Background

For decades, the Belgian medical nomenclature has been widely discussed. During the determination of the fees, only the duration and complexity of the activities of care were taken into account. However, the quality of the care process, the actual workload, and the multidisciplinary collaboration were not considered. This has led to unfair differences between the medical disciplines and an outdated system that does not take into account the evolutions of the medical activities.

Objectif

This study investigates how the nomenclature of the medical services performed by physicians, more specifically the part of the consultations and associated services, can be reformed. The aim of this reform is to develop a fair tariff system that supports the health objectives, that is cost neutral and future-proof, and that anticipates evolutions such as more multidisciplinary collaboration and the possibilities of tele-medicine.

Methodology

The first phase exists of two parts. First, the Belgian nomenclature will be discussed in detail (codes and underlying principles). Second, the tariff systems of the consultation activities of other countries (France, Switzerland, the Netherlands, Germany, and Ontario) will be discussed. More specifically, there will be examined how communication, (multidisciplinary) collaboration, coordination, and surveillance is financed. Also, the applications of tele-medicine will be taken into account. The second phase exists of semi-structured interviews with physicians from the varying medical disciplines. During these interviews, the tariff systems and principles found in phase 1 will be discussed and points of interests will be formulated. Each medical discipline will be questioned during these interviews, with 3 to 5 interviewees per group. This leads to a first design of the new Belgian nomenclature that will be validated through focus groups in phase 3. Furthermore, a plan of action for the following phases will be formulated during this phase.