KEY DATAGeneral IN HEALTHCARE Hospitals Edition 2019 1060 Brussels (Belgium). Place 40boxVictor Horta 10 Tom Auwers, RESPONSIBLE PUBLISHER & policyinformation’ unitsandSciensano. financing’ and‘ManagementOffice’ as wellas‘Data care, in particular the‘Acute & chronic care’, ‘Hospital The membersoftheDirectorate-Generalfor Health EDITORIAL COMMITTEE are highlighted. regarding theoperationinthissectorof healthcare activitiy’, ‘Financing’ and ‘Quality’, some trends key figures.In four chapters on ‘Organisation’, ‘Care ation ofgeneral hospitalsbasedonanumberof This reportprovides abrief overview oftheoper SUBJECT Colophon Legal deposit:D/2019/2196/41 and www.healthybelgium.be www.health.belgium.be Environment: Federal Health,Food Public Service ChainSafety and This documentisavailable onthewebsite ofthe ted provided thatthesourceisacknowledged. Any partial reproduction ofthis document is permit CONTACT INFORMATION: Phone +32 (0)2 524 97 97 (contact center) Phone +32(0)252497(contact 1060 Brussels (Belgium Place 40,boxVictor Horta 10 Directorate-General Healthcare - - - 2
KEY DATA IN HEALTHCARE General Hospitals 3. 2. 1. HOSPITALS WITHIN GENERAL CARE ACTIVITY hospital Nursing carewithinthegeneral general hospitals The mostfrequentdiagnosesin Hospital stays 3. 2. 1. LANDSCAPE OF THEHOSPITAL ORGANISATION hospital sector Employment trendsinthegeneral Categorisation ofhospitalactivities Types ofhospitals 4. 3. 2. 1. QUALITY 21 20 13 12 Medical imaging Pay forperformance major causeofantibiotic resistance Inappropriate useofantibioticsasa with guidelinesforhandhygiene Positive developmentsincompliance 3. 2. 1. GENERAL HOSPITALS FINANCING OF 11 7 6 5 Justified hospitalbeds The financialresourcesbudget Sources offinancing 34 31 29 28 27 26 25 24 23 3
KEY DATA IN HEALTHCARE General Hospitals specific phenomenonwithinarelevant domain. from ourDGor other organisations that focus on a reports view detailed onaspecificdomainthane.g. and atthesametimewithamorecomprehensive of ourhealthsystem, ofwhich theFPSisapartner, such asthereportofKCEonperformance levelmore detailed than already existing initiatives These eye-catchers areintendedtobesituated at a mentioned above. put theminto perspective regardingthe domains keycontain figuresinacomprehensiblemanner and of ‘policybriefings’ -or ‘eye-catchers’ -that would withinthisstrategywastargeted thedevelopment and exploitation ofourdata. A new productthatwas resulted fromthisexercise was better accessto policy.our data Oneofthestrategiclinesthat DG Healthcaretowork outhow we couldimprove comprehensive exercise was carried outwithinthe In 2017, inresponsetothiscriticismparticular, a it for themarket anditsusers. pumping uptheoilthanonrefiningitandpreparing focus inrecentdecadeshasoften beenmoreon times heartheremarkandcriticismthat as ofdata the metaphor “the new oil”, we some professionals healthcare. If we and mental continue emergencymedical care,healthcare of hospitals, onthedomains HFCSE historicallyhasalotofdata The Directorate-Generalfor HealthcareoftheFPS organisations arenoexception. ble partofthestrategyeveryorganisation;policy linking andanalysinghasbecomeanindispensa data that anintelligentapproach processing, tocollecting, areunrealisticandutopian,itisclear bilities ofdata though some of the expectations about the possi is It issometimessaidthatdata “the new oil”. Even DEAR READER, INTRODUCTION - - - funds and patient organisations, the social partners, funds andpatientorganisations,thesocialpartners, tutions andhealthprofessionals, healthinsurance government, the field of work of healthcare insti atvariousical policymakers, levels civilservants of sector.our hospital groupisbroad:polit- Ourtarget manner, of inordertoenhancetheirunderstanding wethe data have at our disposal in a comprehensible landscapeanoverview of healthcare andthehospital to give prior knowledge readers with a certain of in particular.hospitals It is amodest first attempt in your hands. Its focus and general is on hospitals, You are holding the first edition of this eye-catcher Director-General Healthcare Pedro Facon feedback. We wish you happy to your reading and look forward and sharing. initiatives canbelinked inthespiritofcooperation to explore withthelatter how ourprojectandtheir ernment andknowledge institutions. We would like figures are available fromourpartnersinthegov remain an “isolated initiative”. andkey data Certain Finally, it is not the intention for the eye-catcher to the eye-catcher. incorporated tofurtherincreasetheaddedvalue of how someoftheseinterpretative elementscanbe ripe for debate.Infuture editions,we willexamine figures requireadditional interpretation. These are them and highlight a number of trends. Some show anumberofkey figures, accuratelydescribe the In thefirstinstance, eye-catcher isintendedto The approach isnotevaluative ornormative innature. researchers etc. andconsultants, - - 4
KEY DATA IN HEALTHCARE General Hospitals ORGANISATION OF THE HOSPITAL LANDSCAPE
2019 103 general hospitals
79 7 17
HIGHLIGHTS classic general general hospitals general hospitals university hospitals with a university character
Source CIC: 01/01/2019
Over 20 years, Decrease of acute beds in the number of total hospital beds in favour of beds has continuously more beds for chronic decreased in general patients. hospitals.
Number of professionals in general hospitals has continued to grow. General Hospitals
5 IN HEALTHCARE KEY DATA 1. Among thegeneral hospitals, we candistinguish3typesofhospitals: exclusively provide geriatric,revalidation orpalliative care). (whichtals exclusively (which provide disorders)orspecialisthospitals carefor peoplewithmental The presentdocumentfocuses ongeneralhospitals. As such, itdoesnotcover psychiatric hospi- do nothave asurgicalorinternalmedicinedepartment. in thefield ofpsychiatry. Bydefault, althoughthey theseentitiesarenow partofgeneral hospitals, atthetime,otherspreferredgeneral hospital toexpand theiractivities, generallyby addingservices to the federated entities. While some of the entities in question chose to merge with a “classic” transfer competencefor (offering specialist hospitals exclusively revalidation and/or geriatricservices) alsofall hospitals into thiscategory. reform,Some atypical Duringthe6thstate itwas decidedto disciplines such asgeriatrics,maternity, paediatrics,neuropsychiatry andrevalidation, for example. andofferassistance, surgicalandinternalmedicinetreatments,complementedby various other thatreceiveThese patientsbothby areessentiallyhospitals day andby nightfor specialisedmedical ‘CLASSIC’ GENERALHOSPITALS Types ofhospitals C 9 37 WALLONIA 52 FLANDERS 14 BRUSSELS Source CIC:01/01/2019 (75 sites) (96 sites) (26 sites) 1 (197 sites) 103 hospitals general Organisation ofthehospital landscape
6
KEY DATA IN HEALTHCARE General Hospitals 2. services, medical or medico-technical services and functions necessary forcare. quality medicalormedico-technical andfunctionsnecessary services, services ways” for groupofpatients. atarget They aretheresultofanarrangement between hospitalisation Care programmes canbedefinedasanorganisational framework for implementing “carepath management, clinicalbiologylaboratory, etc. pharmacy,hospital palliative care, intensive/emergency blood bank, mediation, pain care, hospital or region): (community and control authority subject to specific standards by the accreditation Functions activitiesmadeavailable arehospital departments. toallhospital Various functionsare andkidneyhuman geneticscentres,radiotherapy dialysis services centres. (CT-scan,Medical-technical include medicalimagingservices services NMR,Pet-Scanner, etc.), includetransplantcentresorfor burnvictims. or equipmentareprovided. Medicalservices by thepublicauthoritiesisidentical appliesinequalmeasuretoboththepublicandprivate sectors,andtheirfinancingon Hospitals recent decades,many institutions arenow alegacyofboth the publicandprivate sectors. The Law universities or former companyHowever, hospitals. given mergers in the large number of hospital organisations. Historically, thelatter were theresultofreligiouscongregations,mutual societies,free (municipality,ity intermunicipal,province, region,etc.),and72%areprivate and run asnon-profit Of the103 inBelgium, hospitals 28%arepublicasof01.01.2019, i.e.managedby apublicauthor ent onauniversity. thathaveThese aregeneralhospitals beenallocatedanumberofuniversitybedswhich aredepend GENERAL HOSPITALS WITH A UNIVERSITYCHARACTER a universitywithmedicalschool offering afullcourseofstudy. health professionals, scientificresearch anddeveloping new technologies. They areconnectedto These offer oftraining but are alsoassignedthetasks asclassicgeneralhospitals, thesameservices GENERAL UNIVERSITYHOSPITALS medical or medico-technical services and , wherepatientsresideduringtheirstay inhospital, services is madebetweenhospitalisation Services group together activities that have aspecific location within the hospital. A distinction grammes. The hospitalischaracterised by itsactivity, organised into services, functionsand care pro- Categorisation ofhospitalactivities 2 , where certain specific services requiring special expertise specific services , where certain Organisation ofthehospital landscape 2 - - - 7
KEY DATA IN HEALTHCARE General Hospitals 2.1. Types ofhospitalisationservices There are currently various care programmes: of medical,paramedicaland nursingstaff. bed capacity, occupancyrateorrequired level of activity, technical andnumber equipment andtype includingminimum mustbe accreditedandmeetspecificstandards, Each withinthehospital service patients isassigned.Morethan25specificindexes areusedtoclassifytheseservices. cific form ofcare for asubgroupofpatients. For each anindex identifyingthesubgroup of service, aregrouped into services “care units”ineachHospitalisation Each hospital. ofthemoffers a spe- • • • • • • ments: invasive procedures,electrophysiology, orinterventional pacemaker placement,and disorders orheartfailure. Itincludesvarious sub-sectionsrelatedtodifferent oftreat types The one withnon-invasive care,theotherfor invasive treatments. The of thegeriatricpatientinclosecollaborationwithfront-lineprofessionals. or fragilities. The programmeisbasedonthediagnosis,therapeuticprocessandrevalidation average ageabove 75years whorequireaspecificapproach duetoage-relatedco-morbidities The fectly adaptedtotheneedsofchildren. of diseasesinchildren andprovides aframework, infrastructure andequipmentthatareper The cialised version. A specificprogrammeisalsodescribed for thetreatmentofbreastcancer. The (Assisted MedicalReproduction) techniques. diagnosis andtreatmentofinfertility problems,includingindicationsregardingtheuseof AMP The heart transplants. 3,995 CHRONIC BEDS ACUTE BEDS 34,962 PSYCHIATRIC BEDS 13,608 Source CIC:01/01/2019 geriatric patientcare programme, which thegeriatricpatientpopulationwithan targets care programme for children cerebrovascular accidentcare programme (CVA), subdividedinto2sub-programmes: “reproductive health” care programme, which includesvarious activitiessuch asthe “cardiac pathology” care programme which isoffered topatientswithheartrhythm oncology patientcare programme, which includesa‘basic’version andamorespe , which focuses on the diagnosis, treatment and follow-up 52,565 beds accredited
Organisation ofthehospital landscape - - - 8
KEY DATA IN HEALTHCARE General Hospitals A 10 000 20 000 0 000 0 000 0 000 0 000 0 EVOLUTION OF THE NUMBEROF ACCREDITED HOSPITAL BEDS according towhetherthey aremoreacute/chronic ormoresomatic/psychic innature. In ordertogive abetter overview, we cangroupthedifferent services ofhospitalisation types and specialisthospitals. 2015, general asaresultofmergersbetween asmallincreaseinaccredited bedscanbeobserved Indeed, adecreaseof3,762 accreditedbedshasbeenrecorded.Nevertheless, between 2010 and The general evolution in the number of accredited beds between 1990 and 2019 is decreasing. • • • 1990 (index C),internalmedicine(index D),paediatrics(index E),careofpremature infants (index “Acute” beds:for shortstays, i.e.stays surgery thatdonotrequirelong-termtreatment:e.g. A2, T and T1) orfor children (index K,K1andK2). and neuropsychiatric disorders: observation with mental treatment for adults (index A, A1, “Psychiatric” beds:intendedfor thecareofpatients,possiblyonlyduringday oratnight chogeriatric pathologies),palliative care(index S4). pathologies, S3 for neurological pathologies, S5 for chronic polypathologies and S6 for psy geriatrics (index G),revalidation (indexpathologies,S2:locomotor S1for cardiopulmonary “Chronic” beds:for longer-term orfor hospitalisations patientsrequiringchronic treatment: (indexNIC), maternity M). 199 2000 200 2010 Organisation ofthehospital landscape C 201 A T 2019 - 9
KEY DATA IN HEALTHCARE General Hospitals 2.2. The geographicaldistributionofaccreditedhospitalbeds number ofbeds. tively. Walloon BrabantandFlemishBrabant,ontheotherhand,areprovinces withthelowest Insecondandthirdplacewebeds per100,000 find inhabitants. West Flandersand Hainautrespec presentedabove,According to thedata theBrussels-Capital Region hasthehighestnumberof have to offer: that thehospitalsinBelgium and thedifferent services Learn more aboutthelocation 1 NUMBER OF BEDS (ALL INDEXES COMBINED) PER 100,000 INHABITANTSNUMBER OFBEDS(ALLINDEXESCOMBINED)PER100,000 www.health.belgium.be PER PROVINCE AS OF01.01.2019 INGENERALHOSPITALS E 2 C R 9 0 H 1 1 91 N 290 0 A Organisation ofthehospital landscape L 1 0 L L
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KEY DATA IN HEALTHCARE General Hospitals 10 000 20 000 0 000 0 000 0 000 0 000 0 000 3. 1 0 in general and university hospitals hasincreasedbyin generalanduniversityhospitals 7,171 full-timeequivalents (+6%). to increaseover time(seebelow –chapter over Intotal, 4 years, Careactivity). thevolume ofstaff stays, andthereforenoted thatthenumberofhospital thenumberofpatientsadmitted, continues ries. This may seemstrangegiven thereductioninnumberofaccreditedbeds,butitshouldbe In addition,over time,thevolume ofFTEshiredby isincreasinginallprofessional hospitals catego as many doctorswork withself-employed status andaretherefore staff’. notreportedas‘hospital However,hospitals. thefigures Overall, nursing staff (nurses and orderlies) represent just over half of the full-time equivalents in Employment trendsinthegeneralhospitalsector Source: Finhosta 201 BREAKDOWN BY CATEGORY OFPROFESSIONALS(IN TERMS OFFTES)IN2017 EVOLUTION OF THE VOLUME OFFTES 2 201 C 1 1 [1] , shown inthegraphbelow, largelyunderestimatemedicalactivity, 201 2 1 1 0 201 1 019 Organisation ofthehospital landscape 201 A 22 12 A C - 11
KEY DATA IN HEALTHCARE General Hospitals CARE ACTIVITY WITHIN GENERAL HOSPITALS HIGHLIGHTS Patients living in We have observed a 13.9% Flanders increase in contacts/ generally have fewer hospital stays over a period of contacts with 10 years. hospitals than people living in Wallonia and Brussels.
The most common reasons for classic and day hospitalisations are due to diseases of the digestive system, admissions for chemo- and immunotherapy and diseases concerning the nervous The average . system length of stay fell by 1 day over the last ten years.
From 2013 onward, the number of day hospitalisations is higher than the number of classic hospitalisations. General Hospitals
12 IN HEALTHCARE KEY DATA 1. 2 1.1. Evolution ofthenumberstays/contacts have specificdiseasestreated(for example, for cancer chemotherapy) ordueto various causes. by ahospitalisation(day orclassic).Insomecases,apatientstays several timesduringayear to referred withemergencydepartment”)aswell toasan asacontactfollowed contact “ambulatory stay viatheemergency department maywithouthospitalisation(hereinafter meanacontact where thepatientstays and/orwhereadailycostischarged. atleastonenightinthehospital A withoutspendingthenightthere,unlikepatient comestothehospital classichospitalisation During a There stays contacts. are various of hospital or hospital types of classichospitalisation. departments (+15.5%). Another lessonisthatfrom2013 onwards, day stays hospital exceed those with emergency contacts due to a higher number of day (+29%) and ambulatory hospitalisations From per100,000 inhabitants. tacts to2017, 2008 thisnumber increasedby 13.9%. This ismainly To accuratelycomparethisevolution tolookatthenumberofstays over /con time,itisnecessary in 2017. withemergencydepartments)was contacts 5,138,177.latory This numberincreasedto6,214,325 stays numberofhospital (which thetotal In 2008, includesclassicorday stays hospital andambu Hospital stays the genderofpatient cannotbedetermined,stays inday for hospitalisation which amini-fee ornofixed sum was charged. (except thefirstperiod of alengthy stay,fullpsychiatric hospital stays, stays ofnewborns which were notinvoiced, stays for which (MZGinDutch)’. Data Source offigures‘Minimum Hospital The followingtypes ofstays were notincluded:non-terminated stays 1,971,865 2,420,814 1,821,646 EMERGENCY DEPARTMENT AMBULATORYCONTACTS WITH DAY HOSPITALISATIONS CLASSIC HOSPITALISATIONS
[2] Care activitywithingeneralhospitals 6,214,325 in 2017 contacts stays / day hospitalisation, the
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13
KEY DATA IN HEALTHCARE General Hospitals N N 10 000 20 000 0 000 0 000 0 000 0 000 10 000 1 000 20 000 2 000 3 1.2. 0 Number ofhospitalstays/contactsaccordingtoregion Region. althoughremains alittlecomparable per100,000 inhabitants, lessfrequentintheBrussels-Capital Flemish regionandtheBrussels-Capital is Region. Inallthreeregions, theclassichospitalisation departments lower. the ashighbetween istwice emergencyservices The rateofuseambulatory withtheemergency contacts issignificantlyhigherandtheuseofambulatory of day hospitalisation care use is lowerIn general, the rate of hospital in Flanders than in the other regions. two The use A closerlookatthe3regionsreveals several differences between them. 58,495inBrussels and58,023in 2008), (+9.4%since2008) Wallonia (+14.4% since2008). In 2017, numberofstays inFlanderswas per100,000 thetotal 50,862(+14.4% inhabitants since Region oforiginthe patient. 200 ru e C e o BY TYPE OFHOSPITALISATION AND BY REGION (2017) 2009 PER 100,000 INHABITANTSPER 100,000 BY TYPE OFHOSPITALISATION NUMBER OFSTAYS INHABITANTS PER100,000 EVOLUTION OF THE NUMBEROFSTAYS/CONTACTS 2010 2011 e e o 2012 201 201 oo e o 201
201
Care activitywithingeneralhospitals 201
[3] C D A C D A 14
KEY DATA IN HEALTHCARE General Hospitals N 10 000 1 000 20 000 2 000 1.3. 000 0 New hospitalstaysduringtheweek non-existent duringtheweekend. The numberofweekday ofstays stays day andisalmost ishigherthanothertypes hospital following morning. onwards. This slightincreaseonSundays isduetostays for surgicalproceduresscheduled for the graduallydecreasefromMonday toSaturdayin classichospitals andincreaseagainfromSunday the week. butstays withemergencydepartmentremainfairly stable, contacts The ambulatory department per day was 16,947. However, this average number varies according to theday of For theyear 2017, theaverage withtheemergency stays numberofnew andcontacts hospital o stays/contacts perday 16,947 ue AVERAGE WEEKLY NUMBEROFNEWSTAYS BY TYPE OFHOSPITALISATION (2017) e e
ur r S ur
Su Care activitywithingeneralhospitals C D A 15
KEY DATA IN HEALTHCARE General Hospitals A 1.4. 01 0 0 10 11 1 1 20 21 2 2 0 1 0 1 0 1 0 1 0 1 0 1 90 91 9 9 1 Age andgenderofthepatient childbirth. careby womenof hospital aged20to40comparedmeninthisagegroupismainlyrelated women have stays number ofhospital duetolongerlife ahighertotal expectancy. The higher use for children emergencies. aged1to5years,After mainlyduetohigheruseofambulatory age80, About one-fifth usersarebetween55 and70 years ofage. service ofhospital There is alsoapeak C 20% 55 patients between 200 000 and 1 0 000 D ofstays are 70 years 100 000 0 000 N A 0 0 000 ofage 100 000 Care activitywithingeneralhospitals 1 0 000 200 000 16
KEY DATA IN HEALTHCARE General Hospitals 1.5. 6 5 4 10 1 20 2 0 0
0 D 0 1 2 Average lengthofstayinclassichospitalisation 4 days. In maternity, in55%ofcases,thedurationdoesnotexceed 3days and80%ofstays donotexceed length ofstayfor acutecareis4.6days. just over halfofacutecarestays donotexceed 2days andthattheaverage ofhospitalisation, A closeranalysis ofthenumberdays forshows spentinhospital acutecareandmaternity that and 2017,2008 theaveragedecreasedby oneday. lengthofstayintheseservices are excluded) inanacutedepartment(whereasstays atthematernity lution ofthelengthstay starting started intoaccountthespecificsituationof careandtaking ofpatients. We examine here,firstly, the evo- ensure efficiency infrastructure andappropriateuseofhospital withoutcompromisingthequality For several years, healthcarepolicieshave inorderto encouragedareductioninthelengthofstay are notshown inthis graph for thesake ofreadability. Psychiatric andchronic stays arenotincluded inthesegraphs.Stays longerthan10 days (9%ofacutestays, stays) 2%of maternity represented nearly1.5 in2017. millionhospitalisations stays Maternity represent7.6% ofstays. staysIt isthecasethat81%ofclassichospital correspond toacutecare(excluding departments),which staysinmaternity starting are takenintoaccount. (index (index forC),internalmedicine(index E)andcarefor surgery D),pediatry newbornsStays inaservice (index thatstart NIC) DURATION OFSTAY FORCLASSIC STAYS ACCORDING TO THE TYPE OFSTAY 0 [6] 200 1 [4] AVERAGE DURATION OFSTAY PER TYPE OFSTAY and,secondly, department.Between thelengthofstaysatmaternity starting 2 2011 D (2017) 201 201 Care activitywithingeneralhospitals 9 A 10 [5] A 17
KEY DATA IN HEALTHCARE General Hospitals 100 1.6. 10 20 0 0 0 0 0 0 90 0 Emergency admission department isfollowed by aday hospitalisation. followed inmorethanhalfofthecasesby Rarely consultingtheemergency classichospitalisation. department aremorefrequent. After withtheemergencydepartmentis theageof70,acontact in hospitalisation. While amongtheelderly, following hospitalisations avisittotheemergency children,With youth useofemergency departmentsresultsrarely andyoung adultsanambulatory BREAKDOWN ACCORDING TO AGE withtheemergencydepartment(withouthospitalisation). contacts the ambulatory The following following graphsdescribehospitalisations anemergencydepartmentvisit,asregards 1 C PERCENTAGE OF TYPE OFSTAY FOLLOWING A VISIT TO THE EMERGENCY DEPARTMENT 01 0
0 10
11 1
1 20 D 21 2
2 0
1 BY CATEGORY OF AGE (2017)
0 C A 1
0
1
0
1
0 Care activitywithingeneralhospitals
1
0
1
90
91 9
9 18
KEY DATA IN HEALTHCARE General Hospitals 100 10 20 0 0 0 0 0 0 90 0 emergency department. These resultsreflect different usesofemergencies. 2 regions.In Wallonia andBrussels, four outoffive patients return homeafter theirvisittothe third ofemergencyvisitscontinuewithhospitalisation. This proportionishigherthanintheother andone areproportionallylessused,per100,000 inhabitants, In Flanders,theemergencyservices mentioned below.itants which isrelatedtothebreakdown,ofstays accordingtoregions,ofthetypes per 100,000 inhab- department, comparedtojustover 60%intheBrussels-Capital Region andthe Walloon Region, withavisittotheemergency intheFlemishregionstart withahospital Almost 45%ofcontacts REGION ACCORDING TO BREAKDOWN Remark: The stays inthedayarelessthan1%andtherefore hospitalisation nottaken intoaccountinthefigure. ru e C e o AND ACCORDING TO THE REGION OF THE HOSPITAL (2017) PERCENTAGE OFSTAYS BY TYPE e e o oo e o
Care activitywithingeneralhospitals C A H 19
KEY DATA IN HEALTHCARE General Hospitals 2. 7 gender ratioisreversed system. for diseasesofthecirculatory A highernumberofwomen than men aretreatedfor disorders of the osteoarticularsystem; this diagnoses beingchronic pain,sleepdisordersorepilepsy. systemare in2ndposition. Diseases of thenervous arein3rdposition with the most frequent problems as the most common diagnoses. Stays related to chemotherapy and immunotherapy gastricandintestinal thisinmind,digestive tractdiseasestopthelistwithinthisgroupdental, With or different reasons. borne inmindthatduringthesameyear, apatientmay several stay inhospital timesfor thesame ten maingroupsofdiagnosesaccordingtotheICD-10-CM classification The graphbelow shows thenumberofstays (classicanddaycombined)for hospitalisation the The mostfrequentdiagnosesingeneralhospitals chapter were notincludedin the analysis. Chapters ofICD-10-BE, intoaccount onlychemo- taking andimmunotherapy for chapter XXI(62%). The otherstays fromthis 1 1 1 1 1 1 1 9 1 9 1 1 09 0 E R C L T N C D TOP 10 OF THE MOST FREQUENT DIAGNOSTIC GROUPS(2017) 10 10 9 11 1 1 9 9 Care activitywithingeneralhospitals 1 01 E R L T C N C D [7] for allages.Itshouldbe 20
KEY DATA IN HEALTHCARE General Hospitals 3. 8 • • You canfindmoreinformation inthisregardhere. a grouping system that is used as a basis for funding surgical, internal and paediatricnursing care. These five broad categories correspond more or less to the Nursing Related Groups (NRG). This is and theamountoftimespentonthiscareareincrease. number ofnursingactivitiesandthecareburdenintermsrequiredcompetencenurse If thecaregroupsarearranged frombasiccarelow tohigh-technical care,we would seethatthe abloodsampletopatientventilation. rangingfromtaking actions, ontheotherhand,aretasks such withfood,hygienic asassistance assistance withtravel, care,assistance etc. Technical care canbedescribedasnursingsupportinmeetingtheneedsofgeneraldailylife (ADLtreatment) less technical careisprovided, of‘basic’care(theremaining90%). butalargevariety The basic groups. The groupwithhighly‘technical’ care(about10% ofthenursingperiod)andagroupwhere wepatient permomentintheirstaycanimmediatelyseethattherearetwolarge atthehospital, patient into 5 large groups of ‘types’ of nursing care. When we look at the care provided to the of informationtodividethecollectioncareprovided withrespecttonursingcare,wethe try Nursing careinourBelgian isdiverse.. hospitals Inanattempt togainmoreinsightintothereams • • Nursing carewithinthegeneralhospital Source numerical data: MHD 2017Source numericaldata: This includes patients who are distinguished by the high number of technical care they receive. the services for diagnosisthe services infectious diseasesandin es maternity, rehabilitation, Characteristic for theservic only follow-up fromanurse. are independent and receive This includespatientswho Characteristic ofintensive caredepartmentsand burncentres. nurse. Those patientsreceive often alotofbasiscaretoo. These patientsreceive alotofmedication,canbeventilated andare closelyfollowed upby a and treatment. LOW - • • ment. vices for diagnosisandtreat room andinthegeneralser room, thelabourand delivery Characteristic for therecovery such aswashing oreating. are accompaniedinactivities This includespatientswho MEDIUM AND HIGH MEDIUM AND TECHNICAL CARE BASIC CARE MEDIUM - - Care activitywithingeneralhospitals • • • and seniors. provided toyoung children ofcareis Thismainly type units. diatrics andpalliative care neonatology, geriatrics,pae Characteristic oftheservices ed. more technical careislimit ing. The administration of dressingandeat washing, with,forsistance example, often receive completeas This includespatientswho [8] HIGH - - - - 21
KEY DATA IN HEALTHCARE General Hospitals 3.1. 22 Nursing carewithinamaternitydepartmentandgeriatricservices Most characteristic nursingactions: NURSING CAREFORMOTHERS WITHIN A • • • MATERNITY DEPARTMENT (59%) Episiotomy) Wound careonasuture (e.g. a baby bath,etc.) Education onbreastfeeding, giving Structured specificeducation(e.g. maternal flow, etc.) lactation, monitoring ofuterineheight, Specific carepost-partum (e.g. 2 H T 1 H Most characteristic nursingactions: • • • • WITHIN GERIATRIC SERVICES: bedsores Support inhygienic carePrevention of Help witheatingand/ordrinking Care relatingtomobility excretion andfaecal Care relatingtourinary T NURSING CARE L
Most characteristic nursingactions:
A NURSING CAREFORBABIES WITHIN • • • • • MATERNITY DEPARTMENT (41%) Care relating to mobility: assistance assistance Care relatingtomobility: excretion andfaecal Care relatingtourinary Skin-to-skin contact umbilicalstump)point (e.g. Wound careonasuture orinsertion balance Follow-up ofnutritionalandmoisture in installing/movingpatients T 2 L 2 1 Care activitywithingeneralhospitals L H 9
22
KEY DATA IN HEALTHCARE General Hospitals FINANCING OF GENERAL HOSPITALS
The turnover of the general hospitals amounted to approximately €18.2 billion in 2017. HIGHLIGHTS
The Financial Resources Budget is allocated partly on the basis of fixed sums and partly on the basis of the justified activity of each hospital.
The Financial Resources Budget consists of 3 main components
Costs for Operating costs Costs for infrastructure and regularisation of materials previously allocated financial resources budgets General Hospitals
23 IN HEALTHCARE KEY DATA 1. 10 9
10 12 1 1 1 20 0 2 pharmaceutical andsimilarproducts,roomsupplementsthepatientshare. categoriesofmedicalandparamedicalstaff,doctors, dentistsandcertain INAMI/RIZIVfixed sums, The mainsourcesoffinancingaretheFinancial for hospitals ResourcesBudget(FRB) fees of The sectorrepresentsEUR18,2 turnover generalhospital billionintotal in2017. Financial Resources In ordertodemonstrate theevolution, categories A1 and A3 were included. Source: Finhosta 2010 2011 EVOLUTION OF TURNOVER AND BMF 2012 H 0 BREAKDOWN OF TURN-OVER (2017) 201 1 1 201 201 [10] A 0 RI I INA I 201 R 0 R 201 Financing ofgeneral hospitals [9] R T 24
KEY DATA IN HEALTHCARE General Hospitals 2. 12 11 C: B: A:
THE SUBDIVISIONSOF THE BUDGETFINANCIALRESOURCES services. the FRB (PART financingis mainly basedon lumpsums,realcosts or ). C Hospital fee-for-service costs budget(PART B) andabudgetfor theregularisationofpost-financing ofthe various partsof The FRBhasthreemaincomponents:aninfrastructure andmaterialsbudget(PART A ), anoperating was setatamaximumamountof€ 6,251,249,619 for generalhospitals oftheoveralldistribution amongallhospitals budget hospital throughthefinancial The financingofahospital resources budget comesfromtheindividual CORRECTIONS OPERATIONAL COSTS INFRASTRUCTURE &EQUIPMENT The financialresourcesbudget ties by reform. thesixthstate Therefore thecategories A1 and A3 areexcluded. We noticethatthecompetence concerningthefinancingofinfrastructure (A1 and A3)hasbeentransferred to the federated enti- of thebudgetfor thefinancialresources ofhospitals. The allocationismadeonthebasisof procedureslaiddown intheRoyal Decreeof25 onthefixingandsettlementApril 2002 B9: B8: B7: B6: B5: B4: B3: C3: B2: A3: C2: B1: A2: A1: Social agreementsexpenses Costs relatedtothesocialnature ofthepatients Costs relatedtouniversityfunctions Employee benefits expenses excluding FRB Pharmacy operatingcosts Recycling andfixed fees Operating costsNMR-Radiotherapy -Petscan Partial recoveryofroomsupplements charges service Hospital Investment expenses NMR-Radiotherapy -Petscan Catch-up amounts chargesCommon service Short-term creditcharges Investment expenses [11] . InJuly 2019, thisoverall budget [12] . Financing ofgeneral hospitals (july 2019) 42.87% 23.58% 17.24% -0.16% 8.34% 0.33% 0.56% 1.93% 1.72% 1.02% 1.37% 1.19% %
25
KEY DATA IN HEALTHCARE General Hospitals Justi ed beds 10 000 1 000 20 000 2 000 0 000 3. 000 0 by anormative occupancyratemultipliedbyajustified 365toobtain numberofhospitalbeds. justifiedof stay according totheirpathology. numberofjustified The total days hospital isdivided of admissions forthe number and type a reference year. Each person admitted is granted a length by is determined, hospital hospital. The of each activity is therefore hospital defined according to For a funding is essentially based on patient-related activity: acute hospitals, “justified activity” Justified hospitalbeds 201 EVOLUTION OF THE NUMBEROFJUSTIFIED BEDS 201 201 201 201 201 2019 445 2,212 2,213 7,792 24,275 Financing ofgeneral hospitals intensive care Service forneonatal Maternity Pediatry Geriatric service and treatment Service fordiagnostics 26
KEY DATA IN HEALTHCARE General Hospitals QUALITY HIGHLIGHTS
In 2017, it was found that in To limit resistance more than 70% of the cases, to antibiotics, the guidelines for hand unnecessary use hygiene were complied with. of antibiotics must be avoided.
The «Medical images The first steps are being taken to are not holiday reward hospitals if they snapshots» campaign achieve positive results in the context prompts a decrease in the of certain indicators via the Pay number of CT scans for Performance for children and programme. adolescents. General Hospitals
27 IN HEALTHCARE KEY DATA 15 14 13 1.
the useofpsychotropic drugs, transmuralcareandintegratedcare,etc. newbornmentioned inthecontext care,theuseofbloodproducts, ofclinicalpharmacyinhospitals, years tomeasureandimprove ofhealthcareinBelgium. thequality Otherinitiatives couldalsobe This chapter highlights,by way ofexample, anumberofinitiatives thathave beentakeninrecent measuresinthefield,and taking benchmarking, peerreviews andfinancialincentives. development ofguidelinestoawareness-raising campaigns,laying down measurementindicators etc.), butalsointernational(OECD, EU, WHO, etc.). These initiatives takevarious forms: fromthe or even within the framework of private initiatives bodies, (scientific associations, accreditation of federated entities (VIP² onthe Dutch-speaking side, PAQS on the French-speaking side, etc.), Public Health,butalsoINAMI/RIZIV, KCE,Sciensano,SuperiorHealthCouncil,etc.)oratthelevel To actonthesedifferent levels, various initiatives by aretaken different federal authorities(FPS patient safety, patientsatisfaction, theintegratednature for better ofinterventions continuity... technologies andtreatmentsfor thepatient,efficacy ofcare,anenvironment thatguarantees The ofcarecovers issueofquality awiderangeofelements:the choice ofthemost appropriate hands (percentage ofhandhygienehands (percentage compliance) theextent towhich observed hospitals healthcareproviders complywiththeregulations for clean of handhygiene andimprove theuseofalcoholgelfor hands.Before and after each campaign, recent years, various campaignshave beenorganisedinBelgian tohighlighttheimportance hospitals toprevent interventions healthcare-associatedinfectionsof themostimportant inpatients According tothe World HealthOrganisation(WHO), goodhandhygiene shouldbepromotedasone ciated infection (2017) at any given time, approximately 7.3% suffer of patients in acute hospitals from a healthcare-asso considered amajorthreattopatientsafety. The resultsofaEuropeanstudy show thatinBelgium, Healthcare-associated infections (infections that occur 48 hours after the day are of hospitalisation) website (http://www.nsih.be/surv_hh/inleiding_nl.asp). More information onthe methodologyandresultsofthehand hygiene campaigncanbefound inthenational reportontheNSIH who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf?ua=1 World HealthOrganisation.(WHO). Geneva Globalreporton surveillance. Antimicrobial resistance: 2014. Available from:http://apps. from: http://www.nsih.be/ecdcpps/download_nl.asp Resultshospitals: oftheECDCPPS2017. Brussels, Belgium: Sciensano; 2018. 34p.Report Number: D/2018/14.440/37. Available Vandael B, LatourK.Point E,Catry Prevalence Study ofhealthcare-associatedinfections andantimicrobialuseinBelgian acutecare guidelines forhandhygiene Positive developmentsincompliancewith [13] . associated infection suffer froma of patientsinacutehospitals 7.3% [15] .
healthcare-
[14] . In - Quality 28
KEY DATA IN HEALTHCARE General Hospitals 100 17 16 2. 10 20 0 0 0 0 0 0 90 0
(on average +7.5%) withthebestresultsfor nurses. post-campaign (147 participating hospitals). An improvement was among all care providers observed (national weighted average) rosefrom71.6% pre-campaign(170 to78.0% participatinghospitals) the guidelinesfor handhygiene areadheredto.Duringthelastcampaign,handhygiene compliance The figure below shows a clear increase over time and after each campaign in the extent to which In Belgium, there are an estimated 530 deaths every year peopledieeveryyear inEuropeasaresultofinfection33,000 bacteria. duetoantibiotic-resistant by thesemedicines. hasbecomea majorprobleminhealthcare.Indeed,aroundThis resistance totheeffectsBacteria canbecomeresistant ofantibiotics,meaningthatthey cannolongerbekilled modelling analysis. LancetInfect Dis2019;19(1):56-66. years causedby infections bacteriaintheEUandEuropean Economic with antibiotic-resistant Area in2015: apopulation-level Cassini A, HögbergLD, Plachouras D, Quattrocchi A, Hoxha A, SimonsenGS, etal. Attributable deathsand disability-adjustedlife- Source: Nationalreport7thhandhygiene campagne –www.nsih.be of antibioticresistance Inappropriate useofantibioticsasamajorcause 200 Around antibiotic-resistant bacteria as aresultofinfection dueto die everyyear inEurope EVOLUTION INFOLLOWING THE GUIDELINESONHANDHYGIENE 200 200 33,000 people 33,000 200 2009 2010 2011 [17] 201 . The inappropriate use of antibiotics 201 201
[16] 201 201 Quality 29
KEY DATA IN HEALTHCARE General Hospitals 20 19 18 D DDD 100 200 00 00 00 00 00
0 time, butthereisalargevariation between hospitals. 2012-2017. thatthemedianantibioticconsumptionremainsfairlyover Ithasbeenobserved stable The figurebelowfor theperiodtype ofhospital shows themedianantibioticconsumptionper waspitals 30.5%(spreadamongEuropeancountries:15.9-55.6%) andinintensivegeneral university hospitals care. The prevalence inallparticipatingEuropeanhos care (52.7%). This is to be expected given that more patients with more serious problems are in given moment. This (30.8%)and withinintensive figureishighestingeneraluniversity hospitals aretreatedwithatleastoneantibioticanyestimated 28.1%ofthepatientsinanacutehospital be properlymonitoredand,wherenecessary, adapted is amajorcauseofbacteriadeveloping antibioticresistance. As such, theuseofantibioticsmust are not sufficient or nolonger work. Nevertheless, the useofbroad-spectrum antibiotics remains broad-spectrum antibioticscanbestoredfor complicated caseswherenarrow-spectrum antibiotics trum, according to the guidelines (only active against a specific group of bacteria). For example, ment withantibioticsisnecessary, itisrecommendedtouseantibioticswithinanarrow spec useofantibioticsmustbeavoided. toantibiotics,unnecessary Iftreat- In ordertolimitresistance Source: Belgian Hospitals - Surveillance of Source: Belgian -Surveillance Antimicrobial Consumption,Sciensano Hospitals 2018;23(46).Surveill doi:10.2807/1560-7917. results fromthesecondpointprevalence survey(PPS)ofhealthcare-associatedinfections andantimicrobialuse,2016 to2017. Euro Plachouras D, Karki T, HansenS, HopkinsS, Lyytikainen O, MoroML,etal. Antimicrobial useinEuropeanacutecarehospitals: https://doi.org/10.1787/9789264307599-en OECD (2018), Stemming theSuperbug Tide: Just A Few DollarsMore,OECDPublishing, Paris. Available from: The resultsofastudy ontheuseofantibioticsinBelgianfrom2017 acutehospitals show thatan EXPRESSED INDAILY DAYS DOSES(DDDS)PER1000 OFHOSPITAL USE,PER TYPE OFHOSPITAL C 2012 (EXCLUDING DAY HOSPITALISATIONS AND PSYCHIATRIC WARDS), 201 MEDIAN ANTIBIOTIC USEIN ACUTE HOSPITALS 201 [20] [18] 201 . [19] . 201
201 - - Quality 30
KEY DATA IN HEALTHCARE General Hospitals 23 3. 22 21 website. concerning amoreeffective antibioticpolicyinBelgium. Moreinformation canbefound ontheir spectrum antibioticsareattention pointsfor improvement. The KCEwrotesomerecommendations The large variation and the high consumption of broad in antibiotic use between acute hospitals ISQUA ACCREDITATION mance programme’ andthefullsetofindicatorscanbefound here. A numberofindicatorsarehighlightedbelow. information Moredetailed aboutthe‘Pay for perfor indicators willbeoptimized inthecomingyears. short-term feasibility arefour elementsthatplayed aroleinselectingtheindicators. The setof a fully-fledged P4P programme. pragmatism, and A modeststart-up, availability ofnationaldata andpathology-specific indicators.range ofhospital-wide These canbeseenasafirststep towards In 2018 and2019, thefirstP4Pindicatorsets for Belgian hospitals were developed,a consistingof of thetreatedpatients. for thecareprovided theorganisationandprocesseswithinhospital, andthehealthoutcomes cially ifthey achieve goodresultsonaselectedsetofindicators. These indicatorsareayardstick financing.the reform ofhospital “Pay for Performance” isasystem thatrewards finan hospitals The introductionofaPay for Performance programme (P4P) antibioticuseinBelgium, Europeancountries):16-62% spreadbetween high (about30%oftotal itation of health and external care institutionsitation evaluation is a mostly voluntary method that refers actual ofcareischecked quality andnorms. andtestedagainstdefinedhighstandards The accred ISQUAIn a hospital-wide for in Health (International Care) Society Quality http://isqua.org/docs/accreditation/cf-001-iap-application-form.docx Pay forperformance KCE Reports vol 118A. D/2009/10.273/50. programma’sQuality” Research inBelgië. HealthServices (HSR).Brussels: Federal Knowledge Centrefor HealthCare(KCE).2009. C, Van Herck P, Vanmeerbeek M, S,Willems DeGauquierK. Voordelen, nadelenenhaalbaarheidvan deintroductie van “Pay for Annemans L,Boeckxstaens P, Borgermans L,DeSmedtD, Duchesnes C,Heyrman J, Remmen R,Sermeus W, Van DenBroecke www.healthstat.be. Consumption). Moreinformation canbefound aboutthissurveillance viahttp://www.nsih.be/surv_gm/introduction_en.asp and The (BeH-SAC: useofantibiotics,inBelgium, vianationalsurveillance isobserved of Belgian– Surveillance Antimicrobial Hospitals A P4P-PROGRAMME 2019 (N=100 HOSPITALS) ISQUA-ACCREDITATION N 1
[22] is a clear priority inthecontext of isaclearpriority 20 [23] accreditation, the accreditation, [21] ). ). - - - Quality 31
KEY DATA IN HEALTHCARE General Hospitals hospital to familyhospital andfriends. of satisfaction stay andtheextent withthehospital towhich thepatientwould recommendthe The 2019 P4Pprogrammeevaluates thepatient’s experiences intwo ways: thepatient’s level improve care. Healthcare institutions can use patients’ feedback to improve of their care. the quality Measuring patients’ Patients experience isimportant. shouldbeinvolved asactive partnersto PATIENT EXPERIENCE phase arefinanciallyrewarded throughtheP4Pprogramme. thathave thecertificateas Hospitals well asthosethatarestillinapreparatory alreadyobtained Healthcareinstitutionspital. make greatefforts certificate. anISQUA quality toobtain accreditation professionals. Itisamajorexercise thathasanimpactonalldepartmentsandlevels inthehos validated by anindependentexternal body, ISQua,which isinternationallyrecognisedby hospital “the reference” recommended by body. an accreditation The body and its manual are accreditation operation and practices, a set of formalised requirements presented in the form of a manual, i.e. to aprofessional processby which ahealthcareinstitution demonstratesthatitmeets,inits friends hospital 94.2% (score ≥ 80%) satisfied of allpatientssurveyedwere and recommends the
withthestay to familyand - Quality 32
KEY DATA IN HEALTHCARE General Hospitals 24
C 100 10 20 0 0 0 0 0 0 90 0 average of90%. achievingsee alargevariationwith8%ofthehospitals betweenhospitals, value thetarget ofan pacemaker, antibiotic prophylaxis took place in accordance with the antibiotics guidelines. We For anaverage stays in2012, of53.7%hospital 2013 and2014 withafitting ofa(permanent) an alternative iscefuroxime (1.5 gramsperday). taken intoaccount. The preferred antibioticiscefazoline (min.1gramtomax.2gramsperday) and guidelines for fitting a(permanent)pacemaker measures whethertheselectionanddoseofantibioticisinaccordancewithantibiotics forindividual patients and reduce the risk of bacterial resistance the general population. This indicator prophylaxis”. This for isimportant optimizing the use of antibiotics to avoid the risk of infection in including the indicatorindicators in hospitals, “Choice of the antibiotic in the context of surgical Committee) for 2014-2019 of continuous monitoring of some quality underlines the importance tribute topatientsafety. The policypaperoftheBAPCOC (Belgian Antibiotic Policy Coordination Antibiotic policyandinfection ofcareandalsocon pillarsfor thequality controlarefundamental PACEMAKER ANTIBIOTIC PROPHYLAXISDURINGIMPLANTATION OF A (PERMANENT) therapy 2012-2013 (Belgian/Luxembourg edition),189-197.) Sanford, J.P., Gilbert,D.N., Chambers,H.F., M.S. R.C.,Saag, Eliopoulos,G.M.,Moellering, The Sanford guidetoantimicrobial DURING IMPLANTATION OF A PERMANENT PACEMAKER COMPLIANCE WITH ANTIBIOTIC GUIDELINESANTIBIOTIC COMPLIANCE WITH N N 10 1 [24] ; thetimeanddurationofprophylaxis arenot 20
2 T - Quality 33
KEY DATA IN HEALTHCARE General Hospitals 4. 25 The following heavy-duty medicalimagingdevicescanbedistinguished: andevaluatesupport medicalinterventions treatments. medicalimagingisusedtodiagnose,detectandmonitordiseasesatanearlystage, In hospitals, ‘Medical imaging’isacollective termfor various techniques foranimageofthebody. obtaining for another applicable technique. What isagoodimagingtechnique for onedisorderisnotalways thesame The above techniques allhave theirstrengthsandweaknesses. There istherefore nogenerally Medical imaging Source: National registry for heavy,Source: Nationalregistry medicalequipment. These arethedevices which andpermissions andwhich have accreditations were the necessary reportedtotheFPSPublic health. • • • • accurate picture ofthedistributioninjectedproduct. ahighly directions.Bycombiningtheinformationin two from2measurements,doctorsobtain radioactive productusedinPET hastheuniquecharacteristic thatitcanalways bemeasured PET (includingPET-CT andPET-MRI): As withSPECT-CT, aradioactive productisused. The in ordertoclearlyseewheretheinjectedproductisdistributed. aroundthepatient. with detectorsthatrotate The measurementsarethenaddedtoCTimages SPECT-CT: aradioactive productthatisinjectedusedhere. The radiationisthenmeasured the innerbody. MRI: MagneticResonance Imagingusesastrongmagneticfield andradio waves toimage ‘the scanner’. such, the patient is ‘scanned’, as it were. This device is therefore colloquially referred to as T: C Incomputertomography, X-rays areusedtomake cross-sectionsoftheinner body. As NUMBER OFHEAVY MEDICALIMAGING DEVICESINBELGIUM(01/01/2018) ECT CT 1 121 RI ET ET CT 0 CT 2 2 [25] Quality 34
KEY DATA IN HEALTHCARE General Hospitals 10,000 15,000 20,000 25,000 26 5,000 0 with othercountries,many CTscansareperformed inourcountry. of techniques such asCTscans,namelytheincreasedexposure toionising radiation.Incomparison plays greaterroleinourhealthcare.However, anevery thereisalsoadownside tothefrequentuse Medical imaginghasplayed amajorroleintheenormousprogressmademodernmedicineand under theageof20. scans among children and young people things, inadecreasethe numberofCT rapidly to askquestionstheirdoctormore izens were better informed and inclined The campaigns had a wide reach, so cit are notholiday snapshots). zijn geenvakantiekiekjes” (Medicalimages 2012 and2016, called “Medische beelden launched anannualcampaignbetween the FPS Publicmedical imaging, Health ofthecorrect use ofthe importance To inform thesectorandpublicabout MEDICAL IMAGES ARE NOT HOLIDAY SNAPSHOTS Note: IrelandandSweden,notavailable. Source: Eurostat(onlinedatacode:hlth_co_exam) http://www.becaremagazine.be/nl_NL/2479/39752/belgian_medical_imaging_platform_belmip.html For moreinformation about theresultsofinquiry, takealook at: Hospitalsonly. Luxembourg Iceland [26]
France NUMBER OFCT-SCANS INHABITANTS INEUROPEPER100,000 IN2011 AND 2016 . This was reflected, amongother
el i 2011:notavailable. Turkey Portugal Latvia Estonia 2011:definitiondiffers. Slovakia Denmark Greece Austria Germany 4 Breakinseries.
- Cyprus Hungary Poland www.zuinigmetstraling.be Spain 5 2012insteadof2011. Czechia Switzerland Lithuania Malta Netherlands 6 2015insteadof2016. United Kingdom Croatia Italy Slovenia Bulgaria 7 2013insteadof2011. Serbia Liechtenstein Finland The former Yugoslav Republic of Macedonia Romania Quality 35
KEY DATA IN HEALTHCARE General Hospitals 10 000 20 000 0 000 0 000 0 000 0 000 0 000 0 000 90 000 27 0 equipment per 100,000 inhabitants perregionwasequipment per100,000 inhabitants calculated.Inordertobringthisratiomoreinto To determinethesupplyofmedicalimagingequipmentobjectively, theratio ofthenumber well attuned to theneeds. ashiftobtain that theoffering fromusingCTscans toMRIscans.Inthisregard,itisimportant is the FPS Public Health collaborates with the INAMI/RIZIV and experts from the sector in order to CT scans)donotinvolve aradiationriskandcanbeanalternative toCTscansfor indications, certain scans means that the Belgian public is exposed to more radiation. Since MRI scans (as opposed to Overall, however, continuestoincrease. theuseofCTscansinourcountry The largenumberofCT three years. protocol of5November 2018). These new deviceswithintwoto willbeoperationalinhospitals was decided in 2018 to expand the numberof MRI devices again, thistime by 18 devices (follow-up 12 devices (protocolagreementof24February 2014). Following anevaluation ofthisexpansion, it line withthedifferent partsofthecountry, thenumberofMRIdevices was increasedin2014 by Source: facturation fromRIZIV/INAMI. data 2012 NUMBER OFCTSCANSONCHILDREN AND YOUNG PEOPLE 201 201 02 ER OLD) (0-20 YEARS 201 [27] 201 201
201 Quality 36
KEY DATA IN HEALTHCARE General Hospitals RELATED TO LEARN MOREABOUT • • • • • • • • • • • • • • QUALITY Belgian Antibiotic Policy CoordinationCommittee (BAPCOC): BeCare Magazine World HealthOrganisation OESO PAQS ofcare Quality Farmaceutical care Belgian in Quality Transfusion(Be-Quint) Guidelines for bestpracticesinmedicalimagery Belgian manualfor clinicalauditsinmedicalimagery Colleges ofPhysicians Patient safety Initiative for baby-friendly hospital Development-oriented care • • • • Correct useantibiotics You areingoodhands Handhygiene Consultative bodies INITIATIVES :
Quality 37
KEY DATA IN HEALTHCARE General Hospitals