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Country profiles of health system responses to the crisis | Belgium 341 % Belgium: Fig. 1 Economic and fiscal indicators 2000–2007 and 2008–2011 60 55 50 45 40 35 30 25 20 15 10 5 0 −5 −10 −15 −20 −25 −30 _ _ _ _ ● ● _ _ _ _ _ _ _ _ ● _ ● ● _ _ Real GDP per capita growth _ _ ● ● _ _ _ _ _ _ _ ● ● ● _ _ _ Deficit/surplus (% GDP) _ _ _ _ _ _ _ _ _ _ ● ● _ _ _ ● _ ● _ ● _ _ _ _ _ Government spending (% GDP) _ _ _ _ _ ● ● ● ● ● _ _ _ _ _ Government health spending (% total government spending) _ _ _ _ _ _ _ ● _ ● ● ● ● _ _ _ 10−year bond rates _ _ _ _ _ _ _ _ _ ● ● ● ● ● _ _ _ _ _ Unemployment rate Notes: Deficit/surplus: Eurostat; 10-year bond rates: European Central Bank; Other indicators: WHO Health for All. Year 2000−2007 2008 2009 2010 2011 Belgium: Fig. 2 Trends in per capita spending on health, 2000–2011 3000 Public spending per capita OOP spending per capita Non−OOP private spending per capita Per capita spending $, PPP 2000 1000 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 40 Growth % 20 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Public spending per capita growth OOP spending per capita growth Note: Spending calculated from WHO Health for All. Non−OOP private spending per capita growth

342 Economic crisis, health systems and health in Europe: country experience July 2008 this measure was extended to children up to 15 years of age and in May 2009 to up to 18 years of age. In addition, the age limit for those eligible to have their annual preventive dental check-up reimbursed was raised from 60 to 63 years of age in 2012. • Benefits package for the self-employed and their dependants extended to include so-called small health risks (e.g. ambulatory care, pharmaceuticals for outpatient care, home care, dental care) in 2008, removing the distinction in coverage between the self-employed and the rest of the population (decision taken before the start of the crisis). The benefits package • Introduction of reimbursement of travel costs for chronically ill children under 18 years of age treated in rehabilitation centres and cash benefits for incontinence materials for people with untreatable incontinence (2011). • Extended entitlement to benefits in kind to ambulatory care for some vulnerable population groups (benefits paid by the sickness funds: social thirdparty payment system) (2011). • HTA-determined reduction in the number of conditions eligible for reimbursed oxygen therapy (2012). User charges • Cap on payment above the reference price per prescription drug introduced (2010). • User charges for GP office consultations simplified to four levels to increase transparency (2011). The amount of the co-payment depends, since December 2011, on the eligibility for an increased reimbursement of medical costs and on having a global medical file. Also, supplementary fees for out-of-hours consultations are fully reimbursed by the SHI. • Cost-sharing for services included in the DMPs eliminated for patients with type 2 diabetes or chronic renal failure (2009). • Cap on OOP payments (maximum billing system) extended to include prescription drugs in psychiatric hospitals (2009) and travel costs for children treated in rehabilitation centres (2011). • Increased reimbursement extended to people on a low income receiving fuel benefits and to indebted people (2011). • Additional charges for hospital rooms with more than one bed (2010) prohibited; also prohibited additional fees charged in hospital rooms with more than one bed, except for day care provided by physicians who did not sign the agreement with the sickness funds (2013).

Country profiles of <strong>health</strong> system responses to the <strong>crisis</strong> | Belgium<br />

341<br />

%<br />

Belgium: Fig. 1 Economic <strong>and</strong> fiscal indicators 2000–2007 <strong>and</strong> 2008–2011<br />

60<br />

55<br />

50<br />

45<br />

40<br />

35<br />

30<br />

25<br />

20<br />

15<br />

10<br />

5<br />

0<br />

−5<br />

−10<br />

−15<br />

−20<br />

−25<br />

−30<br />

_ _<br />

_ _<br />

● ●<br />

_ _<br />

_ _<br />

_ _ _<br />

_<br />

●<br />

_<br />

●<br />

●<br />

_ _<br />

Real GDP<br />

per capita growth<br />

_ _<br />

● ●<br />

_<br />

_ _ _ _<br />

_ _<br />

●<br />

● ●<br />

_ _ _<br />

Deficit/surplus<br />

(% GDP)<br />

_ _ _ _ _ _ _ _<br />

_ _<br />

●<br />

●<br />

_ _<br />

_<br />

● _ ●<br />

_<br />

●<br />

_ _ _ _ _<br />

Government<br />

spending<br />

(% GDP)<br />

_ _ _ _ _<br />

● ● ● ● ●<br />

_ _ _ _ _<br />

Government<br />

<strong>health</strong> spending<br />

(% total government<br />

spending)<br />

_ _ _ _ _<br />

_ _ ● _ ●<br />

●<br />

●<br />

●<br />

_ _ _<br />

10−year<br />

bond rates<br />

_ _ _ _<br />

_ _<br />

_ _<br />

_<br />

●<br />

●<br />

●<br />

●<br />

●<br />

_ _ _ _ _<br />

Unemployment<br />

rate<br />

Notes: Deficit/surplus: Eurostat; 10-year bond rates: European Central Bank; Other indicators:<br />

WHO Health for All.<br />

Year<br />

2000−2007 2008 2009 2010 2011<br />

Belgium: Fig. 2 Trends in per capita spending on <strong>health</strong>, 2000–2011<br />

3000<br />

Public spending per capita OOP spending per capita Non−OOP private spending per capita<br />

Per capita spending $, PPP<br />

2000<br />

1000<br />

0<br />

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011<br />

40<br />

Growth %<br />

20<br />

0<br />

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011<br />

Public spending<br />

per capita growth<br />

OOP spending<br />

per capita growth<br />

Note: Spending calculated from WHO Health for All.<br />

Non−OOP private spending<br />

per capita growth

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