The Belgian health care context

1. The Belgian health care context • Belgium was evaluated the sixth best country in the world, according the the UNDP-list • Health insurance is compulsory for Belgian citizens (implies a SIS-card) • Health care is not free but the health insurance covers a large part • Belgians living in poverty can apply for a ‘third-party-payment’ • Hospital bills since recently have a ‘ceiling-arrangement’

2. Right to health care for asylum seekers • When an asylum seeker arrives in the country an asylum centre is appointed to him/her. The person can stay there but can also decide to live somewhere else. • The asylum centre is responsible to pay for any medical costs, whether the person in inside or outside the centre • Psychological support: depends on the asylum centre and the doctor inside the centre

3. Right to health care for illegal immigrants • Belgian law of 1996 gives illegal immigrants the right to health care. • The law is called ‘Aide Médicale Urgente’ • Not only urgent but most aspects of health care are included • Health care is for free for illegal immigrants • Health care suppliers can get payment from the local Public Centre for Social Assistance (CPAS)

4. Cases of concern • Difficult administration: different procedures for each CPAS • Lack of communication between CPAS, health care suppliers and patients • Delays in payment by the federal government and by the CPAS • No continuity of care – saturation of facilities • Mental health is neglected

5. Testimonial Mohammed, 34 years, Moroccan • Eye problems in Morocco, looking for treatment in Belgium • Diagnosed with diabetes in Belgium, after arrival in 2001 • Delays in treatment, complications • Now regularised situation, handicapped for life

6. Access to health careby MSF General objective: • To assure a systematic and structural access to health care for the excluded in the cities of Antwerp, Brussels and Liège – medical, social and psychological

7. Access to health careby MSF Specific objective: • To assure before the end of 2005 the acceptation of an operational model by the local authorities, which would allow a medical, social and psychological access to health care for asylum seekers and illegal immigrants in the cities of Antwerp, Brussels and Liège. • For non-medical problems refer the patients to the most adequate structures.

8. The work of MSF Result 1: integrating patients into the existing health care structures by • Offering social, medical and psychological consultations for people with a difficult access to health care • Referring to adapted services • Specific identification and reference to the services concerning mental health care

9. The work of MSF Result 2: making the intervention of MSF unnecessary by • Lobbying so that services and procedures are functioning efficiently • Simplification of procedures (federal, regional, local) • Promotion of an access to health care model, • More knowledge between GP’s about the specific procedures (AMU) • More visibility for the project

10. Number of patients 2003 • 9947 consultations for 4407 patients in 2003, from which • 4884 in Brussels • 2967 in Antwerp • 2096 in Liège

11. Status of the patients2003

12. Nationality of the patients 2003

13. Lobbying strategy Focus on all levels involved: Collaboration with local and regional NGO’s and institutions • Federal: Ministry of Social Integration • Regional: Flemish, Brussels and Walloon Unions of Cities – section CPAS • Local: CPAS, city • Health care suppliers: GP’s • Political: inform party or opposition members • Media attention • (International)

14. Solutions could be simple • Ensure a number of principles in the procedures applied by the CPAS such as a ‘medical card’ • Promotion of good practices • Promotion of follow-up by GP • Recognize importance of mental health care • Faster payment • Information