-
02 October 2024 | Country Update
New integrated care program for vulnerable pregnant women and newborns in the first 1,000 days of life -
01 December 2022 | Policy Analysis
A new plan for integrated care in 2024 -
01 July 2022 | Country Update
Care pathways for long COVID patients
Patient pathways
The patient pathway is defined as the route a patient takes from their first contact with the health system to the completion of their treatment. In Belgium, patients have direct access to medical specialists (no gatekeeping) or can go directly to the emergency department of a hospital. There is therefore no single patient pathway; however, some national initiatives have been developed to improve primary care and the continuity of care between and within settings.
- In 2009, care pathways (zorgtraject/trajet de soins) for patients with chronic conditions, including diabetes and chronic renal insufficiency, were established to organize cooperation between patients, their GPs, specialists and other health professionals. These care pathways were shown to be effective in improving the follow-up of care processes and patient satisfaction, but due to a lack of information on the existence of these pathways for both the public and health professionals their use was not optimal (NIHDI, 2014a).
- In 2018, integrated care projects for the management of chronic patients were initiated such that stakeholders (including social care) are incentivized to set up innovative initiatives of care centred around patients across different care settings in their geographical area (see also Chapter 6) (MoH, 2018e).
Some care pathways are also developed by institutions developing guidelines. For example, a clinical pathway for the diagnosis and management of lower back pain and radicular pain was developed by the KCE in 2017 in collaboration with a multidisciplinary expert team (Jonckheer et al., 2017).
Initiatives have also been developed at the hospital level (for example, the Belgian Dutch Clinical Pathway Network, established to support hospitals in developing, implementing and evaluating clinical pathways; see Gerkens & Merkur (2010) for more details on clinical pathways in hospitals). The creation of reference centres for complex care, such as pancreatic cancer surgery, has developed formalized referral agreements and cooperation between hospitals (see Chapter 6).
As part of the new interfederal plan for integrated care, a dedicated care pathway has been established for vulnerable pregnant women and their newborns during the critical first 1,000 days of life. These early days play a pivotal role in a child’s growth, development, and overall quality of life, both in the short and long term.
The program aims to ensure that vulnerable pregnant women receive effective access to healthcare and continuous support throughout this crucial period. Managed by a care coordinator, the multidisciplinary program is tailored to meet the specific needs of each woman and her family.
A proactive approach has been implemented to identify vulnerable pregnant women, supported by a screening tool for psychosocial vulnerabilities. This tool is available through the online platform “Born in Belgium.”
Authors
References
To face the challenges of ageing and the increase of people with chronic conditions, the Belgian health care system has progressively evolved from a disease-management approach to a more person-centred care approach. Integrated care initiatives, in the form of pilot projects, have been progressively put in place and can be grouped into three main domains, that is, care for chronic disease patients, care for the elderly, and mental health care. However, people working in the field have the impression that existing initiatives are not yet sufficiently coordinated and too scattered. Therefore, a new interfederal plan on integrated care is planned for early 2024 to try to tackle this lack of coordination. To support the developmentof this interfederal plan, a wide range of health care professionals, social workers, experts, and patients were consulted. As a result of this consultation process, the following priorities were identified:
- Define a clear policy framework: Stakeholders called for an interfederal collaboration agreement in which all levels of government would coordinate their different initiatives and jointly define the reforms and other initiatives they wish to implement. The development of the interfederal plan on integrated care, by both federal institutions and the federated entities, will address this priority.
- Use a territorial approach: The development of integrated care must be done according to a territorial approach (per zone) in order to identify the needs of the population in the zone and the relevant cooperating partners.
- Strengthen the collaboration between the various actors: A "multidisciplinary network" around the patient should be set up, including workers in preventive, somatic and mental health but also the sectors of social services and personal assistance, both in outpatient and inpatient settings. Such a development also necessarily requires the use of common digital tools.
- Reform the current financing model: The current system of health care financing is mainly based on fee-for-services. Such a system is seen as one of the main barriers to integrated care, as it does not provide sufficient incentives for collaboration, coordination and prevention. Ideally, a mixed financing model should be pursued, with alternative financing (for example, flat-rate) not directly linked to the number of services provided, as well as incentives for quality.
Authors
References
Lambert A-S, Op de Beeck S, Herbaux D, et al. Towards integrated care in Belgium: stakeholders' view on maturity and avenues for further development. Health Services Research (HSR). Brussels: Belgian Health Care Knowledge Centre (KCE); 2022. KCE Reports 359. (https://kce.fgov.be/en/towards-integrated-care-in-belgium-stakeholders-view-on-maturity-and-avenues-for-further-development)
NIHDI. Interfederal Plan on Integrated Care. Brussels: National Institute for Health and Disability Insurance; 2022. (https://www.inami.fgov.be/fr/professionnels/information-tous/plan-interfederale-soins-integres/Pages/default.aspx)
Since 1 July 2022, care pathways for long-COVID patients can be concluded via conventions between primary care providers and sickness funds for a one-year period. Such pathways give access to a reimbursed personalized care plan that can include, depending on the patient’s needs, physiotherapy, speech therapy, psychological care, and advice from a dietician or occupational therapist.
For more details see: https://www.riziv.fgov.be/fr/themes/cout-remboursement/maladies/Pages/post-covid-remboursement-soins-1re-ligne-symptomes-persistants.aspx (French) / https://www.riziv.fgov.be/nl/themas/kost-terugbetaling/ziekten/Paginas/post-covid-tegemoetkoming-kosten-eerstelijnszorg-aanhoudende-symptomen.aspx (Dutch)