Healthcare in Belgium

Belgium Education in Belgium Culture of Belgium
University Hospitals Leuven Sint-Rafael

Healthcare in Belgium is composed of three parts. Firstly there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few (commercially run for-profit) private hospitals.[1] Secondly is the insurance coverage provided for patients. Finally, industry coverage; which covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in universities and hospitals.

Organization

Healthcare in Belgium is mainly the responsibility of the federal minister and the "FOD Volksgezondheid en Sociale Zekerheid / SPF Santé Publique et Securité Sociale" ("Public Administration for Public Health and Social Security"). The responsibility is exercised by the governments of the Flemish, Walloon regions and the German-speaking community. Both the Belgian federal government and the Regional governments have ministers for public health and a supportive administrative civil service.

Political and regulatory

Territorial Competence Administrative service
Federal
Legislative Federal Parliament
Executive Federal Minister of Public Health and Social Security [2][3] Maggie De Block (2014-2019)
Judiciary Administrative court: Council of State (Raad van State / Conseil d'État)

Appeals: Court of Labour (Arbeidshof / Cour du travail)
First Instance: Labour Court (Arbeidsrechtbank / Tribunal du travail)

Public Administration for Public Health, Food Chain Safety and the environment [4] (FOD Volksgezondheid, Veiligheid van de Voedselketen en Leefmilieu / SPF Santé publique, Sécurité de la Chaîne alimentaire et Environnement)

Public Health

MEDEX:[5] Department for Medical Expertise
  • Civil service staff, absences, accidents at work, work related diseases
  • Medical certification of pilots & air traffic controllers
  • Medical certification of professional drivers
  • Medical certification of ship officers
  • War victims & military victims in peacetime
  • Victims of violent crime
  • Ombuds service
  • Medical evaluation centres
Superior Health Council:[6] Scientific advisory board
  • Psychiatric health care: behaviour issues, addiction, education in psychiatric healthcare, best practise in therapy
  • Environmental issues: Ionising radiation, sound & dust pollution
  • Chemical environmental issues: chemical agents, pollution agents, biocides and pesticides
  • Health and safety in nutrition and in the food chain
  • Biohazards: (human) blood products, tissues and organs, infectious diseases, epidemiological monitoring
  • Cosmetology
  • Public Health Genomics
Consultative bodies:[7] Commissions and consultations between public administration and healthcare institutions and organisations
National Council for Hospitals and Care institutions Nationale Raad voor Ziekenhuisvoorzieningen (N.R.Z.V.) Coordination advisory council between government and hospitals & care institutions
Multipart structure Consultation advisory council constituted of:
  • professional organisations of:
    • physicians, general practitioners, and specialists,
    • nurses
    • other medical practitioners
    • hospitals and care institutions
    • medical insurers
  • the government
  • experts from:
  • Inspectorate of Finance (from Treasury Department, public spending).
Joint Commission (De Nationale Paritaire Commissie Geneesheren-Ziekenhuizen"') Consultation and advisory commission physicians - hospitals
Commissions Working groups (Special Interest Commissions) on:
  • Telematica (application of digital technology)
    • Hospital digitisation
    • Health networks
    • Communication 1st & 2nd-line care
    • Digital data communication of care practitioners
    • Personal health data management
    • Remote healthcare
  • Embryo in vitro
  • Antibiotics
  • Patient rights
  • Euthanasia
  • Abortion
Federal Platforms Advisory boards for:
  • Palliative care
  • Psychiatric care
  • Coma patients
  • Hospital hygiene
  • Blood transfusion (BeQuinT)
Board of physicians Medical practise, quality and evaluation advisory:
  • Cardiac Pathologies
  • Geriatrics
  • Specialised Emergency response and care
  • Intensive care
  • Chronic kidney disease
  • Mother and newborn infants
  • Medical imaging and Radiation therapy
  • Reproductive Health
  • Oncology
  • Paediatrics
Inter-ministerial and intergovernmental conferences Consultative and coordination between Ministerial Depts. of Federal and Regional governments
  • Agriculture
  • Food safety
  • Scientific R&D Policy
  • Public health
    • General policy
    • Epidemic control
  • Drug spolicy
Committees Consultative committees
  • Belgian counselling Committee for Bio-ethics
  • Medical - pharmaceutical committee
  • Federal breastfeeding committee
  • Committee for medical utensils and machinery
Planning Commission Investigates and plans Demand for care practitioners.
  • Working group on physicians (GP) and specialists
  • Working group on physiotherapists
  • Working group on dentists
  • Working group on nurses
  • Scientific working group
Scientific Institute of Public health:[8] Scientific expertise in public healthcare
Directorate Communicable and infectious diseases Plays an important role within the Belgian, European and international networks of surveillance and response to infectious diseases and food safety hazards.
  • detection
  • early and rapid identification
  • microbiological monitoring of communicable and infectious agents,
  • preventing and treating such diseases.
  • food borne pathogens
  • bacterial diseases
  • viral diseases
  • mycology and aerobiology
  • immunology
Directorate Expertise, service provision and customer relations Providing the logistical, technical and scientific support.
  • Biological standardisation: Assessment and checking the quality of biological medicines for human use (vaccines and blood products) before market
  • Quality of medical laboratories: Assessment and checking the quality of clinical biology laboratories and in vitro diagnostic and medical devices
  • Biosafety and biotechnology & platform Molecular biology and biotechnology: Assessing the risks linked to the use of genetically modified organisms (GMOs)
Directorate Food, medicines and consumer safety Analytical chemical research to promote public health: detect the presence of chemical substances in food, consumer non-durables and the environment; scientific research in the following domains:
  • Medicines
  • Consumer safety
  • Chemical residues and contaminants
Directorate Public Health and surveillance epidemiology and toxicology centre To provide reliable, practical and impartial information on the health of the Belgian population, inform the policy makers and population on factors that influence public health and public health policy.
  • risk factors that affect health and well-being
  • monitoring health problems illnesses that constitute a risk to public health
  • assess the impact of lifestyle on public health
  • improve quality of care
  • assess risks of exposure to chemical substances and radiation
  • coordinate sharing and transmission of health information in Belgium
Belgian GLP Monitoring Programme Quality Assurance Bureau (QAB) of IPH has been the official GLP (Good Laboratory Practice) Monitoring Authority for Belgium since 1988
Federal Agency for medicines and health products.[9] The competent authority for medicines and health products in Belgium.

Safety of the food chain

Federal Agency for the Safety of the Food Chain (FASFC).[10] The competent authority for safety of the food chain in Belgium

Environment

Federal agency for nuclear control (FANC) [11] Monitors and controls the general public, workers, and the environment against the dangers of radiation.

Plants and animals

CODA-CERVA (Veterinary and Agrochemical Research Centre [12] Proactive policy in terms of food production safety, animal health and public health, at both the Federal and international levels:
  • scientific research
  • expert advice
  • provision of services
    • veterinary activities:
      • epidemic, endemic and emerging transmittable diseases in animals
      • zoonotic and emerging infectious diseases threatening public health
      • epidemiology: surveillance, risk analysis, and molecular epidemiology
    • agrochemical activities
      • contaminants and the quality of the environment in the framework of safe food production
Flemish Community
Legislative the Flemish parliament
Executive the Flemish Government, competent minister for welfare and social affairs, as of 2015 Jo Van Deurzen [13]
Judiciary none competent at this level
The competent administration is the Flemish Public service for family-matters, wellbeing and health. [14]
  • health strategic competences
    • public smoking ban, regulation and control, assistance with smoking cessation
    • regulations on sale of alcohol
    • drug and alcohol abuse and addiction
    • health risks in construction
    • radiation of wireless antennae
  • subsidizing
    • school milk and fruit
    • controls on food quality and industrial kitchens
    • sexual health
    • hearing damage prevention
  • help and assistance with:
    • psychological help
    • violence and abuse
    • addiction
  • healthcare
    • prevention
    • vaccination programs
    • prevention in hospital and care environments
    • patient rights
    • insurance
  • care situations
    • home care
    • psychiatric care
    • geriatric care
    • palliative care
  • disabled
    • basic support budget (Basisondersteuningsbudget - BOB) and personal assistance budget (Persoonsvolgende budget - PVB) financial support programs for the disabled
    • elderly support benefit
    • assistance for people with limited mobility
    • recognition as disabled person and caregiver
    • assistance with living for disabled
    • learning and working for the disabled
    • mobility issuers for the disabled
French Speaking Community
Legislative The Parliament of the French-speaking Community
Executive [15] The Walloon government Competent minister, as of 2015 Joelle Milquet
Judiciary none competent at this level
The competent administration is the "Direction de la Santé Publique de la federation Wallonie- Bruxelles". [16]
  • health strategic competences: public anti-addiction programs, smoking ban, drug and alcohol abuse, addiction support
  • school health and kitchens
  • healthcare prevention, vaccination programs
  • care situations: home care, psychiatric care, geriatric care, care for the disabled
German-speaking Community
Legislative The Parliament of the German-speaking community
Executive The government of the German-speaking community [17]

Competent minister for welfare and social affairs, as of 2015 Herr Antonios Antoniadis,[18] Minister für Familie, Gesundheit und Soziales

Judiciary none competent at this level
The competent administration is the "Ministerium der DG". [19]
  • health for Children: school health and kitchens, health care, prevention, vaccination programs
  • health for the elderly: home care, geriatric care, psychiatric care, industrial kitchens
  • care for the disabled
Provincial authorities
Legislative The Provincial Council, which is the elected body
Executive The Deputation or Provincial College and the Governor, who is appointed by the regional government, are the executive body. Within that college one deputy has the

responsibility for welfare and social affairs.

Judiciary none competent at this level
The Provincial authority for welfare is competent for matters that transcend the local level or local competences.
  • assistance of people with disabilities and special needs
  • assistance with chronic care
  • assistance with psychological care
  • assistance for palliative care
  • geriatric care
  • care of children taken into public care by the juvenile judge
  • hygienic control of industrial kitchens
  • monitoring and registering of genetic birth defects

The provincial authority is also competent for catastrophe planning and management of the emergency services.

  • ambulance services
  • fire-fighting services, including the civil protection service
  • private subcontractors (towing services, salvage, lifting and transport services) in case of emergencies or catastrophes
  • coordination of all emergency services (police, highway services, army) during catastrophes
Local authorities
Legislative City or Communal Council
Executive College of Mayor and Aldermen ; dedicated alderman for Social affairs
Judiciary none competent at this level
The Public Centre for Social Welfare is a local authority public service.
  • in Dutch - Openbaar centrum voor maatschappelijk welzijn (OCMW),
  • in French - Centre public d'action sociale (CPAS)
  • in German - Öffentliches Sozialhilfezentrum (ÖSHZ).

In larger cities these public services manage large budgets, with a substantial administrative burden. They operate hospitals, clinics, rehabilitation centers, retirement/pensioners residences and day care centres. The largest PCSW is the one in Antwerp. In 2013, it managed a budget of 461 million euros, and paid benefits to people with no or very low incomes, for a total of 125 million. The PCSW employs a workforce of over 1000 people.[20] Hospitals and other care institutions are grouped into a separate organisation called ZNA. [21] (Care Network Antwerp) employs another 7000 people, and in 2010, had a budget of approximately 568 million euros.

A recent decision (made public in January 2015) by the Flemish regional government, aims at abolishing this local authority service, which had a substantial measure of independence and authority from the political elected councillors. It will bring it under the authority of the communal council within the next 2 years. This decision is being contested by the opposition, and by legal impediments at the federal governmental level.

Organisation of Care

Generally speaking, health care is organised in three layers:

Physicians

For common diseases like cold, flu, injuries and pain, patients contact their GPs.

Physicians in private practice are generally self-employed. Officially, they are categorized in the following framework:

Most doctors working in hospitals also have a private practice. Exceptions include neurosurgeons or radiologists because they cannot invest in the high tech equipment required. Doctors are usually paid on a per medical act basis either by the patient at their private practice or by the hospital. Some specialists are employees on a hospital payroll or for research labs or universities. Assessment consultants are paid a fixed fee for their assessment report by whoever hired them.

Emergency services

Entrance of a hospital emergency department in Brussels

For accidents and medical emergencies everybody can call on the emergency services. There are two phone numbers to contact the Emergency Services Network, 100 or 112. 100 gives access to the Ambulance service or Fire department. In larger cities the Fire department operates the Ambulances, elsewhere Ambulances might be allocated to hospitals. 112 gives access to the Police, Ambulance Services and Fire department. The dispatching centers for the 100 and 112 services, dispatches an available ambulance from the closest hospital or ambulance center. The operator is qualified to decide to dispatch a MER-vehicle. Additionally, the Red Cross operates a number of ambulances as do privately owned companies that operate ambulances for the emergency network. The Red Cross and a number of other "cross" charities own ambulances and have volunteers that man first-aid posts during events like football matches, cycling races, sports or other mass events. They don't participate in the daily Emergency services network, but they do liberate the Emergency Services network from allocating too many assets and resources during those mass events.

Calling an ambulance is not a free service. The ambulance will bring the patient to the nearest hospital. An ambulance is manned by two people - a driver and a paramedic. Depending on the medical condition, a Medical Emergency Response vehicle may be dispatched. That is manned by three people - a driver, an ER-doctor and a senior ER-nurse. The ER-doctor will choose the nearest appropriate hospital that has the necessary facilities based on the patient's symptoms and condition, or a hospital in which the patient is under active treatment.

Hospitals

The Federal Service for Public Health describes the hospital sector[22] in the following manner:

General structure

There are two distinct types of hospitals: General hospitals and Psychiatric hospitals. Psychiatric patients are not mixed with the general hospital population.

There are 209 hospitals:

The vast majority of hospitals are publicly funded. They are independent units or part of a larger organization that get funding from the public health service based on the activities they deploy, number of beds operated, specialist knowledge etc... In Belgium, there are only a handful of privately owned/operated hospitals that work outside and without the public health service funding. They provide luxury services and luxury accommodation for patients that can afford such exclusive services.

Healthcare Belgium is a non-profit organisation established in 2007 by six prominent Belgian hospital groups with support from the medical technology industry in Belgium.[23]

Outside these categories there are:

In a general hospital any of the following departments may be at the disposal of patients, but not all general hospitals offer all these facilities and departments:

Nursing

Different levels of nursing training are available: basic nurse, midwife, full nurse

Pharmacy

Internet medication: if a patient buys medication in another EU country from a pharmacy for his personal use, by prescription or over the counter, he can import them into Belgium in his luggage or vehicle. Belgian patients may legally buy over the counter painkillers such as paracetamol in the Netherlands where they are cheaper, and take them to Belgium. However, attempting to import prescription drugs without a prescription, unregistered or forbidden medication, or narcotics purchased on the internet or for recreational drugs illegally on the street is prohibited and customs and police track this business rather strictly. Illegally imported drugs are confiscated, and the carrier might be fined or imprisoned.[24]

Under the Healthcare Act of 30 October 2018 electronic prescriptions will be mandatory.[25]

Health insurance

History

Working

Health insurance is only one of the pillars of the system of social security provided for every Belgian citizen. Every Belgian citizen has access to the social security system—it is compulsory—but there are gaps in the system where people can drop out. For example, not paying contributions is one such exit and another is homelessness (social security is only available to people with an address).

Financing the system : compulsory social security

Every wage-earning worker or employee in a factory, office, working as house personnel (maids, chauffeurs etc.), and anyone working in Belgium is registered to a central system as well as the unemployed. The self-employed, such as shopkeepers, innkeepers, lawyers, and doctors, are also registered.

Workers are paid a daily or monthly wage their gross salary. From that gross salary, their employer has to deduct a certain amount (approx 13%) for social security and another (approx 20%) for taxes. The employer has to pay these amounts directly to the Social Security Services and the Inland Revenue Service (employers make these payments for the employee and deduct these payments from his wage). On top of the gross salary, the employer has to pay an employer's contribution for social security of approx 15–22% to the Social Security Services. Failing to make these payments regularly and on-time is closely monitored and often causes failing businesses to be taken to court for failing to comply with their social security and fiscal obligations towards their workers. This reduces the risk for workers when they remain unpaid or when their contributions are not paid for them.
The Self-employed have a system in which they have to declare their earnings and based on their earnings a contribution is calculated which is roughly 20%-22%, but they are not covered like workers. People can opt into the system through this self-employed scheme. The government forms its tax earnings finances in part the social security system. This is a wealth re-distribution mechanism, because the contributions are incremental, this means that the more someone earns the more this person will contribute. Moreover, for health services, the compulsory health insurance and the refund system is the same for everybody (corrected for the lowest incomes) : i.e. for a consultation at the GP everybody pays the same and gets the same refund (irrespective of their income).

Financing the system: complementary systems

There is a complementary system of health insurance offered by the mutualities (extended hospital cover and travel cover), available to all mutuality members, and there is private insurance with commercial insurance companies for extended care (hospital and aftercare) and for travel care.
These systems are pure premium based insurance system.

Covering healthcare costs

1. Consultations with GPs or specialists in their private practise

2. Consultations at hospitals (polyclinic)

3. Hospitalisations and medical interventions

Managing healthcare money streams

Patient identification

In the 1980s an "SIS-card" (plastic creditcard-size chipcard like bank card) was introduced, the social security card. With it the Federal Government introduced a "national number", that identified each individual uniquely based on his/her birthday. Every individual had such an SIS card, and it established their entitlement to social security.
In 2014 that system was superseded by the plastic ID card (Belgium EID card) with social security information on a card chip, readable with a simple card-reader.

According to the Euro health consumer index, which placed it in fifth position in its 2015 survey, Belgium is probably the most generous healthcare system in Europe.[27]

Social security

Social security encompasses health, old-age (and other) pensions, unemployment, disability and handicap, both managing the finances (collection of contributions, subsidies and payment of refund, allowances etc.), but also the management of different kinds of care, regulation of the market of medicines, health and safety at work, health and safety of any public service rendered to the general public, Monitoring and safety of the food chain etc.

See also

References

  1. ^ Corens, Dirk (2007). "Belgium, health system review" (PDF). Health Systems in Transition. European Observatory on Health Systems and Policies. 9 (2).
  2. ^ Belgium.be portal Gezondheid (in dutch)
  3. ^ Belgium.be portal Santé (in french)
  4. ^ Belgium Health portal
  5. ^ "MedicalExpertise". fgov.be.
  6. ^ SHC
  7. ^ Consultative bodies
  8. ^ SIPh/WIV/ISPS
  9. ^ "What does the FAMHP ?". fagg-afmps.be.
  10. ^ "Federal Agency for the safety of the food chain (FASFC)". afsca.be.
  11. ^ "Homepage - Federaal Agentschap voor Nucleaire Controle - FANC". fgov.be.
  12. ^ "CODA-CERVA". coda-cerva.be.
  13. ^ "Vlaams minister van Welzijn, Volksgezondheid en Gezin". vlaanderen.be.
  14. ^ "Gezin, welzijn en gezondheid". vlaanderen.be.
  15. ^ "Portail FW-B - Portail de la Fédération Wallonie-Bruxelles". federation-wallonie-bruxelles.be.
  16. ^ "Accueil - Administration Générale de l'Aide à la Jeunesse, de la Santé et du Sport - Fédération Wallonie-Bruxelles". cfwb.be.
  17. ^ David Mattar. "Regierung der Deutschsprachigen Gemeinschaft - Die aktuelle Regierung der Deutschsprachigen Gemeinschaft Belgiens (DG)". dgregierung.be.
  18. ^ David Mattar. "Regierung der Deutschsprachigen Gemeinschaft - Antonios Antoniadis". dgregierung.be.
  19. ^ dmattar. "DG.be - Familienfreundlicher Standort". dg.be.
  20. ^ Annual report of the PCSW of Antwerp
  21. ^ "ZNA". zna.be.
  22. ^ "Ziekenhuizen". belgium.be.
  23. ^ "Members". Healthcare Belgium. Retrieved 24 December 2016.
  24. ^ "Important legal changes in Belgium's healthcare sector". Lexology. 5 December 2018. Retrieved 21 January 2019.
  25. ^ "New Belgian Healthcare Act: Impact on the health sector". Lexology. 21 January 2019. Retrieved 2 March 2019.
  26. ^ Abel-Smith, Brian; Alan Maynard (1978). The organization, financing, and cost of health care in the European Community. Commission of the European Communities. p. 9. ISBN 978-92-825-0839-8.
  27. ^ "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26 January 2016. Archived from the original (PDF) on 6 June 2017. Retrieved 27 January 2016.