the belgian health care context
DESCRIPTION
The Belgian health care context. Belgium was evaluated the sixth best country in the world, according the the UNDP-list Health insurance is compulsory for Belgian citizens (implies a SIS-card) Health care is not free but the health insurance covers a large part - PowerPoint PPT PresentationTRANSCRIPT
1
The Belgian health care context
• Belgium was evaluated the sixth best country in the world, according the the UNDP-list
• Health insurance is compulsory for Belgian citizens (implies a SIS-card)
• Health care is not free but the health insurance covers a large part
• Belgians living in poverty can apply for a ‘third-party-payment’
• Hospital bills since recently have a ‘ceiling-arrangement’
2
Right to health care for asylum seekers
• When an asylum seeker arrives in the country an asylum centre is appointed to him/her. The person can stay there but can also decide to live somewhere else.
• The asylum centre is responsible to pay for any medical costs, whether the person in inside or outside the centre
• Psychological support: depends on the asylum centre and the doctor inside the centre
3
Right to health care for illegal immigrants
• Belgian law of 1996 gives illegal immigrants the right to health care.
• The law is called ‘Aide Médicale Urgente’• Not only urgent but most aspects of
health care are included • Health care is for free for illegal
immigrants• Health care suppliers can get payment
from the local Public Centre for Social Assistance (CPAS)
4
Cases of concern
• Difficult administration: different procedures for each CPAS
• Lack of communication between CPAS, health care suppliers and patients
• Delays in payment by the federal government and by the CPAS
• No continuity of care – saturation of facilities
• Mental health is neglected
5
Testimonial
Mohammed, 34 years, Moroccan • Eye problems in Morocco, looking
for treatment in Belgium• Diagnosed with diabetes in
Belgium, after arrival in 2001• Delays in treatment, complications• Now regularised situation,
handicapped for life
6
Access to health careby MSF
General objective:• To assure a systematic and structural
access to health care for the excluded in the cities of Antwerp, Brussels and Liège – medical, social and psychological
7
Access to health careby MSF
Specific objective:• To assure before the end of 2005 the
acceptation of an operational model by the local authorities, which would allow a medical, social and psychological access to health care for asylum seekers and illegal immigrants in the cities of Antwerp, Brussels and Liège.
• For non-medical problems refer the patients to the most adequate structures.
8
The work of MSF
Result 1: integrating patients into the existing health care structures by
• Offering social, medical and psychological consultations for people with a difficult access to health care
• Referring to adapted services• Specific identification and reference to
the services concerning mental health care
9
The work of MSF
Result 2: making the intervention of MSF unnecessary by
• Lobbying so that services and procedures are functioning efficiently– Simplification of procedures (federal,
regional, local) – Promotion of an access to health care model, – More knowledge between GP’s about the
specific procedures (AMU)– More visibility for the project
10
Number of patients 2003
• 9947 consultations for 4407 patients in 2003, from which– 4884 in Brussels– 2967 in Antwerp– 2096 in Liège
11
Status of the patients2003
Statuut Brussel Antwerpen Luik TOTAAL
Clandestien 1299 419 144 1862
Illegaal 394 246 182 822
Asielzoeker 132 67 33 232
Art 9 § 3 396 231 167 794
Visum 110 20 40 170
Verblijf < 3 maanden 0 42 0 42
Legaal 77 62 51 190
Andere 34 12 28 74
Onbekend 9 24 8 32
TOTAAL 2451 1123 653 4218
12
Nationality of the patients 2003
Nationaliteit Brussel Antwerpen Luik TOTAAL %
Belg 60 52 68 180 4
EU 28 16 20 64 1
Afrika 559 230 213 1002 23
Maghreb 575 144 192 911 21
Europa niet-EU 724 341 149 1214 28
Azië 96 104 59 259 6
Latijns-Amerika 459 241 6 706 16
Noord-Amerika 0 1 6 7 0,15
Onbekend / Andere 10 46 8 54 1
TOTAAL 2511 1175 721 4397
13
Lobbying strategy
Focus on all levels involved:Collaboration with local and regional NGO’s and
institutions• Federal: Ministry of Social Integration
• Regional: Flemish, Brussels and Walloon Unions of Cities – section CPAS
• Local: CPAS, city
• Health care suppliers: GP’s
• Political: inform party or opposition members
• Media attention• (International)
14
Solutions could be simple
• Ensure a number of principles in the procedures applied by the CPAS such as a ‘medical card’
• Promotion of good practices• Promotion of follow-up by GP• Recognize importance of mental health
care• Faster payment• Information