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Designing the Belgian “To Be” State: Transforming MZG/RHM and Finhosta for Patient-Based Costing, Care-Process Alignment, and DRG Reform

Introduction In Belgium, hospital financing reform should start from the target state to be achieved rather than from the inherited institutional configuration to be incrementally adjusted. That is especially important because the Belgian health system is structurally path-dependent: it combines near-universal compulsory insurance with direct access, predominantly fee-for-service remuneration, and a division of responsibilities between the federal state and the federated entities that was deepened by the sixth State reform. In hospital financing, Belgium already uses All Patient Refined Diagnosis Related Groups (APR-DRG)/Severity of Illness (SOI) information for budget allocation, but not as a true case-based payment system with national cost weights; the current B2 logic of the Budget of Financial Means (BFM) uses national average length of stay by APR-DRG/SOI as a proxy for resource use. At the same time, Belgium has two mandatory hospital datasets with major strategic value: Minima...
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Why Healthcare Reform Should Be Designed from the “To Be” State Rather than the “As Is” State

Introduction Healthcare reform is not merely an exercise in repairing defects in an inherited administrative order. It is, more fundamentally, an exercise in institutional design: deciding what kind of health system a society wants, what outcomes it values, and how governance, financing, service delivery, workforce policy, and information systems should be aligned to achieve those outcomes. Contemporary reform agendas across advanced health systems increasingly converge around stronger primary care, better care integration, digital transformation, affordability, and more people-centred care. That convergence already suggests that reform is guided by a desired future state, not by passive extrapolation from legacy arrangements. For that reason, healthcare reform should begin conceptually from the “ to be ” state. A target-state approach clarifies the normative goals of reform and helps orient institutions toward outcomes that matter: better patient experience, better population health, ...
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SNOMED CT During the Admission: A Realistic Operating Model for Concurrent Care-Process Management, Quality Control, and Quality Assurance in a General Hospital

Abstract The central implementation question is not whether SNOMED CT can improve coding at discharge, but whether it can become part of the care process itself. The answer is yes, but only under specific socio-technical conditions. SNOMED CT is most useful during admission when it is used as the semantic layer for working diagnoses, procedural events, pathway activation, clinical context, task orchestration, and real-time feedback , rather than as a retrospective abstraction exercise. Official SNOMED CT guidance explicitly frames the terminology as a means to “collect once and use many times,” and as an enabler of point-of-care analytics, decision support, and reporting that directly benefit clinicians and patients. In practice, this means that diagnoses and procedures must be recorded in small, workflow-specific SNOMED CT subsets; linked to timestamps, locations, and care states; and continuously reused for clinically relevant alerts, meaningful dashboards, and quality assurance (QA...
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