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Funding Inpatient Care


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Funding Inpatient Care
Dr. Chantal Licoppe
Beyrouth 2013
Semaine Belge au Liban

Published in: Health & Medicine
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Funding Inpatient Care

  1. 1. Funding Inpatient Care Containing costs but maintaining quality of care Dr Chantal Licoppe Belgo-lebanese week – February 2013
  2. 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 2
  3. 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 3
  4. 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. 4
  5. 5. Efficacy of regulation based on normative rules 5
  6. 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. 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 7 '95 '96 '97 '98 '99 '00 '01 '02
  8. 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 (…) ». 8 Franck Vandenbroucke, Ministre Fédéral de la Santé
  9. 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 9
  10. 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). 10
  11. 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. 11
  12. 12. MERCI La semaine Belge au Liban 26 February 2013 12