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

LIST OF ABBREVIATIONS 10 -- SCIENTIFIC REPORT 13 -- 1 INTRODUCTION AND BACKGROUND 13 -- 1.1 A RATIONALISATION PROCESS OF HOSPITAL SERVICES 13 -- 1.2 A HIGH DENSITY OF MATERNITY SERVICES WITH A LARGE VARIABILITY IN CASELOAD AND LOW OCCUPANCY RATES 15 -- 1.3 AN INTERNATIONAL TREND OF LESS AND LARGER MATERNITY SERVICES 15 -- 1.4 SCOPE AND AIM OF THE CURRENT REPORT 16 -- 1.5 METHODS 17 -- 2 ORGANISATION OF MATERNITY AND NEONATAL CARE SERVICES IN BELGIUM 19 -- 2.1 THE SYSTEM OF PERINATAL HOSPITAL CARE IN BELGIUM 20 -- 2.2 LEGISLATION: PROGRAMMING AND LICENSING STANDARDS 21 -- 2.2.1 Programming standards 21 -- 2.2.2 Minimum activity standards 22 -- 2.2.3 Architectonic and functional licensing standards 22 -- 2.2.4 Licensing standards for staff numbers and qualifications 24 -- 2.3 HOSPITAL REVENUE SOURCES 26 -- 2.4 A HIGH DENSITY OF MAINLY SMALL MATERNITY SERVICES 27 -- 3 ACTIVITY PROFILE OF MATERNITY AND NEONATAL CARE SERVICES IN BELGIUM 29 -- 3.1 OBSTETRIC PATIENTS IN MATERNITY SERVICES 29 -- 3.1.1 Selection of stays 29 -- 3.1.2 Patient clinical profile 29 -- 3.1.3 Deliveries in Belgian maternity services 36 -- 3.1.4 Occupancy rate in Belgian maternity services 42 -- 3.2 NEWBORNS IN MATERNITY AND NEONATAL CARE SERVICES 46 -- 3.2.1 Selection of stays 46 -- 3.2.2 Patient clinical profile 46 -- 3.2.3 Newborn activity according to bed index 47 -- 3.3 KEY POINTS 51 -- 4 AN EFFICIENCY ANALYSIS OF BELGIAN MATERNITY SERVICES 51 -- 4.1 INTRODUCTION 51 -- 4.1.1 Rationale for an efficiency analysis 51 -- 4.1.2 Scope and concepts 51 -- 4.2 DATA ENVELOPMENT ANALYSIS (DEA) 54 -- 4.2.1 Method and interpretation 54 -- 4.2.2 Assumptions about the technology 56 -- 4.2.3 Overall, technical and scale efficiency 59 -- 4.2.4 Structural efficiency 60 -- 4.2.5 Second stage analysis 62 -- 4.2.6 Sensitivity analysis 63 -- 4.2.7 Additional robustness checks 63 -- 4.2.8 DEA analysis for maternity services 63 -- 4.3 DATA 64 -- 4.3.1 Units of interest 64 -- 4.3.2 Period of analysis and number of maternity sites 64 -- 4.3.3 Staff related data 65 -- 4.3.4 Clinical activity data 68 -- 4.3.5 Capital input 70 -- 4.4 RESULTS 71 -- 4.4.1 Base model 71 -- 4.4.2 Minimum efficient scale 73 -- 4.4.3 Second stage analysis 79 -- 4.4.4 Sensitivity analysis 90 -- 4.4.5 Additional robustness checks 99 -- 4.5 KEY POINTS 100 -- 5 GEOGRAPHIC ACCESSIBILITY OF MATERNITY SERVICES 101 -- 5.1 INTRODUCTION 101 -- 5.2 GEOGRAPHIC INFORMATION SYSTEM TO MEASURE ACCESS TO MATERNITY SERVICES WITHIN A SPECIFIED TIME LIMIT 101 -- 5.3 RESULTS 103 -- 5.3.1 Current possibility to reach a maternity service within 30 minutes 103 -- 5.3.2 Possibility to reach a maternity service within 30 minutes following scale efficiency 107 -- 5.4 KEY POINTS 111 -- 6 MODELLING PATIENT FLOW AND BED CAPACITY NEEDS 111 -- 6.1 INTRODUCTION 111 -- 6.1.1 Context 111 -- 6.1.2 Research questions 113 -- 6.1.3 Scope and concepts 113 -- 6.1.4 Overview chapter 114 -- 6.2 QUEUEING SYSTEMS, DATA AND METHODOLOGY 114 -- 6.2.1 Background on queueing systems 114 -- 6.2.2 Data 119 -- 6.2.3 Methodology 121 -- 6.3 RESULTS 137 -- 6.3.1 Running the model 137 -- 6.3.2 Validation 137 -- 6.3.3 Research question 1: Bed capacity needs 138 -- 6.3.4 Research question 2: Change in bed capacity needs when the number of maternity services is reduced due to efficiency and geographical considerations 147 -- 6.4 KEY POINTS 159 -- APPENDICES 160 -- REFERENCES 181