Pay for Quality

KCE Reports 118 Pay for Quality 109
7 P4Q IN BELGIUM
7.1 DESCRIPTION OF (PAY FOR) i QUALITY INITIATIVES IN
BELGIUM
7.1.1 Introduction
Chapter 7 transfers knowledge from previous chapters towards the context of Belgian
healthcare. The overall study objective is to assess the feasibility, advantages and
disadvantages of P4Q implementation in Belgium.
Previous chapters already extensively clarified that health system, payer, provider and
patient characteristics are of a significant influence on how P4Q might or might not
reinforce quality of care within a specific context. In addition, the design of components
of the central quality circle, which is the core of any P4Q initiative, also depends on
what is already in place in Belgium in terms of quality support.
Based on reports such as provided by the European Observatory on Health Systems
and Policies (2007) 240 , the health system, payer, provider and patient characteristics in
Belgium can be described as followed:
Healthcare jurisdictions in Belgium, as a federal state, are divided over a national and
regional j level. The federal government is responsible for the regulating and financing of
the compulsory health insurance, determining accreditation criteria, financing hospitals,
legislation covering professional qualifications, registration of pharmaceuticals and their
price control. The three regional governments are responsible for health promotion
(prevention), maternity and child health services, different aspects of elderly care, the
implementation of hospital accreditation standards, and the financing of hospital
investment. In terms of jurisdiction especially the tools supporting cost containment are
managed at the federal level.
The Belgian health system is primarily funded through social security contributions and
taxation. Public sector funding as a percentage of total expenditure fluctuates around
70%.
The six non-profit non commercial Belgian sickness funds, acting as care purchasers,
receive a prospective budget from the National Institute for Sickness and Disability
Insurance to finance the healthcare costs of their members.
The dominant payment system of medical providers is Fee For Service, although the
amount of fixed payments is increasing (e.g. for the use of medical imaging, clinical
biology and certain drugs as part of hospital care). Capitation is only used to reimburse
a few primary health care centres. Specialists and the majority of GPs are paid on a FFS
basis. Hospital accommodation services, nursing activities and emergency services are
financed via a fixed prospective budget system based on diagnosis related groups.
GPs and specialists work mostly as private self employed independent contractors, with
the exception of some GPs in primary health care centres and specialists in university
hospitals who are salaried (