy: http://kce.fgov.be/sites/default/files/page_documents/KCE_263_S_Organisation_and [...] Format of e-copy: PDF (1 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3823
ISSN : D/2016/10.273/22 : € 0,00
Etude 2014-08
Languages : French (fre)
Descriptors: Indexation
2014-08 ; After-Hours Care ; Emergency Medical Services ; Emergency Service, Hospital ; Health Care Reform ; R263
Classification
WX 215 - Emergency serviceAbstract: Dans notre pays, chaque hôpital a un service d’urgence – et parfois même plus d’un quand il a plusieurs sites. Ce qui donne au final 1,24 service d’urgence pour 100 000 habitants, un chiffre considérable en comparaison avec les autres pays. La moitié de ces services ont moins de 55 contacts par 24 h (en moyenne), et moins de 6 contacts par nuit. Leur répartition sur le territoire n’est pas non plus très rationnelle. Par conséquent, le Centre Fédéral d’Expertise des Soins de Santé (KCE) recommande de limiter le nombre de services d’urgence.
De plus, une grande partie des patients qui se rendent aux urgences d’un hôpital pourraient aussi bien être traités par un médecin généraliste. Mais les 70 postes de garde de médecine générale qui ont été ouverts ces dernières années ne font pas baisser le nombre de ces patients. C’est pourquoi le KCE préconise d’héberger sur les sites hospitaliers, à côté des services d’urgence, des permanences de médecine générale, ouvertes 24h/24 et 7jours/7. Ces permanences, qui seraient coordonnées par les cercles locaux de généralistes, fonctionneraient de manière autonome par rapport à l’hôpital.
Le service d’urgences et la permanence de médecine générale formeraient ensemble un ‘centre de soins aigus non planifiés’ avec une porte d’entrée unique, donnant accès à une zone de triage. Une équipe clinique spécifiquement formée à cet effet y recevrait les patients et les orienterait vers la permanence de médecine générale ou le service d’urgence, en fonction de leur situation médicale.Contents note: PRÉFACE. 1 -- MESSAGES CLÉS 2 -- SYNTHÈSE . 5 -- 1. INTRODUCTION 7 -- 1.1. LES SERVICES D’URGENCE HOSPITALIERS OU TOUT SIMPLEMENT « LES URGENCES » 7 -- 1.2. AUGMENTATION DU NOMBRE DE CONTACTS AVEC LES SERVICES D’URGENCE HOSPITALIERS 8 -- 1.3. POURQUOI CETTE ETUDE ? 8 -- 1.4. APPROCHE METHODOLOGIQUE 9 2. SERVICES D’URGENCE : ORGANISATION ACTUELLE ET PROPOSITIONS DE RÉFORMES 10 -- 2.1. UNE FONCTION DE SOINS URGENTS SPECIALISES DANS LA QUASI-TOTALITE DES HOPITAUX 10 -- 2.2. UNE GRANDE ACCESSIBILITE MAIS UN MORCELLEMENT DES RESSOURCES FINANCIERES ET HUMAINES 11 -- 2.3. UN NOMBRE DE CONTACTS AVEC LES URGENCES TRES VARIABLE D’UN HOPITAL A L’AUTRE. 12 -- 3. LES SOINS DE PREMIÈRE LIGNE: ORGANISATION ACTUELLE ET PROPOSITIONS DE RÉFORMES . 16 -- 3.1. ORGANISATION DES SOINS DE PREMIERE LIGNE EN-DEHORS DES HEURES DE BUREAU .16 -- 3.1.1. Une petite partie de l’activité de médecine générale, mais un impact potentiel sur le recours aux urgences. 16 -- 3.1.2. Évolution d’un système de rotations vers des postes de garde 16 3.1.3. Postes de garde : des initiatives partant du terrain pour améliorer les conditions de travail des médecins généralistes. 18 -- 3.2. DE NOMBREUX CONTACTS AVEC LES SERVICES D’URGENCE POURRAIENT PARFAITEMENT ETRE TRAITES PAR LE MEDECIN GENERALISTE 19 -- 4. FINANCEMENT ACTUEL ET PROPOSITIONS DE REFORME .25 -- 4.1. COMMENT SONT FINANCÉS LES SERVICES D’URGENCE ET LES MÉDECINS QUI Y TRAVAILLENT ? 25 -- 4.1.1. Le budget alloué aux hôpitaux pour leur service d’urgence est de plus en plus basé sur leur activité 25 -- 4.1.2. Rémunération des médecins 27 -- 4.1.3. Coût du personnel des services d’urgence 28 -- 4.2. COMMENT SONT FINANCÉS LES SOINS DE PREMIÈRE LIGNE EN-DEHORS DES HEURES OUVRABLES ? 28 -- 4.2.1. Le paiement à la prestation reste également la principale source de revenus28 -- 4.2.2. Travailler dans un poste de garde : rentable en journée mais pas la nuit .29 -- 4.2.3. Le budget INAMI pour les postes de garde 29 -- 4.3. MANQUE D’HARMONISATION DES TICKETS MODÉRATEURS DES SOINS DE PREMIÈRE LIGNE ET DES SERVICES D’URGENCE 32 -- RECOMMANDATIONS 34 -- REFERENCES 38 Link for e-copy: http://kce.fgov.be/sites/default/files/page_documents/KCE_263_S_Organisation_and [...] Format of e-copy: PDF (1 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3824
