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Country profiles of health system responses to the crisis | Belarus 339 of the country and telemedicine and tele-consultation have still seen considerable investment (2011). • Allocation of budgetary funds to specific projects decided according to economic evaluation. • The pilot project (see above) aimed for allocation of about 40% of the total health care funding to outpatient institutions (including emergency medical care); expansion of rights and independence of managers and heads of health care institutions in cost-management and use of resources; restructuring of hospital bed numbers initiated, taking into consideration population needs and morbidity (2013). Priority setting or protocols to change access to treatments, coordination of care and patterns of use • Decreased proportion of inpatient services and redirection of resources to day care and outpatient care (expenditure allocated to outpatient institutions as a percentage of total health expenditure increased from 31.4% in 2008 to 35.0% in 2009, 38% in 2010 and 40% in 2011). • Elimination of laboratory testing duplication at different levels of the system (2010–2012). Waiting times • No response reported. Health promotion and prevention • Annual increases in the price of alcohol and tobacco (since 2010). • Increase in the price of tobacco by 62% and in the price of alcohol by 28.4% (2012).
Belgium Irina Cleemput and Carine Van de Voorde Economic trends • The Belgian economy contracted in 2009 and the government has run larger deficits since that time. Overall, the economy has been recovering, with below average unemployment rates and real per capita GDP growth returning to pre-crisis levels. Government spending as a share of GDP has remained high relative to other European countries, which led to higher deficits beginning in 2009. • Health as a share of government spending has been stable above the European average. Public per capita health care spending grew more slowly in 2010 but continued to show positive growth. OOP expenditure per capita decreased by 1.6% in 2009 (however, this may reflect, in part, the inclusion, in 2008, of the coverage of minor health risks for the self-employed into the compulsory health insurance scheme) (Belgium: Figs 1 and 2). Policy responses Changes to public funding for the health system • Because of the economic crisis, the compulsory health insurance system did not transfer revenue to its reserve Fund for the Future (set up to compensate SHI for population ageing) in 2011 or 2012. • The usual compulsory health insurance budget cap (the “growth norm” of 4.5% in real terms plus inflation) was not applied in 2012. The budget was set at a lower rate of €25.6 billion (€0.2 billion less than in 2011). • The budget cap was reduced to 2% in 2013 (from 4.5%) and 3% for 2014. • The share of VAT and tobacco tax revenues earmarked for social security was increased to limit government subsidies and reduce employer contributions and labour costs (a gradual increase since 2008). Changes to health coverage Population (entitlement) • Co-payments for dental care services (but excluding orthodontic treatment) waived from September 2005 onwards for children under 12 years of age. In
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- Page 356 and 357: Albania Genc Burazeri and Enver Ros
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Country profiles of <strong>health</strong> system responses to the <strong>crisis</strong> | Belarus<br />
339<br />
of the country <strong>and</strong> telemedicine <strong>and</strong> tele-consultation have still seen<br />
considerable investment (2011).<br />
• Allocation of budgetary funds to specific projects decided according to<br />
<strong>economic</strong> evaluation.<br />
• The pilot project (see above) aimed for allocation of about 40% of the total<br />
<strong>health</strong> care funding to outpatient institutions (including emergency medical<br />
care); expansion of rights <strong>and</strong> independence of managers <strong>and</strong> heads of <strong>health</strong><br />
care institutions in cost-management <strong>and</strong> use of resources; restructuring of<br />
hospital bed numbers initiated, taking into consideration population needs<br />
<strong>and</strong> morbidity (2013).<br />
Priority setting or protocols to change access to treatments, coordination<br />
of care <strong>and</strong> patterns of use<br />
• Decreased proportion of inpatient services <strong>and</strong> redirection of resources<br />
to day care <strong>and</strong> outpatient care (expenditure allocated to outpatient<br />
institutions as a percentage of total <strong>health</strong> expenditure increased from<br />
31.4% in 2008 to 35.0% in 2009, 38% in 2010 <strong>and</strong> 40% in 2011).<br />
• Elimination of laboratory testing duplication at different levels of the<br />
system (2010–2012).<br />
Waiting times<br />
• No response reported.<br />
Health promotion <strong>and</strong> prevention<br />
• Annual increases in the price of alcohol <strong>and</strong> tobacco (since 2010).<br />
• Increase in the price of tobacco by 62% <strong>and</strong> in the price of alcohol by 28.4%<br />
(2012).