introduction to the belgian healthcare system

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FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU

Introduction to the Belgian healthcare system

Gerits Pol - PhD - Adjoint DG1

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Belgium in a nutshell

Belgium is one of the most densely populated countries in Europe.

Its 10 807 396 inhabitants (1/1/2010 - Federaal Planbureau) live in a total land area of 30 528 km². Brussels is the capital and the largest city.

Belgium has three official languages, namely Dutch, French and German (59,2% = Dutch speaking; 40,2% French speaking; < 1% German speaking). Approximately 8.2% of the population are foreigners, mostly from Italy, Morocco, Turkey, France and the Netherlands.


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Belgium in a nutshell

The living standard is among the highest in Europe.

In 2007 the Gross domestic product per capita PPP was 35 380 $ (OECD 2009).

From an economic point of view, Belgium has in 2007 a low employment rate (62%) and a still significant public debt (94,3% of GDP - OECD 2005).


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A short introduction to the constitutional structure of Belgium.

Belgium is a federal state with a parliamentary form of government.

Three levels of goverment:

federal

regional (3 regions and 3 communities)

local (provinces and municipalities).


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The three communities


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The three regions

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A short introduction to the constitutional structure

• Since the Institutional Reform Act of 1980, part of the responsibility for health care policy has been devolved from the federal government to the regional governments

• Ambulatory services and health care in institutions were transfered to the communities. Health education, promotion and prevention have also been delegated to the communities.

• The health care responsibilities of the provinces and the municipalities are limited.

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Important exceptions

• Organic act – lines of force – basic regulation

• Financing of operational costs of health care institutions when covered by the organic act

• Compulsory health insurance

• Rules concerning the planning of health services


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Important exceptions

• national accreditation criteria on condition that they can have repercussions on planning, financing of operational costs or compulsory health insurance

• establishment of criteria for the accreditation of academic hospitals


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To keep the cost of curative care under control the federal level makes use of three instruments:

determining the basic rules for planning of medical infrastructure

financing of hospital running costs

reimbursement of medical activities

It is based on the principles of equal access and freedom of choice, with a Bismarckian-type of compulsory national health insurance, which covers the whole population.


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An introduction to the Belgian health system

• Even specialists who work full-time in hospitals generate their incomes from individual patient fees rather than from salaries (with exception of the specialists working in university hospitals).

• Methods of payment to hospital specialists are often a mixture of different compensation forms. By pooling the patient fees they receive a lump sum and a variable amount per service, after deduction of hospital costs that cover the hiring of equipment and facilities.

• Furthermore there is no privilege of private or public initiative.


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• The vast majority of GPs work as independent self-employed health professionals.

• Primary care is not yet structured and private group practices are still rare but the number of partnerships among GPs in which each practitioner serves his own patients individually and receives a fee for that service is growing. There are a number of group practices where the fees are pooled.

• Patients do not often have to wait long, if at all, for access to either GPs, specialists or hospitals. Also, GPs make many visits to patients at their homes (37% of total number of GP visits in 2005).

• There is no clearly defined gatekeeper function. The free choice of physician is an important right granted to patients. This is one of the reasons why the average number of physician contacts per person in Belgium is high (2004: 7.1 outpatient contacts per person).


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• The legislation is roughly the same for public and private hospitals. In Belgium the label public / private refers to its ownership.

• There are binding planning criteria: no hospital may be built, replaced or expanded if it does not meet these criteria.

• Each department in a hospital must be accredited by the competent health minister. Accreditation is based upon norms of an architectural, organisational and functional nature (the hospital act).


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• The system of accreditation is primarily concerned with safety, hygiene, quality and continuity of care. The aim is to guarantee that hospital care meets requisite standards.

• In principle, a hospital should have at least 150 acute beds, three basic departments (surgery, internal medicine plus a third one) and a number of basic functions such as anaesthesia, clinical pathology, radiology, rehabilitation, hospital pharmacy and palliative care.

• Hospitals that had not met these conditions by 1 July 1998 were required to either close or merge. For the new mergers there is no maximum capacity.


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• In addition to the minimum hospital capacity the minimum bed capacity depending on hospital type is also fixed. When implementing the bed occupancy standards, account is automatically being taken of the performance in respect of length of stay.

• Hospitals showing a structural undercapacity are required to close a number of beds.

• A bed as a basic element of accreditation is a normally occupied bed that achieves a normal length of stay in relation to the disease and marks a normal shift towards day hospitalisation as compared to the national average.


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• In 1994, the competent advisory wrote a note entitled ‘A Note of Principle: from Structure to Activity programme’. The note contains elements for a new accreditation concept for hospitals.

• Hospitals will be subject to tremendous upheaval as a result of both external and internal factors, such as the ageing of the population, changing attitudes towards hospitalisation and changes in medical technology.

• Accreditations should no longer be primarily based on infrastructure (number of beds, types of beds, ets..) but rather on the nature of medical and nursing care that the hospital provides or intends to provide.


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• The basis for accreditation has to shift from the static hospital facilities data towards the activities which the hospital engages in, expressed as activity programmes intended for well-defined patient groups.

• One can distinguish 2 types of programmes: the basic and the specialised programmes.

• The basic programmes, with a mostly medico-surgical content, that may be differentiated on the basis of the age group of the patient

• Specialised programmes that are directed towards groups of patients with identifiable and clear-cut conditions. They may be either problem/pathology-oriented or rather functional/organizational.


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• Meanwhile, the concept of ‘care programme’ has been included in the Hospital Act.

• A Royal Decree has to specify the accreditation characteristics of each programme, such as the target group; the nature and content of the care; the minimum level of activity; the required infrastructure; the required medical and non-medical staffing and expertise; quality and quality assurance standards; business economics criteria; and finally geographical accessibility criteria.


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At present there are care programmes for reproductive medicine; cardiac pathology; oncology, paediatric, oncology (general and breast cancer) and finally geriatric.

A medical council has to be established in every hospital. This council gives advice to the general manager on five issues: (1) general regulations; (2) medical activities; (3) relations with other staff functions; (4) financial means and finally (5) techniques necessary for medical activity.


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Some key data (vragen aan Anja Baelen)

The total number of acute hospitals is 146 (July 2008). The total number of acute beds is 55 053. The number of admissions in 2008 was 1 809 457 in acute beds and the average length of stay was 7,81 days.

The total number of specialized hospitals is 23. The total number of specialized beds is 1867.

The total number of geriatric hospitals is 8. The total number of beds in this type of hospitals is 1181.

The number of psychiatric hospitals is 69 and the total number of beds in psychiatric hospitals is 15 746.


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Payment mechanisms for hospitals

The structure of Belgian hospital financing consists of four parts:

the hospital budget;

the fees;

the pharmaceutical budget;

And finally the patient co-payment budget.


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The budget for hospitals’ running costs or the hospital budget is set each year and is composed of three major sections (A, B, and C) which are set separately and which are further divided into subsections.

Part A consists of three subsections: A1- investment charges; A2 - short-A1- investment charges; A2 - short-term credit burdens; and finally A3- investment chargesterm credit burdens; and finally A3- investment charges for specific medical for specific medical technical services which are exclusively financed by the hospital budget.technical services which are exclusively financed by the hospital budget.


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Section B consists of 9 subsections: B1- operating expenses of B1- operating expenses of communal services; communal services; B2 - personal expenses of clinical services; B2 - personal expenses of clinical services; B3 - running costs of specific B3 - running costs of specific medical technical services such as radiation medical technical services such as radiation therapy, MRI and PET;therapy, MRI and PET;B4 - cost relating to B4 - cost relating to re-education and fixed prices; re-education and fixed prices; B5- running costs of hospital dispensary; B5- running costs of hospital dispensary; B6 - social agreement - B6 - social agreement - non patient-day personnelnon patient-day personnel; ; B7- costs related to the academic function (since 1.7.02); B7- costs related to the academic function (since 1.7.02); B8 - costs related to the social function (since 1.7.02); and finally B8 - costs related to the social function (since 1.7.02); and finally B9 – costs related to social agreements (since 1.1.06)B9 – costs related to social agreements (since 1.1.06)


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Section C consists of four subsections: Section C consists of four subsections:

C1 - initial costs; C1 - initial costs;

C2 - compensating amounts for previous years; C2 - compensating amounts for previous years;

C3 - supplements and finally C4 - estimated compensating amount.C3 - supplements and finally C4 - estimated compensating amount.


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Payment mechanisms for hospitalsAcute % Sp % Psy % Bra + G + Pal % Total %

A1 6,62 5,08 6,81 3,54 6,50A2 1,04 0,97 0,61 0,98 0,97A3 0,41 0,00 0,00 0,00 0,32B1 24,96 30,79 32,90 22,11 26,35B2 46,06 52,93 44,90 61,73 46,58B3 0,88 0,00 0,00 0,00 0,69B4 10,36 8,04 12,16 8,89 10,44B5 1,89 1,39 0,75 1,00 1,69B6 1,70 0,18 0,02 0,07 1,35B7 3,08 0,00 0,00 0,00 2,42B8 0,45 0,00 0,03 0,02 0,36B9 2,83 0,99 2,01 2,48 2,60C1 0,40 0,35 0,61 0,23 0,42C2 0,00 -0,24 0,96 -0,49 0,11C3 -0,67 -0,46 -0,15 -0,33 -0,58C4 0,00 0,00 -1,62 -0,23 -0,23


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The two most important parts of the hospital budget are

B1 which covers the communal costs and services, more specifically administration, maintenance, heating, catering, laundry and other costs such as depreciation and financing of property investments

and

B2 which covers the costs related to the services of clinical nursing units, emergency admission (accident and emergency services) and nursing activities in the surgical department.

Together the costs of the sum of B1 and B2 represent more than 70% of theTogether the costs of the sum of B1 and B2 represent more than 70% of theTotal budget.Total budget.


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Section B1 Section B1 -principles :-principles :

1°1° Creation of 5 hospital groupsCreation of 5 hospital groups

one group of university hospitalsone group of university hospitals

4 groups of non-university hospitals based on hospital size4 groups of non-university hospitals based on hospital size

2°2° Distribution of the national B1 budget among the 5 groupsDistribution of the national B1 budget among the 5 groups

3°3° Distribution of the budget granted to the group between all Distribution of the budget granted to the group between all

elements of B1 based on a fixed percentageelements of B1 based on a fixed percentage

4°4° Distribution of the budget granted per element based on Distribution of the budget granted per element based on distribution codesdistribution codes

5°5° Sum of budgets granted for each elementSum of budgets granted for each element


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• The national budget B2 is divided among the hospitals on the basis of a scoring system. The national budget B2 is divided among the hospitals on the basis of a scoring system. The scoring system provides basic financing on the one hand and supplementary The scoring system provides basic financing on the one hand and supplementary financing on the other. financing on the other. Each hospital scores a certain number of pointsEach hospital scores a certain number of points

• National B2 Budget / Total of Points Country = POINT VALUENational B2 Budget / Total of Points Country = POINT VALUE

• Hospital budget = amount of points Hospital budget = amount of points xx point value point value

Base : *Base : * AP-R-DRG (All Patients Refined Diagnosis Related Groups).AP-R-DRG (All Patients Refined Diagnosis Related Groups).By comparing the length of stay per DRG of the hospital withBy comparing the length of stay per DRG of the hospital withthe national average, a number of the national average, a number of justifiedjustified beds can be calculated beds can be calculatedby unit.by unit.

-Activities for : surgical day hospital; -Activities for : surgical day hospital; improper classical stays and classical stays.improper classical stays and classical stays.


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This principle of justified activity is applied to the following units :This principle of justified activity is applied to the following units : C, D, I, E, M, C, D, I, E, M, G (and H – B – L).G (and H – B – L).

It is not applied to A, K and NIC units.It is not applied to A, K and NIC units.

Neither is it applied to Sp-units and psychiatric hospitalsNeither is it applied to Sp-units and psychiatric hospitals

Granting of justified bed-days of units proportional toGranting of justified bed-days of units proportional to bed-days billed.bed-days billed.

Hospitals with non officially recognized G-beds: maximum 6 justified beds.Hospitals with non officially recognized G-beds: maximum 6 justified beds.

Justified bed-days per bed-index are divided by the normative occupancy rate to Justified bed-days per bed-index are divided by the normative occupancy rate to obtain the number of justified beds ( for C and D = 80%; E and M = 70% and for G-obtain the number of justified beds ( for C and D = 80%; E and M = 70% and for G-beds = 90%).beds = 90%).


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Basic financing: 1 C-bed = 1 pointBasic financing: 1 C-bed = 1 point

Rational: Personnel norms of the C-unit = 12 people per 30 beds with a Rational: Personnel norms of the C-unit = 12 people per 30 beds with a 80 % occupancy rate = 0,4 person per bed or 0,4 person = 1 point80 % occupancy rate = 0,4 person per bed or 0,4 person = 1 point


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Overall budget in billion eurosOverall budget in billion euros

20022002 4.674.630.000 4.674.630.00020032003 5.093.098.050 5.093.098.05020042004 5.343.074.070 5.343.074.07020052005 5.267.309.4075.267.309.40720062006 5.483.404.2415.483.404.24120072007 5.895.618.9505.895.618.95020082008 6.275.304.8706.275.304.87020092009 6.573.106.1306.573.106.13020102010 6.852.485.0586.852.485.058

There is an increase of 47% in the overall budget from 2002 to 2010.There is an increase of 47% in the overall budget from 2002 to 2010.


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Patients’ rights

The general goal is to increase the accessibility and the compliance.It is a separate, straightforward and clear Act, flanking by policies. It is based on individuals’ rights.The act can be divided in seven sections: (1) the right to receive high-quality medical care; (2) the right to freely choose the health care professional; (3)the right to expect information to assess the health status; (4) the right to well-informed consent; (5) the rights relative to medical records; (6) the right of protection of privacy and finally (7) the right to lodge a complaint


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Patient safety

• Since July 2007: additional financing for the co-ordination of quality and patient safety in Belgian hospitals

• Long-range plan up to 2012 based on the Donabedian’s triad (3 pillars)1. Development of a safety management system (structure)2. Analysis of processes (process)3. Development of a multidimensional set of indicators (result)

• Yearly contracts– Contract year 1 (2007-2008): signed by 80% of the Belgian

hospitals – Contract year 2 (2008-2009): signed by 90% of the Belgian

hospitals


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Patient safety

• 6 topics with regard to quality and patient safety in contract year 1 (2007-2008)

• Most important topic: the assessment of the patient safety culture (Hospital Survey on Patient Safety Culture of the AHRQ)

• Benchmark: 132 of 170 participating Belgian hospitals (voluntary basis)

distribution response % response

physicians 13.883 4.909 35

hospital staff 81.621 47.287 58

Total 95.504 52.196 55


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Compliance with hand hygiene: increase of 50% before the campaign to 70% after the campaign

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International comparison: demographic and economic context1. Between 1990 and 2007 the population growth averaged 0.36 % each year. This is only

half the rate observed in the other OECD countries (0.84%).

2. The percentage of the population that is 65 years or older rose from 12 to 17.1% between 1960-2007 (Average of the OECD countries : from 9.0 to 14.7% - OECD 2009). The percentage of 65+ is expected to be 26.5% by the year 2050.

3. The average fertility rate decreases between 1960 to 2006 from 2.6 to 1.8 (OECD from 3.2 to 1.7 – OECD 2009)

4. GDP/capita in USD PPP in Belgium in 2007 = 35.380 $ (Average OECD = 32.798 $ - OECD 2009)

5. In 2000, the Gini coefficient was 33. This is slighthy higher compared to our neighbouring countries (the Netherlands = 30.9 (1999); France = 32.7 (2004); Germany = 28.3 (2000))


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International comparison: health status

1. Life expectancy at birth in Belgium increased from an average of 70.6 years in 1960 to an average of 79.8 years in 2007. (OECD – from 68.5 years to 79.1 years – OECD 2009)

2. Concerning our neighbouring countries: France, the Netherlands, Germany perform better than Belgium and especially France where the average life expectancy is 1.2 years higher. On the other hand, the life expectancy in Belgium is higher compared to that of the UK and Luxembourg (79.5 and 79.4).

3. On average, life expectancy at birth for women was 82.6 years in 2007 (OECD countries: 81.9 years) and 77.1 years for men (OECD countries: 76.3)


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4. The average life expectancy for women aged 65 was 21 (OECD: 20,2) years in 2007, and 17.3 (OECD: 16,9) years for men. Concerning the neighbouring countries, only France do better than Belgium.

5. Based on simulations, the average life expectancy at 65 years in OECD countries is expected to be 21.6 years for women and 18.1 years for men by the year 2040.

6. Mortality: Little or no recent data are available for Belgium in the OECD report. Only the « infant mortality rate » is available. It dropped from 21.1/1000 living births (OECD: 28.7) in 1970 to 4/1000 (OECD: 3.9) in 2007. Our results are higher than the OECD average and worse than Germany (3.9), France (3.8) and Luxembourg (1.8) and better than those from the Netherlands (4.1) and the UK (4.8).


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7. The percentage of children with low birth weight in Belgium is 7.9 % in 2007 whereas the average across OECD countries is 6.8 % (OECD 2009).

8. Aids incidence in Belgium is 7.6 in 2006) (OECD: 16.2) new cases per one million inhabitants (OECD 2009). The Belgium results are worse than those from Germany but better than those in UK, the Netherlands, France and Luxembourg.

9. Health survey data (2008) show that 23% of the population is not satisfied with their health situation. There are also regional differences: Flanders = 21%; Brussels and Wallonia = 26%. This percentage increases to 48% for 75 +. In England, Denmark, Norway and Switzerland these percentages are 26%; 22%; 20% and 14% respectively.


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International comparison: the relation between the degree of confidence in health care system and health status


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International comparison: non-medical determinants of health1. Tobacco consumption plummeted in Belgium during the 1982 – 2007 period (Percentage daily smokers: from 40.5% to 22 % ; OECD: 36.4 to 23.6). Our results are better than those in Germany, France and the Netherlands but worse than those in Luxembourg and United Kingdom (OECD 2009).

2. However, alcohol consumption increased from 8.9 liter/inhabitant > 15 years old in 1960 to 10.7 in 2007 (OECD: 7.7 to 9.7). These results are higher than the OECD average (OECD 2009)

3. In 2007, 12.7 % of the Belgian population have a BMI > 30 (OECD = 15.4), and this percentage rose by 1,7 % over a period of 7 years. France and the the Netherlands obtained better results (10.5 and 11.2 respectively), but they experienced a faster increase in the past (OECD 2009). In 2008 have 14% of the Belgian population a BMI > 30 (health survey 2008).


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International comparison: health care resources and utilisation1. In 2007 we had an average of 4 active GPs per 1000

inhabitants (3.1). In the ranking we are only preceded by Greece (5.4).

2. This ratio of GPs rose from 1.6 in 1969 to 4 in 2007.

3. Our GP/specialist ratio is good (2.0/2.0) compared to the OECD average (0.9/1.8) and we occupy the first position in this ranking.


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International comparison: health care resources and utilisation4. We observe a similar trend in the number of nurses. In 2007 Belgium had 14.8 active nurses per 1000 inhabitants. That is more than the OECD average (9.6) and more than our neighbouring countries. We are in fourth place in this ranking.

5. The number of acute beds in our country decreased from 5.0/1000 inhabitants in 1995 to 4.3/1000 in 2007. We can observe a similar trend in the OECD countries (4.7/1000 in 1995; 3.8 in 2007). However, the number of beds is much lower in France, the Netherlands and the UK (3.6; 3.0; 2.6).


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International comparison: health care resources and utilisation

6. The Belgium’s average occupancy rate for acute care hospital beds is similar to the OECD average for 2007 (75 %). The UK and Germany have a higher occupancy rate than Belgium.

7. In 2002 Belgium had 1.2/1000 65+ chronic beds in hospitals. This is way below the average within OECD countries (5.7). This is a relatively good result. France, for instance, had 8.1 beds in 2003, the Netherlands 0 beds in 2003 and the UK had 0.4 beds in 2004.


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International comparison: health care resources and utilisation8. Belgium has 152 psychiatric beds/100.000 inhabitants (PHs and

General Hospital Psychiatric Wards). In the WHO-Euro region Belgium comes second, preceded only by Malta (185/100.000).

Italy 8/100.000 (min. number of beds in WHO Euro Region)Germany 75/100.000France 95.2/100.000Luxemburg 97/100.000Netherlands 114/100.000Belgium 152/100.000 Malta 185/100.000 (max. number of beds in WHO Euro

Region)


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International comparison: health care resources and utilisation9. The number of admissions per 100.000 inhabitants in PH and GHPWs in WHO Euro regio)Romania 1301 (max.)Germany 1240France 1020Belgium 900 (eighth place)Scotland 543Netherlands 523England and Wales 286Albania 87 (min.)


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International comparison: health care resources and utilisation

10. The length of stay (median) in Belgian psychiatric hospitals is 36 days and 18 days in GHPWs. There is no information available for this parameter for our neighbouring countries.

11. The number of psychiatrists per 100.000 inhabitants in Belgium is 20 in 2007.

Switzerland 42 (highest number)France 22Belgium 20Germany 19UK 18

Netherlands 15Turkey 3 (lowest number) (OECD 2009)


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International comparison: health care resources and utilisation12. Heavy medical equipment - 1:

In 2004 Belgium had 21.3 mammography devices per one million inhabitants (21.9). France has the highest number of mammography devices: 42.2 per one million inhabitants in 2002.

The number of units for radiotherapy in Belgium was 7.6 per 100.000 inhabitants in 2005, which is more than the average within OECD countries (6.4); and also more than any of our neighbouring countries.


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International comparison: health care resources and utilisation13. Heavy medical equipment - 2:

We had 7.5 MRI units per million inhabitants in 2007. That is below the average within OECD countries (11), but better than some of our neighbouring countries (NL, FR).

In 2007 we had 41.6 CT scanners, which is above the average within OECD countries (22,8) and more than our neighbouring countries. The number of MRI resp. CT exams per 1000 inhabitants was 48 resp. 168 in Belgium in 2007.


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International comparison: health care resources and utilisation14. The number of GP consultations per inhabitant increased from 7.1 in 1980 to 7.5 in 2005. This score is above average (6.8 in 2005) and higher than in any of our neighbouring countries. Our number of consultations per GP, however, is below average (BEL = 1.863 vs. OECD = 2.511).

15a. The number of acute care hospital beds per 1000 inhabitants decreased from 5.0 in 1995 to 4.3 in 2007 (OECD: from 4.7 to 3.8).

15b. The average duration of hospitalization decreased from 9.4 days in 1995 to 7.2 days in 2007. This downward trend can be observed in the other OECD countries as well (8.7 to 6.3).

15d. The number of hospital discharges was 174/1000 inhabitants in 2007 (OECD: 158/1000 inhabitants).


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International comparison: health care resources and utilisation17. We are among the countries performing most « coronoray revascularisation procedures (bypass enden angioplasy) ». Only Germany performs more. It is mainly the number of « angioplasties » that increases.

18. The number of patients undergoing kidney dialysis in Belgium is below the average within OECD countries (2007: Bel = 63 vs OECD = 65/100000 patients)

19. The number of caesarean sections in Belgium is below average (BEL = 17.8 versus 25.7).


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International comparison: health care resources and utilisation20. Belgium performs the most cataract surgery operations than any of its neighbouring countries (Belgium: 1722/100.000; France 943/100.000; the Netherlands 807/100.000; UK 623/100.000).

21. Belgium consumes more antidepressants, antibiotics and anticholesterol products than the average within OECD countries. We are number one in antidepressant and anticholesterol consumption, compared to our neighbouring countries. Only France and Luxemburg use more antibiotics than we do. The Netherlands have the best record for antibiotics use, closely followed by Germany and the UK. As for the other products, only our consumption of antidiabetic products is below the average within OECD countries.


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Health care resources and utilisation: Antibiotic use in Belgium

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Health care resources and utilisation: Antibiotic use in Belgium

93,9 88,9 89,5 91,286,2

92,1

121,2122,6

139,1145,6

152,9

168,9

9,69,310,811,511,913,10

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2000 2001 2002 2003 2004 2005

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Health care resources and utilisation: Antidepressants use in Belgium

020406080

100120140160180200

2000 2001 2002 2003 2004 2005

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Health care resources and utilisation: Anti-depressants use in Belgium

203,7199,3183,9

171,9157,5

145

6,67,16,86,46,95,5

145,5157,4

148,8143,6131,4

121,3

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Access to health care - geographical

Hospitals GPs

Belgium 66,0% 89,0%

Eur 25 50,0% 81,8%

(% Access within twenty minutes) Eurofound, 2005


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Access to health care: international comparisonAccording to the health consumer powerhouse, our results for waiting times are good. We obtained a score of 217/250 for this part of the Euro Canada Health Consumer Index 2009. The UK performs much worse (117/250), as do the Netherlands and France (167/250).

The report by Wang (2007) shows that 61% of Belgian adults with serious addiction problems or anxiety or mood disorders receive treatment. This is more than in the Netherlands (50%); France (48%) and Germany (40%). As far as follow-up care is concerned, the Netherlands perform best, with at least one follow-up consultation in 97% of the cases. Belgium has the worst record (84%) (France = 88%; Germany = 89%).


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International comparison: health expenditure and financing1. In 2007 our score for the health expenditure/inhabitant

ratio was higher than the OECD average (3.595 vs 2.984). France, Luxembourg and the Netherlands perform better.

2. Our yearly increase in health expenditure/inhabitant (1997-2007) is lower than the OECD average (3.6 versus 4.1), but the ratio increases faster than in most of our neighbouring countries (France, Germany, the Netherlands).


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International comparison: health expenditure and financing3. Together with France and Germany we are among the top seven of OECD countries who spend more than 10% of their GDP on health care.


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International comparison: relationship between health status and expenditure (% GDP)


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Quality of care

1. Breast cancer screening (mammography). Our score is above the average within OECD countries, but rather low compared with our neighbouring countries (Belgium 59% vs OECD = 62.2%; the Netherlands = 89%; UK = 70.7%)

Cervical cancer screening. Here as well our score is above the average within OECD countries, but rather low compared with our neighbouring countries (Belgium = 65.3%; Average 64%; the Netherlands = 69.6%; UK = 79.4%; France = 72.4%)


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Quality of care: cancer survival

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Lymhoidleukaemia(Children)

Lung (M)

Rectum(M)

Colomn (M)

Prostate(M)

Lung (F)

Rectum (F) Colon (F)

Breast (F)

Cervixuteri (F)

Eurocare 3

Belgium


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Quality of care: adverse outcomes

In Belgium the % adverse outcomes for surgery is 6.32% and 7.12% for other surgical acts. Compared with other countries, our score is average. Adverse outcomes in other countries vary from 3.7% to 16.6% (Vandenheede et al., 2006).


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Quality of care

3. Vaccination programmes: Influenza vaccination for people > 65: (Belgium 65%; OECD = 55,9%; Germany = 56%; UK =73,5% and the Netherlands = 77%)

Our measles vaccination programmes for children score are similar to the average within OECD countries (92%), but for « pertussis » our score is above average (98,5%)

4. Belgium scores 157/300 points for subdiscipline « outcome » of the Euro Canada Health Consumer Index. (France, Luxemburg and Germany score = 229/300; the Netherlands 257/300; and the UK 186/300).


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Quality of care: decrease of MRSA infections since 2004


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Quality of care

5. In Belgium only 43% of patients seeking help for their addiction problem, anxiety or mood disorders are satisfied with the treatment they get. That is much less than in our neighbouring countries (the Netherlands: 67%; Germany 67%; France 58%).

Wang, P.S. et al. (2007). Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys, Lancet, 370, 841-850.


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Conclusions

Life expectancy in three of the five neighbouring countries is higher than in Belgium. Our country also has a high number of low birth weight infants.

We have obtained considerable results in tobacco control. However, efforts need to be made in the field of alcohol abuse and nutrition (BMI), as well as with respect to suicide prevention.

As far as the number of hospital beds is concerned, we may be faced with overcapacity. Even though we have reduced the number of beds, we still have a high number of beds compared to other countries, especially psychiatric beds. A second indicator that may indicate overcapacity is the relatively low occupancy rate compared to our neighbouring countries.


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Conclusions

As far as heavy equipment is concerned, we are well-equipped.

As far as manpower (doctors and nurses) is concerned, our score is very good. Especially with regard to the number of doctors, we are one of the countries with the highest scores.

Compared to other countries, the accessibility of our health system does very well, as far as both geographical accessibility and waiting times are concerned.


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Conclusions

We spend a relatively high amount of money on health care and are among the top six OECD countries.

On the other hand we can see that, compared to our neighbouring countries, our system is becoming less accessible financially. In 2007 the out of pocket expenditure for exemple was 3.6% of the final household consumption.

There are insufficient outcome results available, which may be the reason why our results are less good internationally.

introduction to the belgian healthcare system

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