Funding Inpatient Care
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Funding Inpatient Care Containing costs but maintaining quality of care Dr Chantal Licoppe Belgo-lebanese week – February 2013
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Funding Inpatient Care Dr. Chantal Licoppe SMEL Beyrouth 2013 Semaine Belge au Liban
Transcript of Funding Inpatient Care
Funding Inpatient Care
Containing costs but maintaining quality of care
Dr Chantal Licoppe
Belgo-lebanese week – February 2013
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Context
Hospital care represents a large part of public health management Hospital expenses account for almost 50% of health care costs.Authorities must
Allow access to care to each citizenAt moderate cost
Public funding must Use public money adequatelyRespect equity between care institutionsPromote responsibility of providersAllow use of innovating techniques
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Evolution of Belgian Funding model
1963-1982: ‘normal’ price per day, based on real expenses1975: choice between normal price revisable afterword's, and ‘expected price’, non modifiable.Issue: the more days of care, the more resources allocated
1982: introduction of new concept called ‘budgetary envelope’ to limit increasing LOS
Budget = Quota of patient-days x fixed per diem price‘Quota’ : maximum nr of days = 95% of observed days in reference year (1980)Issue: method was too restrictive
1986: start of a new and different financing system.Quota of days becomes normative instead of historicalSystem accounts for differences between hospitals
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Hospital - Enterprise
‘AR n°407 of 8 August 1987 ‘principles of the ‘Hospital-Enterprise’ concept, Applicable to all hospitals, public & privateClearly defines 2 levels of job responsibilities:
Managing Director at general strategy level Managing Director at daily managing activities level
Via law, the Authorities will promote more succesful hospital management for sustainability, with continuous cost reduction and better use of public funds.
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Budget of financial means before 2002
Financing the hospital structureNor patient nor medical necessity is taken into account
Medical fee by act/ by
prescription
Fixed sum One-Day day
& other agreements
Pharmaceuticals
Day price(quota in fn of beds)
Hospital Budget / Agreed beds
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New issue: continuous increase of health-care spenditures
'94 '95 '96 '97 '98 '99 '00 '01 '02.000
500.000
1000.000
1500.000
2000.000
2500.000
3000.000
3500.000
4000.000
4500.000
5000.000
100
105
110
115
120
125
130
135
140
145Annual budgetary envelope (in million euros)
Annual Hospital envelope
% budget increase
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Reformation of hospital financing - 2002
« Le principe d’efficacité requiert qu’on ait recours de la manière la plus économique possible aux soins de santé, en tant que bien social financé solidairement, et que l’octroi et l’affectation des moyens se fassent sur la base de considérations relatives à l’utilité.
Cela suppose qu’on se base sur les besoins du patient
(…). L’essentiel de cette politique consiste à responsabiliser davantage les acteurs du système des soins de santé (…) ».
Franck Vandenbroucke, Ministre Fédéral de la Santé12 avril 2001
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BMF after 2002
Financing is centered on the patient & his needs, with regulation
Financing of ‘Justified activities’
Regulation: Norms – NLOS…
(Age categories …)
Justified beds• influences all parts of
hospital financing• Allows global budget
control
Allocation of justified LOS based on Case Mix,
modulated by type of pathology and severity
CASE MIX reporting ICD-9-CM et
3M ™ APR DRG
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‘BUDGET’ & RISK MANAGEMENT
Risk shift = f(financing system).
Cost Activity Per Diem Per Case Episode Capitation
Financial Risk
Provider risk
Payer risk
Unit of Payment
source: N. Goldfield
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Financing based on pathologies(3M™APR DRGs)
Startpoint: law of 25 April 2002 (BS 30/05/02)
1. The nr of agreed beds as financing unit is obsolete.The new metric is the ‘justified beds’.
2. A bed justification depends on its use. The treated pathologies are grouped in 3M APR-DRGs
3. The classical funding based on ‘per diem’ is replaced by a Budget of financial means (BMF).
4. The BMF depends on the number & the type of patients treated ; they translate into ‘justified activities’.
5. How the BMF is computed and used in Belgium is the topic DR Mehalaine is going to explain to you now.
