THE HEALTH CARE SYSTEM IN BELGIUM

J. De Cock – CEONational Institute Health & Disability Insurance (NIHDI)

East Poland Houce - 29 March 2011

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SUMMARY

I. Introduction

II. Organisational structure & management

III. Health care finance & expenditure

IV. Compulsory health care insurance

V. Recent Trends

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INTRODUCTION

Key characteristics:

• Universal and compulsory scheme=> principle of solidarity and fairness

• Large benefit basket => principle of responsiveness• Managed jointly by all stakeholders => principle of responsible partnership• Free choice of patients and large offer of health providers and

services => principle of access• State controlled, executed by private not for profit organizations

=> principle of subsidiarity

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ORGANISATIONAL STRUCTURE & MANAGEMENT (I)

Actors on the federal Belgian level

FPS of Public Health, Safety of the Food Chain en Environment (+ Agency for pharmaceuticals)

FPS of Social Security Federal knowledge centre (HTA, …)

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ORGANISATIONAL STRUCTURE & MANAGEMENT (II)

• National Institute for Sickness and Invalidity Insurance:

– general organisation & financial management– implementation and control of regulations– important bodies:

General Council Insurance Committee

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ORGANISATIONAL STRUCTURE & MANAGEMENT (III)

• health care insurers (“mutualities”)

• health care providers

• insured persons / patients

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ORGANISATIONAL STRUCTURE & MANAGEMENT (IV)

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HEALTH CARE FINANCE & EXPENDITURE (I)

Health care financing

• social security contributions

• government contributions

• external sources of funding

• patient contributions (out-of-pocket payments)

• private insurance

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A BALANCED BUDGET AS FROM 2005

Year Real Expenditure

Growth Budget Boni/Mali

(in mio €) In % (in mio €) (in mio €)

2000 12.814,5 6,5 12.412,7 - 401,8

2001 13.774,4 7,5 13.455,7 - 318,7

2002 14.157,0 2,8 14.411,5 + 254,6

2003 15.383,7 8,7 15.341,8 - 41,9

2004 16.771,5 9,0 16.257,8 - 513,7

2005 17.250,2 2,9 17.398,4 + 148,2

2006 17.735,3 2,8 18.473,1 + 737,8

2007 18.873,4 6,4 19.618,7 +745,3

2008 20.677,1 9,6 21.434,0 +756,9

2009 22.128,2 7,0 23.084,5 +956,3

HEALTH CARE FINANCE & EXPENDITURE (II)

HEALTH CARE FINANCE & EXPENDITURE (III)

Period 2000 - 2009 Share

nominal real 2000 2009

Residential elderly care 8,12 6,01 7,54 8,97

Home care 7,08 4,97 4,28 4,68

Pharmaceutical care 6,02 3,92 19,06 19,01

Hospital care 4,77 2,71 24,85 22,35

Dentistry 6,93 4,81 3,11 3,35

Doctors 5,46 3,39 32,73 31,15

Implants 8,04 5,90 1,92 2,25

Physiotherapy 4,05 1,99 3,07 2,56

Other paramedical care 9,19 7,06 1,62 2,11

Rehabilitation 7,90 5,77 1,76 2,06

Others 75,14 71,56 0,06 1,51

Global 6,02 3,94 100,00 100,00

Bron: RIZIV, 2010

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HEALTH CARE FINANCE & EXPENDITURE (IV)

Budgeting the compulsory health care insurance

Committees on conventions and agreements

Insurance Committee

(+ Committee on budgetary control)

General Council

Minister of Social Affairs

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HEALTH CARE FINANCE & EXPENDITURE (V)

Source : OECD Health Data 2008 – Version: december 2008

Total health expenditure as % of

GDP, 2007

Id, per capita Public health expenditure as % of

total health expenditure, 2007

% GDP (US $) %

BE 10,2 3.595 (74)

NL 9,8 3.837 -

FR 11,0 3.601 79,0

DE 10,4 3.588 76,9

UK 8,4 2.992 81,7

US 16,0 7.290 45,4

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COMPULSORY HEALTH CARE INSURANCE (I)

• Who is covered?

– practically the whole population

– conditions to be eligible: compulsory membership of health insurance fund

payment of a minimum contribution

(six-month waiting period)

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COMPULSORY HEALTH CARE INSURANCE (II)

• What is the extent of the coverage?

both preventive and curative care required for maintaining and repairing a person's health

– medical care is divided in 25 different categories, the most important of which are these: ordinary medical care (GP, specialist, …) - dental care – deliveries - pharmaceutical products (pharmaceutical specialities, generic drugs, …) - hospital care - help required for revalidation – etc.

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COMPULSORY HEALTH CARE INSURANCE (III)

• How are reimbursable benefits determined?

– nomenclature of medical services (± fee schedule)

– list of medicines qualifying for reimbursement

determined by the NISII in consultation with the various actors involved which services are reimbursable, their amounts and the conditions under which they are reimbursed (taking into account the budgetary limits)

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COMPULSORY HEALTH CARE INSURANCE (IV)

• What is the insurance contribution?

health care insurance provides financial contribution to the costs

– nomenclature of medical services: out-of-pocket on average 25 %

– list of medicines: out-of-pocket between 0 % and 80 %

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COMPULSORY HEALTH CARE INSURANCE (V)

• How can patients obtain reimbursement?

– standard procedure: reimbursement a posteriori

– special rule: third-party payer system

• compulsory for hospitals• retail pharmacy

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COMPULSORY HEALTH CARE INSURANCE (VI)

Summary:health care costs in the broadest sense (treatment,

reimbursable and non-reimbursable medicines, infrastructure expenses, …) are largely born by three

main components:

• the community : ± 76,4 %• the patients : ± 17,7 %• the private insurers : ± 5,9 %

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RECENT TRENDS (I)

• Headlines– accessibility: new instruments (maximum billing,

chronically ill)– pharmaceutical policy: new balance between

innovation and responsibility of the industry and health providers

– primary care: new incentives – LTC: new care models– hospitals: new financing mechanisms– sustainability: new procedures for cost containment

and financial responsibility of all actors

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RECENT TRENDS (II)

• Roadmap

– development of health plans for cancer treatment and chronic diseases

– development of integrated care models– development of eHealth strategy– development of quality tools

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Thank you for your attention !

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