The general hospital sector represents a total turnover of €21.3 billion in 2021[1].
The main sources of financing for hospitals are the Financial Resources Budget (FRB) (36.5%), the payments from the fees of doctors, dentists and certain categories of medical and paramedical staff (37.5%), the fixed sum contracts with NIHDI (RIZIV-INAMI) (4.4%), pharmaceutical and similar products (20.8%), room supplements (0.5%) and the additional products (0,2%).
The financing of a hospital through the financial resources budget comes from the individual distribution of the overall hospital budget among all hospitals[1]. In January 2023, this overall budget was set at a maximum amount of €9,935,557,653 for the general hospitals. The FRB has increased by 34% over the past five years from 7.4 billion in 2019 to 9.9 billion in 2023.
Evolution BFM general hospitals on Jan.1
The FRB has three main components: a budget for short-term credit charges (Part A2), an operating costs budget (Part B) and a budget for the regularisation of post-financing of the various parts of the FRB (Part C). Hospital financing is mainly based on lump sums, real costs or fee-for-service services.
FRB in the spotlight
The White Coat Fund (le Fonds Blouses blanches) is financed via the B9 component within the FRB. It aims to improve employment opportunities and training for nurses and support staff. In this way, the effective time for patient care at the bedside can be increased. In January 2023, a sum of €336 million was allocated to general hospitals.
The reform of day hospitalisation has two goals: to encourage innovative techniques and to avoid unnecessary overnight hospital stays. Two financial actions are being undertaken to encourage this:
On 1 January 2023, NIHDI’s list of nomenclature codes related to surgical day hospitalisation was updated. The so-called List A contains 551 nomenclature codes or procedures. Previously, this list included only 246 interventions. These procedures may take place in a surgical day hospital and are eligible for funding via the FRB. The expansion involves procedures such as gall bladder surgery, appendectomy or knee replacement, for example.
List B will be reinstated from 2023 onwards. This is a list of 189 procedures that should be performed in a day hospital, such as the removal of varicose veins, circumcision or the removal of tonsils in a child. A hospital will only obtain reimbursement equivalent to a day admission for procedures on this list. If the patient does stay longer in the hospital, there will be no additional reimbursement for this via the FRB. This would then be regarded as an improper stay. This arrangement applies only to persons under the age of 75 and without additional healthcare problems. This list should ensure that hospitals have no interest in admitting patients for longer than necessary.
The federal government decided in 2020 to provide financial compensation for hospitals and healthcare providers in connection with the COVID-19 pandemic. To this end, advances totalling €2 billion were disbursed to general and psychiatric hospitals. The aim of granting the advances was to assist the hospitals in meeting their financial obligations, i.e. paying active staff members as well as paying invoices from suppliers and service providers on time. Final funding will be determined in 2023 based on the real impact of COVID-19 on each hospital.
Justified beds
In the case of general hospitals, funding is essentially based on patient-related activities. For each hospital, a ‘justified activity’ is determined, as a means to cover the cost of healthcare staff, nursing staff and the use of medical products.
The justified activity is calculated based on the number of admissions in a hospital, weighted in accordance with the national average length of stay by pathology group. The calculation always takes into account the severity level of the patient. If the average length of stay in the hospital for a given patient group is shorter than the national average, it is advantageous to the hospital (because the hospital is funded for more nursing days than it has carried out). If the average length of stay for a patient group is longer than the national average, it is detrimental.
The total number of justified hospital days is divided by a normative occupancy rate multiplied by 365 in order to obtain the number of justified beds of a hospital.
The number of justified beds decreased by 6.7% over the past 5 years. The largest decrease can be observed in the case of maternity (-13.3%). This could be attributed to the project about ‘Giving birth with a shortened hospital stay’, in which the care provided before, during and after the hospital stay has been optimised.
Evolution of the number of justified beds
[1]The allocation is made on the basis of the procedures laid down in the Royal Decree of 25 April 2002 on the fixing and settlement of the financial resources budget of hospitals.
