The document discusses the evolution of funding models for inpatient hospital care in Belgium from 1963 to present. It describes how the models have shifted from using historical patient day quotas to normative quotas, and from per diem pricing to a case mix system that allocates funding based on patient pathology and severity level using diagnostic related groups. The current model centers financing around patient needs in order to promote responsibility and efficiency among healthcare providers using public funds.

1. Funding Inpatient Care
Containing costs but maintaining quality of care
Dr Chantal Licoppe
Belgo-lebanese week – February 2013

2. 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 citizen
At moderate cost
Public funding must
Use public money adequately
Respect equity between care institutions
Promote responsibility of providers
Allow use of innovating techniques
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3. Evolution of Belgian Funding model
1963-1982: ‘normal’ price per day, based on real expenses
1975: 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 historical
System accounts for differences between hospitals
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4. Hospital - Enterprise
‘AR n 407 of 8 August 1987 ‘
principles of the ‘Hospital-Enterprise’ concept,
Applicable to all hospitals, public & private
Clearly 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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5. Efficacy of regulation based on
normative rules
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6. Budget of financial means before 2002
Day price
(quota in fn of beds)
Medical fee
by act
/ by
prescription
Hospital Budget
/ Agreed beds
Fixed sum
One-Day
day
& other
agreements
Pharmaceuticals
Financing the hospital structure
6 Nor patient nor medical necessity is taken into account

7. New issue: continuous increase
of health-care spenditures
5000.000
Annual budgetary envelope (in million euros)
4500.000
145
140
4000.000
135
3500.000
130
3000.000
125
2500.000
120
2000.000
115
1500.000
110
1000.000
Annual Hospital envelope
500.000
105
% budget increase
.000
100
'94
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'95
'96
'97
'98
'99
'00
'01
'02

8. 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 (…) ».
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Franck Vandenbroucke,
Ministre Fédéral de la Santé

9. BMF after 2002
Financing of
‘Justified activities’
Justified beds
• influences all parts
of hospital financing
• Allows global
budget control
CASE MIX reporting
ICD-9-CM et
3M™APR DRG
Regulation:
Norms – NLOS…
(Age categories …)
Allocation of justified LOS
based on Case Mix,
modulated by type of
pathology and severity
Financing is centered on the patient & his needs, with regulation
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10. ‘BUDGET’ & RISK MANAGEMENT
Financial Risk
Unit of Payment
Cost
source: N. Goldfield
Activity Per Diem Per Case Episode Capitation
Risk shift = f(financing system).
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11. 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.
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12. MERCI
La semaine Belge au Liban 26 February 2013
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