5 December 2018
Healthcare systems: pushing back hospital walls
In a time when healthcare providers are aiming to reduce costs and patients want to stay as much as possible in a familiar environment, the services currently supplied by these providers need to be reviewed in order to offer new forms of care.
In the light of this need, GIBBIS (the federation for private health care providers in the Brussels region) and ING brought together a large number of Belgian and French players from the sector at a seminar held on Tuesday, 13 November in Brussels. They all shared their experiences in responding to this shift, including highlighting past and future difficulties.
Is the hospitalisation sometimes a source of waste?
The Organization for Economic Cooperation and Development (OECD) indicates that close to 37 million days per annum are spent in hospital unnecessarily in the organisation’s member countries. In its report “Tracking Wasteful Spending on Health”, issues addressed by the organisation include days patients spend in hospital which could be avoided. But how?
The majority of member countries were able to show that the length of hospital admissions had already been reduced between 2000 and 2015. This was particularly due to the treatment of diseases which had become less traumatic for the patient and also developments in the care provided both upstream and downstream of surgical interventions.
The OECD likewise recommends that new infrastructures be put in place for less serious treatments. This will require efficient coordination in order to avoid patients having to return for emergency treatment, leading to added costs for the hospital.
Pushing back hospital walls
Home care, care hotels, homes for the elderly: a number of alternatives exist to provide tailor-made solutions for different patient needs, but are faced with limitations of their own.
The main limitation relates to coordination among the players involved: the hospitals, of course, but also the consultants, care workers, domestic help etc. This is a totally new way of working which has to be developed to enable the patient to receive care under the optimum conditions.
In situations which favour strengthening the current lines of care, GIBBIS advocates the insertion of a new “1.5” line between the first (general practitioner, physiotherapist etc.) and second (consultant, hospital, residential home, psychiatric institution) lines of care.
What are the conditions for this? One of the main findings is the diversity of needs between the different players.
A hospital cannot allow all its patients to remain under its roof for several days, but nor does it want to discharge them without adequate medical and care support, at the risk of seeing them return.
Patients want to be able to stay at home, but may also want to benefit from support suited to the state of their health and their psychological, social and financial situation. This results in a wide range of requirements, varying from one individual to the next. It is essential to be able to respond to these.
Diversified services that respond to patients’ needs, but at what cost?
At present, part of the cost of hospitalisation is borne by the patient. Patients may be covered by health insurance policies, but these do not always cover the possible costs of care outside the hospital.
In response to the transformation of supply and demand, and to support these new initiatives, the various parties involved (including GIBBIS) favour more automatic and general intervention by the health insurance companies for the cost of services and accommodation for these “new” patients. Taking the French model as a reference, home care will thus benefit from its own financing.
ING intends to perform its duty to society and make its contribution to the area of health by financing studies, as well as the various professional players such as hospitals, residential homes and general practitioners, not forgetting the patients themselves.
ING has therefore participated this year in a collective discussion in collaboration with a number of Belgian experts. This led to a study carried out by ANTARES Consulting.
ING is currently preparing a follow-up study in collaboration with ANTARES Consulting, which will be presented in March 2019. The emphasis will be on the relationship between hospitals and other players who may play a role in the move away from hospitalisation.