1 / 21

THE HEALTH CARE SYSTEM IN BELGIUM

THE HEALTH CARE SYSTEM IN BELGIUM. J. De Cock – CEO National Institute Health & Disability Insurance (NIHDI) East Poland Houce - 29 March 2011. SUMMARY. Introduction Organisational structure & management Health care finance & expenditure Compulsory health care insurance Recent Trends.

dorie
Download Presentation

THE HEALTH CARE SYSTEM IN BELGIUM

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. THE HEALTH CARE SYSTEM IN BELGIUM J. De Cock – CEO National Institute Health & Disability Insurance (NIHDI) East Poland Houce - 29 March 2011

  2. SUMMARY • Introduction • Organisational structure & management • Health care finance & expenditure • Compulsory health care insurance • Recent Trends

  3. 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

  4. 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, …)

  5. 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

  6. ORGANISATIONAL STRUCTURE & MANAGEMENT (III) • health care insurers (“mutualities”) • health care providers • insured persons / patients

  7. ORGANISATIONAL STRUCTURE & MANAGEMENT (IV)

  8. 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

  9. HEALTH CARE FINANCE & EXPENDITURE (II) A BALANCED BUDGET AS FROM 2005

  10. HEALTH CARE FINANCE & EXPENDITURE (III) Bron: RIZIV, 2010

  11. 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 

  12. HEALTH CARE FINANCE & EXPENDITURE (V)

  13. 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)

  14. 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.

  15. 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)

  16. 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 %

  17. 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

  18. 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 %

  19. 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

  20. 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

  21. Thank you for your attention !

More Related