Organisation of maternity services in Belgium

Excess capacity of Belgian maternity services was calculated in KCE report 289 and amounts to about 1 000 beds. Hence, a reduction in the number of maternity services was recommended. This is in line with an international trend to close smaller maternity services and transfer their activities to larger services in order to reduce the average cost per delivery. Even in maternity services with low activity, minimum levels of midwives, nurses, doctors and equipment are necessary, which is expensive.

As part of the ongoing reform of the hospital sector, KCE was asked to define criteria for closing maternity services. We calculated that a maternity service should perform at least 557 deliveries per year to have a cost per delivery at the level of the more efficient maternity services, without compromising the quality or safety of the care provided. However, in addition to efficiency, there is another, crucial criterion: accessibility. Every woman must be able to reach a maternity service within a certain length of time (we used 30 minutes by car as time limit.). Currently, 80% of women has access to 8 or more maternity services within 30 minutes.

KCE recommends that 17 of the 104 maternity services in Belgium could be closed because their number of deliveries is too low. An additional 4 maternity services also have less than 557 deliveries per year, but because of accessibility reasons they should not be closed.