1. TOF 14/3/2016 Welcome!!! Who are you? – International students – Get your keychaines! Practical stuff… – Program – Evaluation – Sleeping and Money Who are we? (ppt about school) This morning’s topic: outpatient, first line healthcare – Belgium and Finland

2. The Belgian healthcare system within an international perspective Interaction necessary!!! Belgium Finland Further discussion

3. International perspective  4 basic models of healthcare systems  Model according to the free market economy (e.g. the USA)  Out-of-pocket model  USA (10% population no insurance), most developing countries  Beveridge model (e.g. NHS in the UK): -Funding is provided through general resources (by means of taxes) -Infrastructure is owned by the government -Policy and management of healthcare are the responsibility of the government

4. International perspective  4 basic models of healthcare systems  Bismarck model: -It uses an insurance system — the insurers are called “sickness funds” — usually financed jointly by employers and employees through payroll deduction. Health insurance plans have to cover everybody and they don’t make a profit. Healthcare providers are often private. -Refund system -Pay-in-kind system -Belgium, the Netherlands, Germany  The National Health Insurance Model  Canada (combination of Bismarck and Beveridge)

5. Characteristics of the Belgian healthcare system  Overview of the characteristics: 1.Mandatory health insurance based on solidarity 2.Comprehensive cover of costs 3.Reasonable overall expenditure 4.Free choice of healthcare provider 5.Consultation on prices and rates 6.A personal patient contribution 7.Increasing tension between the growing expenditure and the macro-economic reality

6. Characteristics of the Belgian healthcare system 1.A mandatory health insurance based on solidarity Also the unemployed, people who live on social welfare payment, pensioners, etc. Self-employed people have to be insured (since 2008) for minor risks (=outpatient care) 2.Comprehensive cover of costs Wide range of healthcare services and facilities Sufficient specialists Limited waiting lists A wide care package is covered 3.Reasonable overall expenditure Belgium was in the middle group in OECD rankings BUT the situation is changing… In 2010, 10.5% of GDP (OECD average was 9.7% of GDP)

7. Characteristics of the Belgian healthcare system 4.Free choice of healthcare provider Patients can choose freely between healthcare providers, hospitals and insurance companies (=ziekenfonds) Advantages: accessibility and competition (quality of service) Disadvantages: it’s difficult to monitor the patient Some global actions in order to structure this free choice: GMD (Global medical record): a better exchange of information between physicians. Benefit for the patient: a 30% discount on co-payment (=remgeld) when consulting a general practitioner As from 01/07/2007: a discount on co-payment for the specialist after a GP referral. 5.Therapeutic freedom for physicians Risk of overconsumption (radiology)!

8. Characteristics of the Belgian healthcare system 6. Consultation on prices and rates Biyearly: Conventions between healthcare insurance companies and healthcare providers (physicians) – Very detailed nomenclature! caregivers have the choice to join these agreements (NIHDI physician = the physician’s fee will be in line with the NIHDI nomenclature) Focus on financing care programs: the consensus is that coordinated collaboration among healthcare professionals is necessary, especially for patients with chronic diseases that require complex treatment – e.g. care pathways for type 2 diabetes and chronic renal impairment since 2009

9. Characteristics of the Belgian healthcare system 7. A personal patient contribution With the co-payment system Aim: to discourage unnecessary use of healthcare resources This is a threat to the equal access to essential care, BUT: Compensation mechanisms exist for vulnerable groups e.g.: maximum invoice (= maximumfactuur MAF) Still: personal contribution is rather large in comparison to other OECD countries

10. Characteristics of the Belgian healthcare system 7.Increasing tension between the growing expenditure and the macroeconomic reality This is the reality: Ageing of society> fewer people work and they are responsible for an increasing number of people Growing expectations towards quality and easy access to healthcare Expensive new technologies (chemotherapy, HIV inhibitors,...) Wage costs increase but are not compensated by increased productivity Personal contribution is rather large in comparison to other OECD countries

11. This is the challenge: Finding a balance between >the legitimate question for fast and qualitative access to necessary health care AND >the given macroeconomic context of shrinking budgets. Solution: emphasis on effective cooperation between all stakeholders = saving costs

12. Extramural healthcare in Belgium Private general practitioner (fixed price/consultation) Private specialist (own practice or in hospitals) Private home care: nursing and midwifery (fixed price/activity) Kind & Gezin: preventive community care for children till 2.5 years (free of costs) CLB: limited healthcare surveillance for pupils (free of costs) No community care for adults! – Some exceptions in bigger cities (24 community care centers, none in our province) No emergency care outside hospitals! – Expensive in hospitals!