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Publications (50)
Introduction
Depuis 2019, une réforme structurelle de la nomenclature des actes médicaux est en cours en Belgique (durée planifiée : six ans). Parmi les objectifs (standardisation, actualisation, classification, justification des tarifs professionnels et des frais des actes techniques et médicaux [ATMC]) figure "la facilitation des comparaisons int...
In Belgium, the Nomenclature des Prestations de Sante or NPS (i.e. Nomenclature of Medical Procedures) is an essential tool for funding physicians and hospitals. If the final objective is to achieve a common classification of medical procedures, then it is necessary to work with specialists from the various medico‐surgical disciplines to standardiz...
Background
In view of the expected increase in expenditure on hip replacement treatment in Belgium, the complication rate and potential waste reduction, as estimated by the Organisation for Economic Cooperation and Development, we are not yet in a position to assess the efficiency of hip replacement treatment in Belgian hospitals. This objective st...
Introduction
La Belgique entreprend une réforme structurelle de la nomenclature des procédures médicales (NSS.V0). La standardisation des libellés et la liaison avec la classification internationale ICHI constituent la première étape (NSS.V1 « descriptive »). La standardisation de l’acte d’origine aboutit souvent à sa subdivision en plusieurs actes...
Introduction
L’Agence technique de l’information sur l’hospitalisation (ATIH) est partenaire du Centre collaborateur OMS (CC-OMS) français pour le réseau des classifications internationales (WHO-FIC network) versant morbidité. À ce titre, l’agence a accepté de coordonner les tests sur site, demandés par l’organisation mondiale de la santé (OMS) pou...
Background In view of the expected increase in expenditure on hip replacement treatment in Belgium [10], the complication rate [3] and the possible reduction in waste estimated by the OECD [1], we are not yet in a position to objectify the effectiveness of hip replacement treatment in Belgian hospitals. This objective study aims to propose a hospit...
Introduction
The objectives of this research are (i) to describe the medicoadministrative profiles of inpatients aged 65 and over and (ii) to determine the main hospitalisation-related diseases in order (iii) to assess and identify predictors influencing hospital costs and lengths of stay thanks to data collected in hospital administrative database...
Introduction
The objectives of this research are (i) to describe the medico-administrative characteristics of inpatients aged 65 and more who are hospitalized for hip joint replacement, (ii) to evaluate the complete hospital cost into costs of medical procedures, drugs costs, prostheses costs, and the administrative costs, and (iii) to identify and...
Objectives: A prospective fixed funding mechanism may be difficult in innovative areas such as oncology. This study aimed to estimate the length of stay (LOS) and cost of oncology hospital stays, to evaluate their variability and to identify drivers affecting the cost per All Patient Refined Diagnosis Related Group (APR-DRG).
Methods: Oncology stay...
Introduction:
Intestinal Clostridium difficile Infection (CDI) treated in hospitals may concern patients whose reason for admission is CDI (primary diagnosis) or who have acquired CDI during their stay (secondary diagnosis).
Objectives:
The objective of this study is to evaluate the cost for social security and hospitals and the length of hospit...
Introduction
L’étude vise à (1) détailler le coût hospitalier des procédures liées au remplacement de la hanche chez le patient âgé de 65 ans et plus et (2) à isoler les facteurs qui influencent le coût.
Méthodes
L’étude se base sur 961 séjours de patients âgés de 65 ans et plus hospitalisés pour un remplacement d’articulation de hanche (APR-DRG 3...
Introduction
Les résultats des analyses économiques par pathologie dépendent des méthodologies utilisées pour calculer les coûts. Les modèles « top-down/gross-costing (TD/GC) » imputent les ressources globales de l’hôpital sur les pathologies en utilisant des données externes à l’hôpital (échelles de valeurs relatives développées en dehors de l’hôp...
Résumé
Une réforme de la nomenclature belge des actes médicaux est souhaitable. Elle devra être basée sur des critères suffisamment transparents admis par la majorité des médecins. Notre étude, bien que ne s’adressant qu’à une discipline (l’anesthésiologie), montre qu’il est possible de trouver dans les exemples étrangers des sources d’inspiration...
From cost to tariffs per pathology. Lessons from an attempt of transposing the French T2A to the Belgian hospital financing system
The Belgian hospital financing system is criticized for its complexity and its lack of transparency. The Ministry has expressed its willingness to introduce a pricing to pathology. The main objective of this article is...
Introduction:
The aim of this study is (1) to describe the characteristics of the organ harvesting activity conducted in 2012 at the Erasme's Hospital, Brussels University Hospital, (2) to highlight the different combinations " type of donor/types of organ's retrieved " in relation to organ harvestings carried out within the hospital, and (3) to c...
RESUME Introduction : Les objectifs de ce travail sont (1) de décrire les caractéristiques de l'activité de prélèvement d'organes réalisée en 2012 par l'Hôpital Erasme, Cliniques Universitaires de Bruxelles, (2) de mettre en évidence les différentes combinaisons " type de donneur/types d'organes prélevés " rencontrées dans le cadre des prélèvements...
Introduction: A lot of studies have demonstrated the possibility of reducing the number of post-operative complications in the domain of major surgical procedures with the use of medical preventive techniques. However, complications following surgical procedures are unfortunately frequent and are a major problem, not only because of the impact for...
Introduction
Les hopitaux constatent regulierement que la duree de sejour a l’hopital de certains patients est prolongee bien que leur presence ne soit plus justifiee par des raisons medicales. Le manque d’infrastructures extrahospitalieres pouvant accueillir des patients apres une hospitalisation, ainsi que la diminution de la disponibilite des ai...
Introduction
L’alcool est un probleme de sante publique. En 2013, l’abus d’alcool, de par ses consequences sur le cout des soins de sante ou judiciaire, representait un cout annuel de 4,2 milliards d’euros pour la societe belge. L’Organisation mondiale de la sante (OMS) estime que l’alcool est la cause de plus de 3,3 millions de deces chaque annee...
Introduction
Depuis sa derniere reforme en 1986, le systeme de financement des hopitaux belges est devenu de plus en plus complexe et de moins en moins transparent. Le gouvernement a annonce une modification du financement hospitalier inspire des recommandations de l’OCDE (financement forfaitaire prospectif a la pathologie). Notre etude visait a es...
Introduction:
A prospective payment system per DRG is announced in Belgium. Is this kind of financing system adequate for oncology? Objectives of this study are: to analyze medical and economical characteristics of oncological inpatients and evaluate the homogeneity of costs and length of stay per DRG.
Methods:
The study was realized in 14 Belgi...
The objective of this study was to estimate the total hospital cost per patient admitted through the emergency department with a primary diagnosis of pulmonary embolism (PE), and to identify the main components and predictors of costs.
Actual costs of care of 652 consecutive patients hospitalised in 10 general hospitals in Belgium, including 31 out...
Thirty percent of people aged 65 and older, living at home fall at least once a year. Few economic data are available in Belgium on this issue. We evaluated the cost borne by social security. 823 inpatient stays aged 65 and more, from home and admitted for injuries after a fall were selected. We observe an average (SD) age of 81 years. The proporti...
Les objectifs de cette étude sont d’analyser les caractéristiques médico-économiques de la patientèle oncologique et d’évaluer l’homogénéité des coûts et de la durée de séjour des principaux APR-DRG cancérologiques.
As soon as Diagnosis related Groups (DRG) were introduced in many hospital financing systems, most nursing research revealed that DRG were not very homogeneous with regard to nursing care. However, few studies are based on All Patient refined Diagnosis related Groups (APR-DRGs) and few of them use recent data. Objectives of this study are: (1) to e...
Background: Few recent data about extra cost associated with nosocomial bloodstream infections are available in Belgium and even in Europe.
Aim: To determine the financial impact of nosocomial bacteraemia in one Belgian general hospital and to evaluate this impact over time.
Methods: Laboratory test results were used to identify cases of nosocomial...
Activity and funding of nurses in an emergency department
The financing of the hospital nursing staff working in emergency departments has been recently modified in Belgium. New rules take into account the annual number of visits in the emergency departments and additional points based on criteria increasing nursing activities. This study aims to i...
Objectives
The objective of this study was to compare costs data by diagnosis related group (DRG) between Belgium and Switzerland. Our hypotheses were that differences between countries can probably be explained by methodological differences in cost calculations, by differences in medical practices and by differences in cost structures within the t...
Objectives of this article are to evaluate the possibility to create a CW scale by pathology on the basis of cost data from Belgian hospitals, to compare several methodologies to create this CW scale, and to evaluate the financial impact of a modification of the financing system on hospitals' income.
CW scales were elaborated according to various m...
In 2010, a Belgian study [1] explored the feasibility of introducing all-inclusive case-based payments for Belgian hospitals. In this kind of financing system, hospital services and patient mix are described in a simplified way through Diagnosis Related Groups (DRGs). A tariff is fixed in advance for each DRG. DRGs are groups of patients based on e...
Cost outliers account for 6 to 8% of hospital inpatient stays and concentrate 22 to 30% of inpatient costs. Explanatory factors were highlighted in various studies. They are the lenght of stay, an intensive care unit stay, the severity of illness index related to DRG and social factors. Patients are not always explained by these factors. The object...
Introduction: In most European countries, hospital funding systems are moving towards prospective payment systems based on Diagnosis related groups (DRGs). This forfaitarisation is still very partial in Belgium. In those systems, tariffs are determined on the basis of actual costs (with some adjustments). Objectives: The objective of this study is...
The financial and human costs of hospital-acquired infections are increasingly recognised in many healthcare systems. This study seeks to quantify excess expenditures on hospital-acquired bacteraemia (HAB) in three Belgian general hospitals in 2003 and 2004. Patients with HAB were compared with patients in the same All Patient Refined Diagnosis Rel...
Background: This study aims to analyse the relationship between inpatient costs and the severity according to APR-DRGs on the one hand, specific costs directly related to the infarction and its severity as determined by cardiologists, on the other hand. Methods: Retrospective study of costs and the severity of pathology were assessed in a public ge...
This study examined the impact of cost outliers in term of hospital resources consumption, the financial impact of the outliers under the Belgium casemix-based system, and the validity of two "proxies" for costs: length of stay and charges. The cost of all hospital stays at three Belgian general hospitals were calculated for the year 2001. High res...
The objective of this study was to find factors that could explain high and low resource use outliers, by associating an explanatory analysis with a statistical analysis.
High resource use outliers were selected according to the following rule: 75th percentile + 1.5* inter-quartile range. Low resource use outliers were selected according to: 25th p...
Objectives: The first one is to evaluate if a result difference (funding-costs) can be explained by a difference in costs between hospitals and to analyze the reasons for them. The second one is to evaluate the impact that a case-mix prospective payment system would have on the financial health of three hospitals. Methods: Calculation of costs, cha...
Studies from around the world have shown that hospital-acquired infections increase the costs of medical care due to prolongation of hospital stay, and increased morbidity and mortality. The aim of this study was to determine the extra costs associated with hospital-acquired bacteraemias in a Belgian hospital in 2001 using administrative databases...
Objective: To evaluate the conditions and the consequences of the substitution of an obsolete nomenclature, updated for fifty years by a process of negotiations subjected to an intense lobbying of the various interested parts (Belgian nomenclature INAMI) by a modern nomenclature, built on scientific bases (French CCAM). Method: All the intervention...
Objectives: This study aims to compare the calculation of the grants made by the Belgian and French authorities to assume the financing of the nurses working in operating theatres. The simultaneous use of two nomenclatures (Belgian "INAMI" and French "CCAM") gave rise to questions about the possibilities of automatic transcribing between these two...
This paper presents the main results of a survey among Belgian hospital leaders about their conceptualisation of hospital performance. The questionnaire was built using a model of performance developed by Sicotte et al. (1998) that is relying on Parsons' theory of social action (1951, 1977). Factorial analysis confirms that performance is viewed as...
Defining hospital performance: a survey among key stakeholders in hospitals This paper presents the main results of a survey among Belgian hospital leaders about their conceptualisation of hospital performance. The questionnaire was built using a model of performance developed by Sicotte et al. (1998) that is relying on Parsons' theory of social ac...
Projects
Project (1)
The objectives of this study are (i) to determine profile of patients according to the level of their frailty score, (ii) to evaluate the cost for hospital and the hospital length of stay (LOS) for frail-patients and (iii) to evaluate the relationships between frailty, comorbidities, age, severity of illness, discharge destination and cost for hospital or LOS.
