Étude de faisabilité de lintroduction en Belgique dun système de financement hospitalier «all-in» par pathologie
Authors: Van de Sande Stefaan , De Ryck Dorien , De Gauquier Kristel , Hilderson Rebecca , Neyt Mattias , Peeters Gert , Swartenbroekx Nathalie , Tambeur W , Vanden Boer G , Van de Voorde Carine 
Published: January 2025

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