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

FOREWORD 1 -- SHORT REPORT 2 -- 1. BACKGROUND 7 -- 1.1. DIAGNOSIS OF THE BELGIAN HEALTHCARE LANDSCAPE 7 -- 1.2. REDESIGN OF SERVICE DELIVERY 8 -- 1.3. OBJECTIVE OF THE REPORT: HOSPITAL CAPACITY PLANNING 10 -- 1.4. METHODS 10 -- 2. HOSPITAL CAPACITY PLANNING WITH HORIZON 2025 10 -- 2.1. RATIONALE BEHIND HOSPITAL CAPACITY PLANNING 10 -- 2.2. DESIGN OF A TREND ANALYSIS MODEL 12 -- 2.2.1. Trend analysis method 12 -- 2.2.2. Selection of stays 13 -- 2.2.3. What data are used? 13 -- 2.2.4. The importance of sociodemographic characteristics and pathology groups in capacity planning 14 -- 2.2.5. Model specification 15 -- 2.3. HOW MANY HOSPITAL BEDS ARE NEEDED IN 2025? BASELINE MODEL 16 -- 2.3.1. Almost 12% increase in inpatient stays with population growth and ageing as the main drivers 16 -- 2.3.2. Average length of stay will continue to decrease in the next decade 18 -- 2.3.3. A 5% decrease in the number of nursing days with a shift from acute to chronic care 21 -- 2.3.4. Shift towards day care continues in the years to come 25 -- 2.3.5. Demographic differences between regions result in different resource needs 26 -- 2.3.6. Required bed capacity in 2025 29 -- 2.4. ACCELERATED SUBSTITUTION FROM INPATIENT TO DAY CARE 33 -- 2.5. ACCELERATED AGEING FROM 2030 ONWARDS 34 -- 2.6. THE CAPACITY OF GERIATRIC HOSPITAL BEDS: THE CASE OF DEMENTIA 36 -- 2.6.1. Capacity needs will intensify in the future 36 -- 2.6.2. A plethora of interventions to reduce hospital use are described and tested: but do they work? 39 -- 2.7. DISCUSSION 40 -- 2.7.1. Future capacity needs dominated by ageing population and chronic conditions 40 -- 2.7.2. Some lessons learned from international experience 41 -- 2.7.3. The importance of good quality data and regular updates of the forecasting model 42 -- 3. THE ROLE OF EVIDENCE-INFORMED PROGRAMMING 43 -- 3.1. TYPOLOGY OF HOSPITAL SERVICES 43 -- 3.2. THE CONCEPT OF EVIDENCE-INFORMED PROGRAMMING 44 -- 3.2.1. Information used to build policy decisions: evidence on a par with expert opinion? 45 -- 3.2.2. The process of evidence-informed decision making 45 -- 3.3. COMPLEX SURGERY FOR CANCER OF THE PANCREAS, OESOPHAGUS AND LUNG 47 -- 3.3.1. Scope and research objective 48 -- 3.3.2. Research evidence 48 -- 3.3.3. Pancreatic cancer 48 -- 3.3.4. Oesophageal cancer 53 -- 3.3.5. Lung cancer 57 -- 3.3.6. Quality demands concentration, but concentration must not lead to waiting lists 61 -- 3.4. RADIOTHERAPY 62 -- 3.4.1. The legal framework is outdated 62 -- 3.4.2. Scope and methods 63 -- 3.4.3. Availability of radiotherapy infrastructure in Belgium 63 -- 3.4.4. Cancer incidence and radiotherapy treatment 66 -- 3.4.5. Calculation of required number of devices based on available guidelines: the importance to account for underuse, retreatments and complexity 68 -- 3.4.6. Reforming radiotherapy capacity: lessons learned 70 -- 3.5. MATERNITY SERVICES 73 -- 3.5.1. Scope and methods 73 -- 3.5.2. Availability of maternity services in Belgium 74 -- 3.5.3. Capacity problems for maternity services: national overcapacity  regional imbalances  -- fragmentation of available resources 77 -- 3.5.4. Overcapacity will intensify in the future when length of stay further decreases 79 -- 3.5.5. Policy actions to better match demand and supply 80 -- 3.6. THE CHANGING ROLE OF HOSPITALS 84 -- 4. EVIDENCE-INFORMED PLANNING AND PROGRAMMING: NEXT STEPS 87 -- RECOMMENDATIONS 89 -- REFERENCES 95