1. Minister Departement WVG Youth Welfare Flemish Agency forCare and Health Care Inspectorate PC Geel PC Rekem Flemish Agency of Disabled Persons Child and Family Strategic Advisory Council Flemish Care Fund Fund for Youth Welfare Policy Council Management committee Flemish Ministry of Welfare, Public Health and Family (WVG)

2. 1.Health and health care policy in Flanders (Machteld Wauters - VAZG) 2.VIPA: funding health care infrastructure (Christophe Cousaert - VIPA) 3.Innovation initiatives: Primary Care Safe and Flanders’ Care (Machteld Wauters)

3. Health and health care policy in Flanders Machteld Wauters Flemish Agency for Care and Health

4. Health in Flanders Belgium: regions and communities Competences in health Flemish policy in health –Public health –Health care

5. Belgium

7. Political situation (De)federalisation process: since 1980 responsibilities for health care are increasingly delegated to regional level (‘devolution’) Complex: 6 authorities responsible for health matters in Brussels! Interministerial conferences to ensure consistency and complementarity of policies

8. BelgiumFlanders (person-related matters) Health/ Health Care - Organic laws - Basis rules planning/ financing infrastructure - Financing regulation operating costs hospitals/nursing homes - Health insurance system - Preventive health care - Health promotion - Implementation hospital standards, quality assurance policy - Ambulatory mental health care - Coordination home care Infrastructure - DBF 40% - Basic rules planning/financing infrastructure - Subsidizing 60% - Specific legislation quality Competences healthcare Belgium/Flanders

9. Health care budget

10. Flanders Competences in health and health care Policy in public health Policy in health care

11. Flemish competences in health Health promotion Prevention of noncommunicable and communicable diseases Implementation of hospital standards, quality assurance policy in health services Subsidizing health care infrastructure Ambulatory mental health care Coordination of home care Objectives of the Flemish health policy Promote the choice for healthy lifestyles Prevent diseases, their risk factors and complications Stimulate and monitor the performance of health care services Tune the supply of health care to the needs of the population Provide accessible and affordable care Strengthen active participation and correct treatment of users of care Flemish agency

12. Flemish Agency for Care and Health The mission of the Agency is to create the conditions to promote, protect and restore the welfare and health of the current and future population of Flanders, aiming for an optimal level of welfare and health of all citizens.

13. Flemish preventive policy Decree on preventive health care 2003 working with health targets METHODOLOGY

14. Decree on preventive health care 2003 Epidemiological basis for policy Health conference  large societal basis –Health targets (SMART) –Prevention strategies Approved by Parliament Executed by government  political commitment

15. Decree on preventive health care 2003 Epidemiological basis for policy Health targets Prevention strategies Implementation of policy Health in all policies Partner organisations Organisations in the field Logo’s Individual providers

16. Main causes of death per age group MenWomen <10 years Several causes of death, but small numbers 10-14 years Transport accidents 15-19 years 20-24 years Suicide 25-29 years 30-34 years Suicide 35-39 years 40-44 years Breast Cancer 45-49 years 50-54 years Lung Cancer 55-59 years 60-64 years 65-69 years 70-74 years Ischemic Heart Disease 75-79 years 80-84 years Ischemic Heart DiseaseCerebrovascular Conditions >85 years Heart Decompensation, Complications and unclear Heart Conditions

17. Evolution of deaths preventable by primary prevention (1999 – 2008)

18. Flemish health targets 1.Diet and physical activity 2.Tobacco, alcohol and drugs 3.Breast cancer screening 4.Suicide prevention 5.Injury prevention 6.Prevention of infectious diseases by vaccination

19. Health care Belgian Health care system Flemish competences and policy

20. Belgian health care system Compulsory public health insurance system Independent medical practice Free choice of health care provider by the patient Fee-for-service payment of providers, with reimbursement

21. Flemish competences in health care  Implementation of hospital standards, quality assurance policy in hospitals and nursing homes  Subsidizing health care infrastructure

22. FLEMISH LEVEL FEDERAL LEVEL EXPLOITATION INFRASTRUCTURE € Division of competences in Belgian health care policy : hospitals Basic legislation Execute (recognitions) Inspection of recognitions Strict legislation VIPA Funding 40% (BFM) € - BFM (budget financial resources) - RIZIV € Subsidy/guarantee 60% €

23. Flemish competences in health care  Implementation of hospital standards, quality assurance policy in hospitals and nursing homes  Subsidizing health care infrastructure  Coordination of primary care and home care  Ambulatory mental health care

24. Flemish policy in health care Priorities:  Stimulate and monitor the performance of health care services  Tune the supply of health care to the needs of the population  Provide accessible and affordable care  Strengthen active participation and correct treatment of users of care

25. VIPA - Flemish Infrastructure Fund Christophe Cousaert Flanders, Belgium

26. 1.VIPA: Flemish Infrastructure Fund 2.Funding hospital infrastructure 3.Facts and figures 4.Policy health infrastructure

27. 1.VIPA: Flemish Infrastructure Fund

28. Minister Departement WVG Youth Welfare Care and Health Care Inspectorate PC Geel PC Rekem Flemish Agency of Disabled Persons Child and Family Strategic Advisory Council Flemish Care Fund Fund for Youth Welfare Policy Council Management committee Policy area Welfare, Healthcare and Family (WVG)

29. “VIPA’s mission is to develop initiatives and provide funding for a high-quality, accessible and affordable infrastructure for the provision of care and services within the framework of matters relating to the individual.” Mission

30. Key assignments The funding, in any way, of infrastructure of welfare and care 1. The coördination, steering and direction of public-public and public-private partnership (PPS) 2. The promotion of knowledge and expertise in terms of concept, finances and technical engineering 3. The building up and management of financial reserves 4.

31. Scope of application Hospitals, psychiatric care homes, psychiatric hospitals Elderly homes, day care centers, short stay centers, local service centers Preventive and ambulatory healthcare Facilities for youth welfare Facilities for disabled persons Creches General welfare centers 1. 2. 3. 4. 5. 6. 7.

32. 2.Funding hospital infrastructure

33. Funding hospital infrastructure 40% 60%

34. New building, renovation, purchase + renovation Max. m²/resident (f.e.: 110 m²/res. general + 25% university; 90 m²/res. psychiatric) Moveable investments = 60% accepted costs Basic rules 60% accepted costs < max. cost price 1.100 €/m² (priority renovations = 10% Flanders) Budget Financial Resources – 40% write-off amounts

35. Alternative funding hospital infrastructure Agreement in principle Flemish minster 20 years utilisation grants linked to utilisation norms (f.e.: occupancy rates, …)

36. I. Approved strategic care plan ( ticket to start ) II. Approved technical-financial plan ( businessplan + plans of architect ) II.1. Agreement in principle (no commitment) ( = spreading funding over economic life of infrastructure (20 years) ) II.2. Funding (utilisation grants) during 20 years linked to functional application to be justified (by reviewing utlisation norms) Procedure alternative funding

37. 3.Facts and figures

38. Facts and figures 10,6 mio inhabitants6 mio inhabitants 45.000 hospitalbeds31.000 hospitalbeds 100 general hospitals71 general hospitals

39. Facts and figures - evolution - 20% Incl. 4 university hospitals – excl. 39 psychiatric hospitals

40. Incl. 4.600 university beds – excl. 10.000 psychiatric beds One day hospital: 34% in 2000 to 47% in 2008 (+ 85% treatments) Facts and figures - evolution

41. 800 mio € (80 mio €/year) 2010-2014: 1.800 mio € (360 mio €/year)! Facts and figures - evolution

42. 4.Policy health infrastructure

43. Quality of infrastructureComfort Healing environment: accent on userscomfort Indoor climate: lower CO2-emissions Sustainable and energy-efficiënt construction: sustainability criteria Evolution to high-tech hospitals: best practices?

44. Quality of infrastructureArt Design meets art – art meets design Flemish government subsidizes art works integrated in infrastructure projects

45. Networking Future challenges = working together Evolution to centers of excellence in specific segments

46. Innovation and Entrepreneurship in Care

47. Care: large economic impact 16% active population 8% GDP Flanders (unchanged policy) source: Planbureau + 70.000 jobs 2014

48. Investing in qualitative and accessible care – Maximizing societal added value Investing in innovative care – Maximizing new perspectives in (health) care Investing in strong entrepreneurship in view of – Market innovation in Flanders – Maximizing economic added value – International valorization Flanders’ Care

49. Care & Innovation & Economy Kris Peeters, Flemish Minister-president economy Jo Vandeurzen, Flemish Minister care Ingrid Lieten, Vice Minister-president innovation

50. Flanders’ Care mission statement To measurably improve the quality of care through innovation and responsible entrepreneurship

51. Governance Structure

52. Innovation perspective RESEARCH & DEVELOPMENT Quality of Care IMPLEMENTATION INTERNATIONAL VALORIZATION DEMONSTRATION Economic Development

53. Policy instruments: finding synergies! CareInnovationEntrepreneurship Policy Impulse office Seed Capital Demonstration projects Innovative tendering

54. “Bridging the Gap” Inform and sensitize stakeholders: – Care organizations – SMEs and other private companies – Knowledge sources Guidance: – Guide initiatives through the different government instruments of policy domains: Welfare, Public Health and Family Affairs (WVG, VIPA, …) Economy, Science and Innovation (EWI: IWT, AO, PMV,…) Flanders International (VI: FIT, VAIS,..) Brokerage: – Direct towards the most optimal government instrument for optimal use and exploitation Customized service Start up: end of October Impulse office Flanders’ Care

55. €20 mio venture fund Managed by PMV (Participatie Maatschappij Vlaanderen) Supports entrepreneurship in care for a more effective implementation of care technology And a more innovative product and service offering in care Target group: start-ups, young companies (SMEs) and companies starting up new activities. Complementary to the existing sources of seed capital Necessary because of barriers specific to the care sector – Long pre-commercialization trajectory – Diversity of stakeholders – Reimbursement system(s) – … Strong involvement care stakeholders in decision making process Seed Capital in Care

56. Care for Talent Competence buildup For innovative solutions in care Concept document: ‘making work of work’ General practitioners and specialists Nurses and other care professionals Primary healthcare conference (December 2010) + 70.000 Jobs in care

57. Similar challenges all over EU Importance of regional positioning – Regions holding the implementation key – ‘Smart specialization’ – Requires a bottom-up approach Collaboration will yield societal benefits – Innovation absorption – Market development – Quality of care increase Benchmarking EU perspective

58. Flemish health portal: www.zorg-en-gezondheid.be Contact: –internationaal.azg@wvg.vlaanderen.beinternationaal.azg@wvg.vlaanderen.be –vipa@vlaanderen.bevipa@vlaanderen.be