Required hospital capacity in 2025 and criteria for rationalisation of complex cancer surgery, radiotherapy and maternity services
Authors: Van de Voorde Carine , Van Den Heede Koen , Beguin Claire , Bouckaert Nicolas , Camberlin Cécile , De Bekker Piet , Defourny Noémie , De Schutter Harlinde , Devos Carl , Gerkens Sophie , Jeurissen Patrick , Kruse Florien Margareth , Lefevre Mélanie , Lievens Yolande , Mistiaen Patriek , Vaandering Aude , Van Eycken E. , van Ginneken Ewout 
Published: January 2025

SCIENTIFIC REPORT 33 -- INTRODUCTION AND BACKGROUND 33 -- 1 PROJECTED FUTURE TRENDS OF HOSPITAL USE IN BELGIUM 35 -- 1.1 INTRODUCTION 35 -- 1.2 TREND ANALYSIS 36 -- 1.3 DATA 37 -- 1.3.1 Population data 37 -- 1.3.2 Hospital data 39 -- 1.4 EVALUATION OF THE REPORT CANNOODT 40 -- 1.4.1 Projection model 41 -- 1.4.2 Comments on the research methodology 45 -- 1.4.3 Evaluation of the projection outcomes 46 -- 1.5 PROJECTION MODEL DEVELOPED FOR THE CURRENT STUDY 59 -- 1.5.1 Defining scope and concepts 61 -- 1.5.2 Rationale for statistical trend analysis 68 -- 1.5.3 Statistical trend model 70 -- 1.5.4 Projection outcomes 78 -- 1.6 INTRODUCTION RESULTS 80 -- 1.7 BASELINE FORECAST RESULTS OF THE PROJECTION MODEL 81 -- 1.7.1 Future need for hospital inpatient care 81 -- 1.7.2 Future need for hospital day care 104 -- 1.7.3 Capacity requirements for isolated categorical hospitals and foreign patients 112 -- 1.7.4 Summary of baseline forecast results 116 -- 1.8 PROJECTION RESULTS SCENARIO WITH ACCELERATED SUBSTITUTION TO DAY CARE 124 -- 1.8.1 Methodology 125 -- 1.8.2 Results 130 -- 1.9 PROJECTION RESULTS SCENARIO WITH ACCELERATED POPULATION AGEING 135 -- 1.9.1 Methodology 135 -- 1.9.2 Results 137 -- 2 HOSPITAL USE BY PATIENTS WITH DEMENTIA 145 -- 2.1 BACKGROUND AND AIM OF THE STUDY 145 -- 2.2 METHOD 147 -- 2.2.1 Literature review 147 -- 2.2.2 Analysis of Belgian hospital registry data 148 -- 2.3 RESULTS ON EPIDEMIOLOGICAL DATA 150 -- 2.3.1 Incidence/prevalence of dementia 150 -- 2.3.2 Hospital use by dementia patients 154 -- 2.4 RESULTS ON INTERVENTIONS TO REDUCE HOSPITAL USE BY DEMENTIA PATIENTS 162 -- 2.4.1 Strategies outside the hospital with an impact on hospital use 162 -- 2.4.2 Strategies in the hospital 164 -- 2.4.3 Strategies with regard to fall prevention 166 -- 2.5 DISCUSSION AND CONCLUSION 166 -- 3 ENGLAND 169 -- 3.1 BACKGROUND 169 -- 3.1.1 Country context 169 -- 3.1.2 Hospital classification 170 -- 3.1.3 Hospital capacity and use 170 -- 3.1.4 English hospitals underwent several changes in service reconfiguration 171 -- 3.1.5 Financial sustainability NHS hospitals 172 -- 3.2 PROXIMITY SERVICES AND SMALL HOSPITALS 172 -- 3.3 CONCENTRATION OF SPECIALISED SERVICES 175 -- 3.3.1 Specialised services are commissioned by NHS England 175 -- 3.4 THE ROLE OF ACUTE CARE HOSPITALS IN INTEGRATED CARE 179 -- 3.5 COLLABORATION FORMS BETWEEN HOSPITALS 179 -- 3.5.1 Mergers: the dominant form of structural collaboration form between English hospitals 179 -- 3.5.2 Collaborative organisation forms 182 -- 3.5.3 Contractual collaboration forms 183 -- 3.5.4 Consolidated collaboration forms 185 -- 3.5.5 Adopt collaboration forms that suit local circumstances 186 -- 3.6 VISION ON THE FUTURE 188 -- 3.6.1 Five Year Forward View 188 -- 3.6.2 From vision towards implementation 190 -- 3.6.3 The envisaged benefits of the reforms plans are overestimated 191 -- 4 FRANCE 193 -- 4.1 BACKGROUND 193 -- 4.1.1 Healthcare regionalisation 193 -- 4.1.2 Health areas 196 -- 4.1.3 Hospital and medical equipment planning 198 -- 4.1.4 Hospital landscape and trends 203 -- 4.2 CONCENTRATION OF COMPLEX SERVICES 206 -- 4.3 SPECIALISATION 209 -- 4.4 PROXIMITY SERVICES AND SMALL HOSPITALS 210 -- 4.5 INTEGRATION OF SERVICES 213 -- 4.6 COLLABORATION FORMS BETWEEN HOSPITALS 215 -- 4.6.1 Hospitals groups 215 -- 4.6.2 Networks 216 -- 4.7 VISION ON THE FUTURE 219 -- 5 THE NETHERLANDS 220 -- 5.1 INTRODUCTION 220 -- 5.2 HOSPITALS IN THE NETHERLANDS 221 -- 5.2.1 The Dutch healthcare system 221 -- 5.2.2 Market reform of the healthcare sector 224 -- 5.2.3 Hospital classification, levels and types 226 -- 5.2.4 Hospital capacity: centralised planning and decentralised influences 230 -- 5.3 CONCENTRATION OF SPECIALISED AND HIGHLY SPECIALISED SERVICES 233 -- 5.3.1 Introduction 233 -- 5.3.2 Organisation: dispersion and concentration 233 -- 5.3.3 Planning of specific procedures 234 -- 5.3.4 Contracting specialised services 235 -- 5.4 DISTRIBUTION OF SERVICES 236 -- 5.4.1 Shifts in provision 236 -- 5.5 EFFORTS TO INTEGRATE CARE 237 -- 5.6 CONCLUSIONS AND FUTURE CHALLENGES. 238 -- 5.6.1 Conclusions 238 -- 5.6.2 Future challenges 239 -- 6 COMPLEX SURGERY FOR CANCER OF THE PANCREAS, OESOPHAGUS AND LUNG 240 -- 6.1 INTRODUCTION 240 -- 6.1.1 Background 240 -- 6.1.2 Organisation of care for adults with rare and complex cancers in reference centres 241 -- 6.1.3 Rare and complex cancers: definition and incidence in Belgium 242 -- 6.1.4 Study objectives and research questions 242 -- 6.1.5 Data sources and methods 243 -- 6.2 BRIEF VIEW ON THE ORGANISATION OF ONCOLOGICAL CARE IN BELGIUM AND IN A SELECTION OF COUNTRIES 245 -- 6.2.1 Introduction 245 -- 6.2.2 Belgium 245 -- 6.2.3 France 245 -- 6.2.4 England 252 -- 6.2.5 The Netherlands 254 -- 6.2.6 Denmark 256 -- 6.2.7 A focus on implementation modalities of reference centres or specialised services. 258 -- 6.3 CANCER OF THE PANCREAS 259 -- 6.3.1 Description of the pathology 259 -- 6.3.2 Burden of pancreatic cancer in Belgium 260 -- 6.3.3 Current practice in Belgium 263 -- 6.3.4 International standards for pancreatic resections 269 -- 6.3.5 What is the required number of reference centres in Belgium in 2017? 272 -- 6.3.6 What is the future number of reference centres required (horizon 2025)? 278 -- 6.4 OESOPHAGEAL CANCER 280 -- 6.4.1 Description of the pathology 280 -- 6.4.2 Burden of oesophageal cancer in Belgium 281 -- 6.4.3 Current practice in Belgium 282 -- 6.4.4 International standards for oesophageal resections 289 -- 6.4.5 What is the required number of reference centres in 2017? 292 -- 6.4.6 What is the future number of required reference centres (horizon 2025)? 297 -- 6.5 LUNG CANCER 298 -- 6.5.1 Description of the pathology 298 -- 6.5.2 Burden of lung cancer in Belgium 300 -- 6.5.3 Current practice in Belgium 303 -- 6.5.4 International standards for lung resections 306 -- 6.5.5 What is the required number of reference centres in 2017? 309 -- 6.5.6 What is the future number of required reference centres (horizon 2025)? 314 -- 7 RADIOTHERAPY SERVICES 316 -- 7.1 INTRODUCTION 316 -- 7.2 AVAILABILITY  CURRENT SITUATION IN BELGIUM 317 -- 7.2.1 Programming and licensing rules for radiotherapy departments 317 -- 7.2.2 Current legislation concerning reimbursement 319 -- 7.2.3 Radiotherapy infrastructure in Belgium 319 -- 7.2.4 Activity profile of radiotherapy centres and satellites 329 -- 7.3 NEEDS  CURRENT AND FUTURE SITUATION IN BELGIUM 333 -- 7.3.1 Introduction 333 -- 7.3.2 Methodology 334 -- 7.3.3 Results 356 -- 7.4 HOW ARE RADIOTHERAPY SERVICES ORGANISED IN A SELECTION OF COUNTRIES? 367 -- 7.4.1 Introduction 367 -- 7.4.2 England 372 -- 7.4.3 France 373 -- 7.4.4 Ireland 375 -- 7.4.5 The Netherlands 376 -- 7.4.6 Denmark 378 -- 7.4.7 Summary and conclusion 379 -- 8 MATERNITY SERVICES 379 -- 8.1 INTRODUCTION 379 -- 8.2 ORGANISATION OF MATERNITY SERVICES IN BELGIUM 380 -- 8.2.1 Current organisation and legislation 380 -- 8.2.2 Maternity services activity profile 390 -- 8.2.3 Geographic distribution 410 -- 8.3 ESTIMATION OF (FUTURE) NEEDS 417 -- 8.3.1 Current situation 417 -- 8.3.2 Baseline forecast 417 -- 8.3.3 Alternative scenario 420 -- 8.3.4 Update of programming criteria 424 -- 8.4 ORGANISATION OF MATERNITY SERVICES IN A SELECTION OF COUNTRIES 425 -- 8.4.1 International overview 425 -- 8.4.2 France 430 -- 8.4.3 England 436 -- 8.4.4 Sweden 441 -- 8.5 CRITERIA FOR CONCENTRATION OF CARE 445 -- 8.5.1 Introduction 445 -- 8.5.2 Costs savings 445 -- 8.5.3 Occupancy rate 448 -- 8.5.4 Volume and outcome 448 -- 8.5.5 Access / Distance 449 -- DISCUSSION AND CONCLUSION 450 -- APPENDICES 451 -- REFERENCES 503