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Geplande zorg voor buitenlandse patiënten : impact op het Belgische gezondheidszorgsysteem [printed text] / Bob De Mars, Author ; Katrien Boulanger, Author ; Paul Schoukens, Author ; Walter Sermeus, Author ; Carine Van de Voorde, Author ; France Vrijens , Author ; Imgard Vinck , Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2011 . - V, 164 p. : ill. ; A4. - (KCE Reports A. Health Services Research (HSR); 169A) .
ISSN : D/2011/10273/71 : € 0,00
Studie : 2009-08
Languages : English (eng) Dutch (nla)

Descriptors:	Indexation 2009-08 ; Elective Surgical Procedures ; European Union ; Insurance, Health, Reimbursement ; Legislation ; Medical Tourism ; R169 Classification W 84.1 Health services. Delivery of health care. General coverage..
Abstract:	Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) onderzocht samen met de K.U.Leuven de instroom van buitenlandse patiënten die zich laten opnemen in een Belgisch ziekenhuis voor een geplande ingreep. De grote meerderheid komt uit andere EU landen, vooral dan uit Nederland en Frankrijk. In vergelijking met het totaal aantal hospitalisaties is hun aandeel nog beperkt (ongeveer 1,5% van alle hospitalisaties), maar op 5 jaar tijd nam hun aantal wel met 60% toe. Een verdere toename kan financiële problemen of wachtlijsten veroorzaken. Het KCE stelt daarom voor om de ziekenhuisfinanciering aan te passen. Daarnaast zou het pas operationele Observatorium voor Patiëntenmobiliteit aan de alarmbel moeten trekken wanneer er wachtlijsten ontstaan.
Contents note:	1. INTRODUCTION 8 -- 1.1. SCOPE AND OBJECTIVES OF THE STUDY 8 -- 1.2. METHODOLOGY AND OUTLINE OF THE REPORT 9 -- 2. LEGAL FRAMEWORK 10 -- 2.1. INTRODUCTION 10 -- 2.1.1. Detailed structure overview 10 -- 2.1.2. Methodology 11 -- 2.2. PATIENT MOBILITY IN THE EU/EEA 11 -- 2.2.1. Patient mobility across different European fundamental rights and freedoms 11 -- 2.2.2. Elective cross-border healthcare in the European social security coordination rules 12 -- 2.2.3. Elective cross-border healthcare and EU primary law in relation to free movement of services 21 -- 2.2.4. EU-citizenship, non-discrimination and healthcare tariffs 34 -- 2.2.5. Patient Mobility Directive 36 -- 2.2.6. Cooperation agreements in border areas 42 -- 2.2.7. Cross-border contracting between Belgian hospitals and foreign health insurers with the EU46 -- 2.2.8. Patients coming from outside EU/EEA under bilateral or multilateral coordination treaty 49 -- 2.2.9. Cross-border contracting at the international level 50 -- 2.3. FOREIGN PATIENTS WITHOUT ANY FUNDING CONTRACT AND/OR CONVENTION 52 -- 2.4. OVERVIEW IDENTIFIED PATIENT TRACKS 53 -- 3. HOSPITAL DATA REGISTRATION SYSTEMS 56 -- 3.1. OVERVIEW STRUCTURE 56 -- 3.2. HOSPITAL DATA AVAILABLE WITH THE FPS PUBLIC HEALTH 56 -- 3.2.1. Transfer of financial and accounting data through FINHOSTA 56 -- 3.2.2. Transfer of individual medical statistical data 60 -- 3.3. DATA AVAILABLE WITH THE NIHDI 64 -- 3.3.1. Hospital invoice data registered within the framework of the statutory health insurance 64 -- 3.3.2. Identification of foreign patients in HBD 64 -- 3.4. SUGGESTIONS TO ADAPT CURRENT HOSPITAL DATA REGISTRATION SYSTEMS TO IMPROVE TRANSPARENCY ON FOREIGN PATIENT INFLOW IN BELGIAN HOSPITALS 71 -- 3.4.1. Need for further transparency 71 -- 3.4.2. Possible adaptations of current hospital registration systems 72 -- 4. VOLUME AND CHARACTERISTICS OF FOREIGN PATIENT STAYS: DATA, METHODOLOGICAL ISSUES AND RESULTS 77 -- 4.1. INTRODUCTION 77 -- 4.2. METHODS 77 -- 4.2.1. Macro analysis of national hospital discharge data 77 -- 4.2.2. Hospital reports 79 -- 4.2.3. Comparison between hospital reports and administrative data 80 -- 4.3. RESULTS OF THE MACRO ANALYSIS 80 -- 4.3.1. Stays for foreign patients not residing in Belgium, based on the MCD 80 -- 4.3.2. Foreign patients with prior authorization or within the context of specific agreements (coordination patients) 91 -- 4.3.3. Integrated overview for inpatient care for year 2008 107 -- 4.4. RESULTS OF THE HOSPITAL REPORTS 108 -- 4.4.1. Characteristics of hospitals included in the survey 108 -- 4.4.2. Evolution of the share of foreign patients in the case study hospitals 109 -- 4.4.3. Differences in tariffs charged 110 -- 4.4.4. Comparison of case mix between different foreign patient flows 111 -- 4.5. COMPARISON OF THE RESULTS OF THE MACRO ANALYSIS AND HOSPITAL REPORTS 111 -- 4.5.1. Hospital A 111 -- 4.5.2. Hospital B 113 -- 4.5.3. Hospital C 114 -- 4.5.4. Hospital D 115 -- 4.5.5. Comparison of the data of all case study hospitals for year 2008 with national databases 116 -- 5. PATIENT MOBILITY AND FINANCING OF BELGIAN HOSPITALS 117 -- 5.1. KEY ELEMENTS OF BELGIAN HOSPITAL FINANCING FOR CLASSIC HOSPITAL STAYS 118 -- 5.1.1. Financing medical interventions of hospital doctors: general aspects 118 -- 5.1.2. Financing of the basis of the Budget of Financial Means 119 -- 5.1.3. Financing of day-care hospital stays 126 -- 5.1.4. Financing capital costs 127 -- 5.2. PATIENT MOBILITY AND HOSPITAL FINANCING: THE PATIENT MOBILITY ACT OF 4 JUNE 2007 128 -- 5.2.1. Tension between patient mobility and closed budget financing 128 -- 5.2.2. The original Patient Mobility Act of 4 June 2007 131 -- 5.2.3. Health Act of 19 May 2010 141 -- 5.3. PATIENT MOBILITY AND HOSPITAL DOCTORS 144 -- 6. HOSPITAL FINANCING (LAW) AND ALTERNATIVES TO CHANGE THE HOSPITAL FINANCING SYSTEM 146 -- 6.1. STATUS QUO: THE FINANCIAL FLOW OF FOREIGN PATIENTS COMING TO BELGIUM IS COMPENSATED BY THE FINANCIAL FLOW OF BELGIAN PATIENTS GOING ABROAD FOR HEALTHCARE 146 -- 6.1.1. Description of the status quo 146 -- 6.2. SEPARATING THE FINANCIAL FLOW OF FOREIGN AND BELGIAN PATIENTS 148 -- 6.2.1. Description of the alternative 148 -- 6.2.2. How to perform that change in the Belgian health system? 148 -- 6.3. CHANGING THE HOSPITAL FINANCING SYSTEM TO MAKE IT MORE ADAPTED TO FOREIGN PATIENTS 150 -- 6.3.1. Description of the alternative 150 -- 6.3.2. How to perform that change in the Belgian health system? 151 -- 6.4. ANALYSIS OF STRENGTHS AND WEAKNESSES OF THE STATUS QUO AND TWO ALTERNATIVES 152 -- 7. NON-FINANCIAL CONSEQUENCES OF PATIENT MIGRATION: WAITING LISTS AND QUALITY OF CARE 153 -- 8. REFERENCES 156
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