1 / 36

FIRST ANNUAL MEETING OF THE INSEAD-EHLP-class 2002 Brussels, May 23, 2003

FIRST ANNUAL MEETING OF THE INSEAD-EHLP-class 2002 Brussels, May 23, 2003. THE PERSPECTIVE OF THE PROVIDER. Marc MOENS, M.D. Vice-president of the Belgian Association of Medical Unions (BVAS-ABSyM)

lorin
Download Presentation

FIRST ANNUAL MEETING OF THE INSEAD-EHLP-class 2002 Brussels, May 23, 2003

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. FIRST ANNUAL MEETING OF THE INSEAD-EHLP-class 2002Brussels, May 23, 2003 THE PERSPECTIVE OF THE PROVIDER Marc MOENS, M.D. Vice-president of the Belgian Association of Medical Unions (BVAS-ABSyM) Secretary-general of the Association of Belgian Professional Societies of Medical Specialists (VBS-GBS) Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 1

  2. Introduction2. Short history of organized interest groups 2.1. Creation of Sickness Funds and Medical Trade Unions 2.2. Physicians’ resistance and strike 3. Elements of the law of August 9, 1963 on Sickness and Invalidity Insurance 3.1. The system of conventions 3.2. Representativity of Medical Trade Unions4. Representation of medical organizations in official organs5. Our principles and objectives6. Conclusion 2 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003

  3. SHORT HISTORY OF ORGANIZED INTEREST GROUPS (1) • The 19th century proletarianism led to the creation of societies of mutual assistance for the working class • Legal basis April 4, 1851 • Allowing the formation of alliances by the law of June 23, 1894 • Governmental support since March 19, 1898 • Remained unchanged until December 31, 1990 3 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003

  4. SHORT HISTORY OF ORGANIZED INTEREST GROUPS (2) • Law of December 18, 1944 : creation of a mandatory sickness and invalidity insurance system for employees • Implementation by Decree of the Regent of March 21, 1945 creating a national committee of directors including : - 8 employees’ representatives - 8 employers’ representatives - 5 representatives of the sickness funds - 3 government commissioners : ministry of health care, social security and finance • No representation of health care providers • Publication of a provisional tariff list by Ministerial Order of April 19, 1945 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 4

  5. SHORT HISTORY OF ORGANIZED INTEREST GROUPS (3) • Till +/- 1950 : lots of small professional societies • July 15, 1954 : creation of the Grouping of Belgian Professional Societies of Medical Specialists (VBS-GBS) and futile attempts reach an agreement with sickness funds • October 10, 1954 : creation of the General Syndicate of Belgian Medical Doctors (ASGB) by Dr. Marcel DE BRABANTER -> shared management of the system -> shared financial responsibility -> generalized and compulsory system of third party payment 5 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003

  6. SHORT HISTORY OF ORGANIZED INTEREST GROUPS (4) • A huge majority of physicians refused the ASGB proposals creating the possibility of rationing of care Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 6

  7. SHORT HISTORY OF ORGANIZED INTEREST GROUPS (5) • February 14, 1961 : prime minister Gaston EYSKENS’ « Law of Union » leads to a near-revolution • Introduces an Institute for medical control (art. 33) • Authorises the King to impose tariffs if no convention is concluded (art. 52, still existing, but somewhat modified in art. 50 § 11 of the coordinated law on medical care and allowances) • End 1963 : creation of the Belgian Association of Medical Trade Unions (BVAS-ABSyM) in opposition to the minister of Social Affairs, E. LEBURTON, by Dr. A. WYNEN 7 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003

  8. SHORT HISTORY OF ORGANIZED INTEREST GROUPS (6) BVAS-ABSyM regroups the - syndicalist chamber of Liège and Luxemburg (created May 17, 1962) - syndicalist chamber of Walloon Brabant, Hainaut and Namur (created March 22, 1963) - syndicalist chamber of the Brussels metropolitan area (created May 31, 1963) - syndicalist chamber of Antwerp, Limburg and Flemish Brabant (created August 23, 1963) - syndicalist chamber of East and West Flanders (created August 29, 1963) Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 8

  9. SHORT HISTORY OF ORGANIZED INTEREST GROUPS (7) • Stiff resistance from physicians against the LEBURTONS’ Law with refusal of - a state-controlled medical care - financial responsibility for the medical care being offered - imposed tariffs - and demand for a social security system for physicians, • leading to a general medical strike from April 1 to April 18, 1964, Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 9

  10. SHORT HISTORY OF ORGANIZED INTEREST GROUPS (8) • followed by the St. John’s agreement of June 25, 1964 between - the government - representatives of the Medical Trade Unions, mainly BVAS-ABSyM - representatives of sickness funds - employers - employees trade unions • The St. Johns’ agreement remains the basis of the current system Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 10

  11. 3. Elements of the law of August 9, 1963 on Sickness and Invalidity Insurance Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 10 bis

  12. 3.1. The system of agreements 3.1.1. Basic principles The law of February 15, 1993 - strengthens the role of the ° government ° social partners - employers - employees’ trade unions - maintains the impact of the sickness funds - diminishes the influence of the providers For example : the convention physicians- sickness funds needs the approval by : - the general NSIII council - the Insurance Committee - the Budgetary Control Commission Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 11

  13. 3.1.2. The Medical Technical Council elaborates the nomenclature of medical services 27 M.D.-members + 1 president 9 sickness funds 7 university 11 medical unions Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 12

  14. 3.1.3. Erosion of free choice in the course of the years Same reimbursement for patients treated by physicians in/out the convention still remains but the legislation is curtailing the therapeutic freedom more and more introducing for example reference prices for some hospitalised patients Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 13

  15. APR-DRG’s SURGERY : number and description 73 Lens procedures w or w/o vitrectomy • Tonsillectomy & adenoidectomy procedures 179 Vein ligation & stripping 225 Appendectomy 228 Inguinal & femoral hernia procedures 263 Laparoscopic cholecystectomy 302 Major joint & limb reattach proc of lower extrem exc for trauma 313 Knee & lower leg procedures except foot 318 Removal of internal fixation device 482 Transurethral prostatectomy 513 Uterine & adnexa procedures for ca in situ & nonmalignancy 516 Laparoscopy & tubal interruption 540 Cesarean delivery 560 Vaginal delivery Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 14

  16. APR-DRG’s internal medicine : number and description 045 Cva w infarct 046 Nonspecific cva & precerebral occlusion w/o infarct 047 Transient ischemia 134 Pulmonary embolism 136 Respiratory malignancy 139 Simple pneumonia 190 Circulatory disorders w AMI 202 Angina pectoris 204 Syncope & collapse 244 Diverticulitis & diverticulosis 464 Urinary stones w esw lithotripsy 465 Urinary stones w/o esw lithotripsy Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 15

  17. 3.1.4. From « fee for service » to agreed lump sum payments (1) • Fee for service remains for most medical acts • Slowly introduction (since 1988) of agreed lump sum payments - laboratory medicine : 75 % - radiology : +/- 31 % Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 16

  18. 3.1.4. From « fee for service » to agreed lump sum payments (2) • More lump sum payments for - accreditation system (all physicians) - global medical record (G.P.’s) - disposability (G.P.’s) - medical record software programmes (G.P.’s) - local G.P.’s circles organizing grand duties (- subsidizing general medical pratices) Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 17

  19. 3.1.5. Acceptance of convention between physicians and sickness funds A convention is not accepted • if > 40 % of the physicians refuse or • if > 50 % medical specialists refuse or • if > 50 % G.P. refuse Counting is elaborated by each legal district. Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 18

  20. Number Number refusals absolute in % General practitioners Medical specialists 17.913 22.753 2.804 4.439 15,65 19,51 Total 40.666 7.243 17,81 Refusals to join the convention of December 12, 2002 Table 1 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 19

  21. All physicians General practitioners Medical specialists 10.12.1990 18.12.1992 (*) 13.12.1993 11.12.1995 (°) 03.11.1997 () 18.12.2000 19.12.2002 12,57 51,50 19,27 16,50 15,60 14,77 17,81 9,78 37,80 18,42 16,18 14,28 11,85 15,65 16,35 63,73 20,02 16,77 16,71 17,16 19,51 Percentage of refusals to acceed the convention between physicians and sickness funds Table 2 * Document Moreaux Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 20

  22. All physicians General practitioners Medical specialists Flemish region Walloon region Brussels region 13,87 21,04 24,20 7,23 24,58 25,94 19,25 18,12 23,08 Total 17,81 15,65 19,51 Refusals to join the convention physicians – sickness funds of December 19, 2002 (in %) Table 3 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 21

  23. 3.2. Representativity of medical associations (1) To be legally representative, a medical association must : • Have both medical specialists and G.P.'s • Have members in at least 2 of the 3 regions • Exist at least 12 months • Count at least 1.500 affiliated individual members, registered with the NSIII Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 22

  24. 3.2. Representativity of medical associations (2) Only 2 organizations fulfil the 4 Criteria : • BVAS-ABSyM (D + F; G.P.'s + M.S.) • Cartel * Confederation of Belgian Doctors - Belgian Gouping of G.P.'s (F, G.P.’s) - Belgian Syndicate of Medical Specialists - General Syndicate of Belgian Medical Professions (D; G.P.'s + M.S.) * Syndicate of Flemish General Practitioners (D) Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 23

  25. 3.2. Representativity of medical associations (3) • counting of members failed since 1964 • elections at four years intervals were incorporated in the law in 1996 and carried into effect since 1998 • the results determine the number of seats in the NSIII councils, committees, commissions … for example in the National Commission Physicians-Sickness Funds Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 24

  26. Physicians Sickness Funds BVAS General practitioners 2 BVAS Medical specialists 5 Total BVAS -ABSyM 7 Cartel General practitioners 4 Cartel Medical specialists 1 Total Cartel 5 General total 12 12 Composition National Commission Physicians-Sickness Funds Table 6 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 25

  27. 1998 2002 Number of ballots sent Number of ballots received Number of ballots sent Number of ballots received Absolute number % of total Absolute number % of total Absolute number % of total Absolute number % of total General practitioners Medical Specialists 16.919 20.464 45,26 54,74 11.755 14.659 69,48 71,63 17.872 22.218 44,58 55,42 10.341 12.241 57,86 55,09 Total 37.383 100,0 26.414 70,66 40.090 100,00 22.582 56,33 Participation in medical elections Table 4 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 26

  28. 1998 2002 BVAS-ABSyM General practitioners 39,7 28,1 Medical specialists 89,2 87,1 total 67,1 60,1 Cartel General practitioners 59,0 69,1 Medical specialists 9,9 9,7 total 31,7 36,9 Invalid/blank General practitioners 0,6 1,3 Medical specialists 0,6 1,7 total 1,2 3,0 100 100 Results of the medical elections June 30, 1998 and June 25, 2002 (in percentage) Table 5 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 27

  29. 3.2. Representativity of medical associations (4) Numerous other medical associations are not representative • Medical specialists - Grouping of Belgian Professional Societies of Medical Specialists (G.B.S.-V.B.S.) - numerous scientific societies • General Practitioners : strongly dispersed and regionalized - Flemish and Francophone local circles of G.P.'s grouped in UHAK and FAG - a Flemish and a Francophone scientific society (WWVH and SSMG) - a Parliament of Flemish G.P.'s Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 28

  30. 4. Representation of medical associations in official bodies (1) 4.1. At the NSIII • Service of Medical Care - Insurance Committee - Budgetary Control Commission - National Commission Physicians-Sickness Funds - National Council for the Promotion of Quality - Accreditation system including - Accreditation Management Group - Joint Committee by Speciality - Working Group on Ethics and Economy - Technical Council for Accreditation - Appeal Commission - Commission of Profiles - Evaluation Committee on Medical Practice relating to Medication • Service of Medical Assessment and Control - Service Unit - Committee - Appeal Board Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 29

  31. 4. Representation of medical associations in official bodies (2) 4.2. At the Federal Public Service, Public Health, Safety of the Food- chain and Environment • Certification of M.D.'s • Legislation on hospitals • Others on - nursing care • paramedical professions • clinical biology • … Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 30

  32. 5. Principles-objectives (1)Ten basic rules : • The patient has a central position • The physician respects the Code of Medical Ethics and in particular Article 36"The physician is free as to his/her diagnosis and therapy. He/She will refrain from prescribing useless examinations or expensive therapies or to perform superfluous acts" • The patient is free to choose his medical doctor • The physician is free to decide between diagnostic and therapeutic alternatives • The protection of medical confidentiality is crucial 31 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003

  33. 5. Principles-objectives (2)Ten basic rules : 6. Physicians ensure the continuity of quality care 7. There is an equivalence between general practitioners and medical specialists 8. There is an equivalence between medical specialists as such 9. An identical pathology gives rise to identical fees, irrespective of the place * Academic or non academic institution * Region * Hospital care or out-patient care 10. In other words, the implementation of a just and objective legislation on the entire territory. 32 Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003

  34. 5. Principles-objectives (3) For the new government to be appointed, we reiterate our vision • Stop the creation of costly and overlapping structures • Give support to the co-operation agreements existing on a small scale between health care providers belonging to the same profession and between providers pertaining to several professions (general practitioners - medical specialists - physicians - nursing staff - paramedics - physiotherapists…) • Restrict the interference of the State in health care • Stop excessive standards and bureaucracy Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 33

  35. 6. CONCLUSION Continuing the concertation model between health care providers and sickness funds, under supervision of the State, is the best option to maintain and promote the high reputation and international level of the Belgian health care system Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 34

  36. Words to remember : "Pas de médecine sans médecins" Dr. André WYNEN) Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 35

More Related