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