Nursing and midwifery in the Belgian health care system

1
Nursing and midwifery in the Belgian health care
system
European Doctoral Nursing Programme, Manchester

• Tom Braes
• Centre for Health Services and Nursing Research
• Katholieke Universiteit Leuven

2
Introduction (1)

• BELGIUM IN FIGURES
• ?population 10,364,388
• ?life expectancy at birth total 78.62 years
  male 75.44 years female 81.94
  years
• ? age structure 0-14 years 16.9
  15-64 years 65.7 65 years 17.4
• ? health expenditure/GDP 9.1
• ? number of nurses 60.142
• ? number of midwives 4912

Source NIS, OECD, CIA World Fact Book
3
Introduction (2)
72 sites ? 15.000 beds
34 sites ? 3.000 beds
221 sites ? 53.000 beds
Source FOD http//www.health.fgov.be - 2001
4
Introduction (3) Belgian
nursing workforce
Source Stordeur et al., 2004
5
?activity rates of nurses by age group
Introduction (4) Belgian
nursing workforce

median age Belgian nursing workforce
Source Manpower Planning SESA UCL - 2003
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Belimage - study

• ?87.1 is proud being a nurse
• ?84.2 is satisfied to very satisfied with the
  current work
• ?68.6 experience the context of care as
  stressful
• ?54.7 would discourage family or friends from
  studying nursing
• ?39.2 wouldnt choose nursing again as a career
• ? 8.5 intend to leave their job within 1 year

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Professional plans for the future

• ? 8.5 intend to leave their job within 1 year
• Canada 16.6
• Germany 16.7
• US 22.7
• Scotland 30.3
• UK 38.9
• (Aiken et al., Health Affairs, 2001)

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Introduction (4) nurse staffing
-2
1 to 10
Source FOD http//www.health.fgov.be
9
?percentage BSN to total staff (A1)
Introduction (5)qualification level
8
28
32
19
27
Source FOD http//www.health.fgov.be
10
?trends in some nursing activities 1988 - 1998
Introduction (6)nursing care
13
19
39
37
37
47
Source FOD http//www.health.fgov.be
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THUS

• ?high increase in nursing intensity
• ?small increase in nurse staffing levels
• ?high increase in qualification levels

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Source of funding global

• ?compulsory health care system
• employers and employees are obliged to contribute
  to social security
• state subsidies (25 for hospital charges
• ? each citizen must choose his own insurance
  company
• ? social security reimburses charges to insurance
  companies
• ? free access to health services
• ? free choice in health care provider
• ? out of pocket costs limited

13
Source of funding primary care

• ?primary health care
• GPs
• pharmacists
• dentists
• physiotherapists
• nurses independent / nursing care services
• ?all are paid on a fee-for-service basis
  (revised regularly)
• ?number of pharmacists and physiotherapists is
  limited.

mostly independent
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Source of funding hospital care

• ?hospital care
• both private and public hospitals (mostly
  private)
• ? physicians are paid on a fee-for-service
  basis
• ? nursing / material / hospital stay paid by a
  fixed amount/patient day
• this amount may vary between hospitals, and
  between nursing units, and is revised annually

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Educational programmes

• ?Bologna declaration since 2005

Master in Nursing/Midwifery Major nursing

Major midwifery
Switch-programme (schakelprogramma) 1 year
Bachelor in nursing (3 years)
Bachelor in midwifery (3 years)
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Status of academic nurses

• ?active in various roles functions
• research associate
• clinical nurse specialist advanced nurse
  practitioner
• head nurse
• nurse
• case manager
• consultancy
• management
• gt hospital care versus home care

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Status of nursing research

• ?research at universities, offering a Masters
  degree
• ?research at colleges, offering a Bachelors
  degree
• ?research by (university) hospitals
• ?research by other health care organizations
• ?research supported by federal or Flemish
  government
• collaboration
• aim / purpose differs
• quality differs