Belgium : Health system review

XXX, 246 p.ill.The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Belgian population continues to enjoy good health and long life expectancy. This is partly due to good access to health services of high quality. Financing is based mostly on proportional social security contributions and progressive direct taxation. The compulsory health insurance is combined with a mostly private system of health care delivery, based on independent medical practice, free choice of physician and predominantly fee-for-service payment. This Belgian HiT profile (2010) presents the evolution of the health system since 2007, including detailed information on new policies. While no drastic reforms were undertaken during this period, policy-makers have pursued the goals of improving access to good quality of care while making the system sustainable. Reforms to increase the accessibility of the health system include measures to reduce the out-of-pocket payments of more vulnerable populations (low-income families and individuals as well as the chronically ill). Quality 0of care related reforms have included incentives to better integrate different levels of care and the establishment of information systems, among others. Additionally, several measures on pharmaceutical products have aimed to reduce costs for both the National Institute for Health and Disability Insurance (NIHDI) and patients, while maintaining the quality of care.Preface v -- Acknowledgements vii -- List of contributors xi -- Glossary xiii -- List of tables, figures and boxes xxi -- Abstract xxv -- Executive summary xxvii -- 1. Introduction 1 -- 1.1 Geography and sociodemography 1 -- 1.2 Economic context 3 -- 1.3 Political context 7 -- 1.4 Health status 9 -- 2. Organizational structure 15 -- 2.1 Overview of the health system 15 -- 2.2 Historical background 18 -- 2.3 Organization 24 -- 2.4 Decentralization and centralization 38 -- 2.5 Health information management 41 -- 2.6 Regulation 50 -- 2.7 Patient empowerment 65 -- 3. Financing 79 -- 3.1 Health expenditure 79 -- 3.2 Sources of revenue and financial flows 83 -- 3.3 Population coverage and basis for entitlement 86 -- 3.4 Out-of-pocket payments 95 -- 3.5 VHI 100 -- 3.6 Payment mechanisms 102 -- 4. Physical and human resources 117 -- 4.1 Physical resources 117 -- 4.2 Human resources 129 -- 5. Provision of services 141 -- 5.1 Public health 141 -- 5.2 Patient pathways 151 -- 5.3 Primary/ambulatory care 153 -- 5.4 Secondary care (specialized ambulatory care/inpatient care) 159 -- 5.5 Emergency care 163 -- 5.6 Pharmaceutical care 165 -- 5.7 Rehabilitation care 175 -- 5.8 Long-term care for the elderly 177 -- 5.9 Services for informal carers 187 -- 5.10 Palliative care 190 -- 5.11 Mental health care 192 -- 5.12 Dental care 197 -- 5.13 Complementary and alternative medicine 198 -- 5.14 Health care for specific populations 199 -- 6. Principal health care reforms and initiatives 201 -- 6.1 Analysis of recent reforms 201 -- 6.2 Future development 216 -- 7. Assessment of the health system 219 -- 7.1 Stated objectives of the health system 219 -- 7.2 Equity 220 -- 7.3 Efficiency of resource allocation 227 -- 7.4 Technical efficiency 228 -- 7.5 Quality of care 231 -- 8. Conclusions 239 -- 9. Appendices 241 -- 9.1 References 241 -- 9.2 Useful web sites 258 -- 9.3 HiT methodology and production process 263 -- 9.4 The review process 265 -- 9.5 About the authors 26