1. Health care system in Belgium How Belgian patients can save 1 billion euro / year and the health insurance system 1,6 billion / year …

2. Belgium

3. Statistical information 30,528 sq km about 10,4 million inhabitants three official languages (Dutch, French and German) life expectancy: 78,29 years average of 1,62 born children / woman. USD 33,000 / capita GDP 8,7 % of this GDP: spent on health expenses 2.269 USD per capita / year: spent for health of which 71,2 per cent are public expenses.

4. Basic principles of the health care system A liberal view of medicine. Most health care providers are self-employed, receive payment for each service provided and enjoy diagnostic and therapeutic freedom. System of compulsory health insurance system (RIZIV), integrated in the Social Security System and financed predominantly through salary deductions. More than 99% of the population is covered by compulsory health insurance at the present time. The freedom to choose both the health care provider and the (private or public) health care establishment, so also free access to specialist doctors.

5. Reimbursement conditions (1) The subscription to one of the existing health funds is compulsory, but the choice among them is free. ANMC, National Alliance of Christian Mutualities is by far the largest with 45% of the population As a general rule, patients pay the total cost of services and then get reimbursed by their Mutual health fund on the basis of a contractually determined amount. The difference between the total cost and the reimbursement is a personal contribution. Exception to this rule: third-part payment, mainly for hospitalisation costs, pharmaceuticals and individuals living in a particular social and financial insecurity

6. Reimbursement conditions (2) Supplementary insurance policies: voluntary offered by Mutual health funds (non profit) and private companies (profit) Essentially co-payments by patients and additional charges private hospital room, rest and care homes…

7. Public health system in danger Budget of RIZIV: 15,3 billion euro Rise of 4% / year Reimbursement of medicines: 2,7 billion euro: Rise of 7,8% / year: expenses increasing twice as fast as the total cost of RIZIV Other reasons (demography)

8. Why medicines bring the system in danger? (1) High prices Higher then the neighbouring countries (France, Netherlands) Zocor (cholesterol-lowering drugs: 26 and 35% higher) NGO Orbi-Pharma: 15 tot 60 times cheaper

9. Why medicines bring the system in danger? (2) Low quality: most expensive medicines are not those scientifically proven to have the most benefit Top 5 of the most expensive medicines for RIZIV (2002) NameTherapeutic classProducerNet cost (in million Euro) 1.LipitorCholesterol lowering drugPfizer70.9 2.ZocorCholesterol lowering drug Merck Sharp&Dohme44.4 3.AmlorAnti-hypertensive drug Pfizer34.5 4.CipramilAnti-depressantLundbeck33.2 5.PravasineCholesterol lowering drug Birstol-Meyers Squibb26.8

10. Why medicines bring the system in danger? (3) Imitations and “me toos” Most of the research is not to search for new medicines, but to make imitations and adjustments of the product To obtain admission of a new product: new medicine has an effect or it should be better than placebo and it’s safe

11. Why medicines bring the system in danger? (4) “New” product: Lucentis (2.000 dollar) Same active component as Avantis (cancer): 20 dollar Study of National Institute for Health Care Management (NIHCM): 153 or 15% of all 1.035 medicines, admitted for sell by the American Food & Drug Administration (FDA) had more therapeutic value

12. Why medicines bring the system in danger? (5) Irrational use of medicines and marketing Direct to consumer advertising for medicines without prescription is legal Producers of Neurofen, Alevem Daflon and Venoruton are making super profits, but have no proven beneficial effect

13. Why medicines bring the system in danger? (6) Valuable and life-saving medicines are withdraw from market when they become too cheap and more expensive alternatives are available (Furadantine, Penidur) Doctors are object of publicity because they lack necessary information (pharmaceutical industry: 1 billion dollar or 1.000 times the amount for independent education)

14. A rational drug policy exists (1) Based on the health system in New Zealand: kiwi-model (Pharmac: quality, effectiveness and price) The new institute aims to realize The most efficient and accessible health policy Highest health protection at the lowest price

15. A rational drug policy exists (2) Strategy of the new institute: Independent team of experts Scientific demand-driven analyses Objective, scientific criteria and studies Public bidding or cross deals Reimbursed if it has a clear therapeutic surplus value

16. Challenges (1) implementation of the kiwi-model without vitamins (protest of pharm. industry, politicians and doctors) public bidding only for products without patent (cholesterol-lowering drugs) Compensation for products that don’t win, but patients pay more Firms get reduction if they use less marketing and publicity

17. Challenges (2) More and more coercive directives of the European Commission, where health a part is of the sector entreprises TRIPS: prices rose with 12 to 200% Availability of cheaper generic medicines slow down 97 of patents are registered in rich countries

18. Challenges (3) Nationalization of the pharmaceutical industry is needed, but a national drugs policy on public tender as the kiwi-model would be a valuable step