Organization and financing of home nursing in the European Union

The aim of this study was to provide an overview of the organization and financing of home nursing in the 15 member states in the European Union. Home nursing was defined as the nursing care provided at the patients' home by professional home nursing organizations. Data were gathered by means of three complementary research methods: desk research, postal questionnaire among identified experts and face-to-face interviews with experts. The results showed that there are large differences between the countries in the way home nursing care is financed. There seems to be a relation between the way of funding and the organizational structure. In member states where the organizations receive a fixed budget, based on the number of inhabitants or the demography of the catchment area, home nursing is mainly provided by one type of organization and is freely accessible for the patients. In this situation there is little competition among the organizations, and the catchment areas of the regional organizations do not tend to overlap. On the other hand, in countries where organizations are reimbursed according to a fee-for-service principle and a referral of a doctor is required, home nursing is provided by different types of organizations and also by independent nurses. It seems that fee-for-service reimbursement stimulates competition between providers and a market-oriented home care. In addition, a fee-for-service method of funding also has the consequence that mainly technical nursing procedures and some basic care are reimbursed; this leaves little room for nurses to perform preventive and psychosocial activities or to provide more integrated care.