Organisation of maternity services in Belgium
Authors: Lefevre Mélanie , Bouckaert Nicolas , Camberlin Cécile , Devriese Stephan , Pincé Hilde , de Meester Christophe , Fricheteau Benoït , Van de Voorde Carine 
Published: January 2025

1. BACKGROUND 5 -- 1.1. THE HOSPITAL LANDSCAPE: FIRST STEPS TOWARDS RATIONALISATION 5 -- 1.2. SCOPE AND OBJECTIVE OF THE REPORT 6 -- 1.3. METHODS 7 -- 2. CURRENT ORGANISATION AND ACTIVITY PROFILE OF MATERNITY AND NEONATAL CARE SERVICES IN BELGIUM 10 -- 2.1. THE SYSTEM OF PERINATAL CARE IN BELGIAN HOSPITALS 10 -- 2.2. A HIGH DENSITY OF MAINLY SMALL MATERNITY SERVICES 12 -- 2.3. OBSTETRIC PATIENTS IN MATERNITY SERVICES 13 -- 2.3.1. Clinical profile of obstetric patients 13 -- 2.3.2. National average bed occupancy rate below 50% but large regional differences 18 -- 2.4. NEWBORNS IN MATERNITY AND NEONATAL CARE SERVICES 19 -- 2.4.1. Clinical profile of newborns 19 -- 3. CAN THE EFFICIENCY OF BELGIAN MATERNITY SERVICES BE IMPROVED BY INCREASING THEIR SIZE? 21 -- 3.1. SEARCH FOR THE MINIMUM EFFICIENT SIZE OF MATERNITY SERVICES 21 -- 3.2. DATA ENVELOPMENT ANALYSIS (DEA) TO MEASURE THE EFFICIENCY OF MATERNITY SERVICES 22 -- 3.2.1. Choice of method 22 -- 3.2.2. Data 24 -- 3.2.3. Can Belgian maternity services gain from economies of scale through expansion? 26 -- 3.2.4. Do efficiency scores depend on specific characteristics of maternity sites? 31 -- 4. GEOGRAPHIC ACCESSIBILITY OF MATERNITY SERVICES 33 -- 4.1. TRADE-OFF BETWEEN EFFICIENCY AND ACCESSIBILITY 33 -- 4.2. GEOGRAPHIC INFORMATION SYSTEM TO MEASURE TRAVEL TIME TO MATERNITY SERVICES 34 -- 4.3. ALMOST ALL WOMEN OF CHILDBEARING AGE HAVE ACCESS TO AT LEAST ONE MATERNITY SERVICE WITHIN 30 MINUTES IN THE CURRENT LANDSCAPE 35 -- 4.4. EFFICIENCY GAINS, ACCESSIBILITY AND PATIENT CHOICE AFTER A RATIONALISATION OF MATERNITY SERVICES 37 -- 5. HOW MANY MATERNITY BEDS ARE NEEDED TO AVOID EXCESS CAPACITY AND GUARANTEE TIMELY ACCESS? 39 -- 5.1. QUEUEING SYSTEMS TO DETERMINE THE REQUIRED BED CAPACITY IN BELGIAN MATERNITY SERVICES 39 -- 5.1.1. Patient flow and queues 40 -- 5.2. MODELLING PATIENT FLOW TO UNDERSTAND BED CAPACITY NEEDS IN BELGIAN MATERNITY SERVICES 41 -- 5.2.1. Admissions differ by patient group, by season, by day of the week and hour of the day 43 -- 5.2.2. Length of stay differs by maternity service, patient group and arrival time 45 -- 5.2.3. Validation of the model 45 -- 5.3. BED CAPACITY NEEDS AND WAITING TIME WITH THE CURRENT NUMBER OF MATERNITY SERVICES 46 -- 5.3.1. Association between bed capacity, occupancy rate and probability of delay 46 -- 5.3.2. Bed capacity needs 48 -- 5.3.3. Waiting times 48 -- 5.4. IMPACT OF A RATIONALISATION OF MATERNITY SERVICES ON CAPACITY NEEDS AND TIMELY ACCESS 50 -- 6. TOWARDS AN ACCESSIBLE GEOGRAPHIC ALLOCATION OF EFFICIENT MATERNITY SERVICES IN BELGIUM 53 -- 6.1. INCREASE THE MINIMUM STANDARD OF 400 DELIVERIES PER YEAR TO ACHIEVE ECONOMIES OF SCALE 53 -- 6.2. ENSURE A MAXIMUM COVERAGE OF MATERNITY SERVICES ACROSS THE TERRITORY 55 -- 6.3. ANALYSE THE ABSORPTION CAPACITY OF THE REMAINING MATERNITY SERVICES 55 -- 6.4. DETERMINE A BED DELAY TARGET 56 -- 6.5. CREATE THE NECESSARY PRECONDITIONS FOR A REFORM 56 -- 6.5.1. Invest efficiency gains in the hospital sector 56 -- 6.5.2. Take accompanying measures for the staff 57 -- 6.5.3. Take accompanying measures for the costs of hospital infrastructure 57 -- 6.5.4. Re-activate the staffing registration in the MZG  RHM 57 -- REFERENCES 58 -- RECOMMENDATIONS 62