Governance models for hospital collaborations
Authors: De Pourcq Kaat , De Regge Mélissa , Callens Stefaan , Coëffé Mathilde , Gemmel Paul , Van Den Heede Koen , Van de Voorde Carine , Eeckloo Kristof 
Published: January 2025

FOREWORD 1 -- SHORT REPORT 2 -- 1. INTRODUCTION 5 -- 1.1. SCOPE AND OBJECTIVES.5 -- 1.2. METHODS.5 -- 2. TYPES OF HOSPITAL COLLABORATIONS AND GOVERNANCE MODELS 8 -- 2.1. TYPES OF HOSPITAL COLLABORATIONS 8 -- 2.2. TYPES OF GOVERNANCE MODELS.10 -- 2.3. GOVERNANCE MECHANISMS AT MACRO LEVEL 10 -- 3. CURRENT HOSPITAL GOVERNANCE AND COLLABORATION TYPES 11 -- 3.1. GOVERNANCE OF BELGIAN HOSPITALS.11 -- 3.1.1. The General Assembly .11 -- 3.1.2. The Board 12 -- 3.1.3. The executive management12 -- 3.1.4. The role of the medical specialist in hospital governance 12 -- 3.2. TYPES OF HOSPITAL COLLABORATIONS AND THEIR GOVERNANCE MODEL AS DEFINED IN THE HOSPITAL ACT 14 -- 3.2.1. Hospital association 14 -- 3.2.2. Hospital group15 -- 3.2.3. Hospital merger.16 -- 3.3. NATIONAL AND INTERNATIONAL CASES.18 -- 3.4. SHORTCOMINGS IN THE CURRENT COLLABORATION INITIATIVES AND IN THE HOSPITAL ACT THAT HINDER SUCCESSFUL COORDINATION AND TASK DISTRIBUTION 20 -- 3.4.1. The relationship between committees of the collaboration and the participating hospitals 20 -- 3.4.2. The composition and functioning of the boards 21 -- 3.4.3. Distance and catchment area requirements for collaborations: outdated or relevant? 21 -- 3.4.4. Different types of partners 22 -- 3.4.5. Hospital staff 22 -- 3.4.6. Authorisation and payment at the collaboration level 24 -- 3.4.7. VAT and collaboration between hospitals 24 -- 3.4.8. Data and privacy 25 -- 3.4.9. Level of competition 25 -- 4. REFORM PROPOSALS: THE COEXISTENCE OF THREE MODELS OF GOVERNANCE STRUCTURE 26 -- 4.1. CONTEXT FACTORS LIMIT THE ROLE OF NEW GOVERNANCE MODELS.26 -- 4.1.1. The intertwined role of the collaboration type and the governance structure 26 -- 4.1.2. The intertwined role of governance structures and governance mechanisms .26 -- 4.1.3. Collaborations and governance structures are evolving concepts .27 -- 4.1.4. Number of partners in the collaboration 27 -- 4.1.5. Goals of the collaboration 27 -- 4.1.6. A more integrated collaboration performs better in the long run .28 -- 4.2. HEALTH SYSTEM .28 -- 4.2.1. Generic characteristics of a health system as a governance model .28 -- 4.2.2. Proposed governance structures.30 -- 4.2.3. Stakeholder perspectives on the health system model 33 -- 4.3. COORDINATED NETWORK 34 -- 4.3.1. Generic characteristics of a network as a governance model 34 -- 4.3.2. Proposed governance structures.36 -- 4.3.3. Stakeholder perspectives on the coordinated network model 39 -- 4.4. AUTONOMOUS COLLABORATION INITIATIVE 40 -- 4.4.1. Generic characteristics of the autonomous collaboration initiative as a governance model .40 -- 4.4.2. Proposed governance structures.41 -- 4.4.4. Stakeholders perspectives on the autonomous collaboration initiative 43 -- 4.5. HOW THE REFORM PROPOSALS ADDRESS CURRENT SHORTCOMINGS 43 -- 4.5.1. Legal form of operation.43 -- 4.5.2. The potential of the proposed models to address shortcomings in the current forms 44 -- 4.5.3. The healthcare landscape 48 -- 5. A CLEAR FRAMEWORK SUPPORTING THE INTRODUCTION OF NEW GOVERNANCE MODELS FOR HOSPITAL COLLABORATIONS 49 -- RECOMMENDATIONS 53 -- REFERENCES.58 --