status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 23
The three main problems on the agenda are:
• Lack of primary care accessibility in rural areas, with difficulties for the
continuity of care;
• Redefinition of the medical offer, including a transfer of tasks;
• Control of the health care expenses.
2.4.1.2 Quality evaluation in action: culture, legislation, financing, organisation and
implementation
The HAS was set up by the French government in August 2004 in order to bring under
a single roof a number of activities designed to improve the quality of patient care and
to guarantee the equity within the health care system. 87 Its mission is to give
independent advice to policy makers, professionals and patients about the quality of
health services and to provide information related to products and services paid by the
health insurance system. The HAS activities include e.g., the assessment of drugs,
medical devices and procedures, the guidelines development, the accreditation of
healthcare organisations and the certification of doctors. Training in quality issues and
information provision are also key components of its work programme. 88
The regional unions of the liberal doctors (Unions Régionales des médecins Libéraux -
URML) are in charge of the evaluation of the professional practices and of quality
improvement. 89
Practice assessment and quality improvement activities are now mandatory for all
practicing physicians. The responsibility of the procedures for quality improvement is
also devoted to the ‘Haute Autorité de la Santé’ (HAS). 90 It is too early to say what
these procedures will be and to what extent the professionals will be associated to their
development. Moreover, the physicians have specific obligations as regards the quality of
care e.g. continuous medical education. Finally, the development of pathways and
networks of care support the promotion of integrated and continuous care at patient
level.
Some initiatives and laws aim to improve the quality of care as for example:
• The FORMMEL (‘Fonds de Réorientation et de Modernisation de la Médecine
Libérale’, 1996). The purpose of this Fund is to help with the modernization
of the medical surgeries, for example by financing the computer systems.
• The FAQSV (‘Fonds d’Aide à la Qualité des Soins de Ville’): offered
possibilities for financing the improvement and the evaluation of the
professional practices, the coordination of the care (networks) and the
continuity of care (on-call health centres). The FIQS (Fond d'Intervention
pour la Qualité des Soins) replaced the FAQSV in July 2007. The Fund
ensures the budget distribution at regional level for health networks,
continuity of care, help for installing new practices and group practices,
quality improvement and coordination of care in urban settings. The
mandatory evaluation of the selected projects will occur after three years
whilst their funding is planned over five years.
• The DNDR (Dotation Nationale de Développement des Réseaux, created in
2001): allows the recurrent financing of health networks, supports the
coordination and the complementarity of health care offer, the development
of quality procedures and the continuity of care.
• The CME obligation for doctors and other health professionals (law nº 2002-
303 of March 4th, 2002 art. 59.I and Law nº 2004-806 of August 9th, 2004):
health professionals have to transmit to the regional council the elements
justifying their participation to approved training activities.
• The obligation of individual evaluation for doctors and health professionals
(Law nº 2004-810 of August 13th, 2004). The non-observance of this
obligation exposes theoretically the doctor to sanctions: the ‘Ordre des
Médecins’ should take measures in case against severe outliers: this never
happened till now. A Decree (2005-346) entrusts to the URML the