Belgium has too many maternity departments, either independent or within general hospitals, according to the Federal Expertise Centre for Health Care (KCE) in a new report (EN).
To remain cost-effective, a maternity unit has to carry out 557 deliveries a year, and not all of them do. “Reform is a pressing matter,” commented Maggie De Block, federal health minister. “we are currently spending more for maternity units than we should, which leaves less for other health services.”
The report draws attention to an international trend towards closing down smaller units and transferring their activities to a larger institution. In order to do the job properly, small units often need to employ as many staff and resources as larger units, despite carrying out fewer deliveries.
Belgium has 104 maternity units – 59 in Flanders, 34 in Wallonia and 11 in Brussels. Under the law at present, each must carry out 400 deliveries a year for a continuous period of three years or they lose their licence. But the KCE puts the actual threshold of efficiency much higher, at 557 births. If the level were to be raised that far, 21 units would have to close.
On the ground, however, 17 of those concerned are within a half-hour car journey from a larger unit – considered the upper limit of a safe travelling time. Those 17 are, the KCE concludes, superfluous. And since the number of births is unlikely to change substantially, the numbers they would have achieved will be transferred to the remaining units, making them even more cost-effective than at present.
One of the units targetted, in Geraardsbergen, has already decided to close. Of the rest, eight are in Flanders and eight in Wallonia. Brussels is not affected.
Willy Borsus, Walloon minister for the economy, commented: “I demand that we have a dialogue with the federal government, and that we adopt a way of thinking that follows the logic of a service to the population and the quality of care, and that it not exclusively be a budgetary matter.”