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12 Economic crisis, health systems and health in Europe: country experience
While the budget surplus equalled €148 million in 2005, it amounted to
€1.8 billion in 2011. Since 2007, part of the budget surplus has been pooled
in a fund called the Fund for the Future (Dutch, Toekomstfonds; French,
Fonds pour le futur) to build up a reserve for future costs caused by the ageing
population. However, because of the economic crisis, no money has been put
into the fund in recent years. The fund could only be used at the earliest from
2012 onwards, but until now no funds have been used, mainly because of
the yearly budget surpluses. Since 2010, the largest part of the health budget
surplus has been transferred to other social security sectors with a deficit.
Once the total budget is determined, sub-budgets for categories of spending such
as physicians, pharmaceuticals and hospitals are fixed. The sub-budgets for about
50 spending categories are the result of policy priorities and close consultation
between stakeholders. Aggregated spending categories, in line with the yearly
reports of the RIZIV, highlight that in 2011 budgets for pharmaceuticals and
physicians were cut more than budgets for other health care sectors.
Statutory health insurance revenue
No major changes have been introduced since the beginning of the economic
crisis in the way health insurance revenue is generated.
Fiscal policy
In Belgium, there are no tax subsidies for OOP payments or PHI premiums.
In recent years, excise duties on tobacco and alcohol, which are earmarked for
social security in general and health care in particular (tobacco), have been
raised. For example, the excise duties on tobacco (July 2013) and on alcohol
(August 2013) were increased by 8%. The expected revenue was €50 million in
2013 and €100 million in 2014.
Priority given to the health sector
Since the beginning of the 1990s, the share of federal spending on health care
has steadily increased, to reach more than 36% of total social security spending
in 2010. The share slightly decreased in 2009 and 2010 (Fig. 1.1).
In effect, the health budget's growth cap is the most important countercyclical
measure that has been used to guarantee the flow of funds to the health sector
during the period of economic crisis in that until 2012 it provided a legal
guarantee that the budget for the compulsory health insurance system could
increase by 4.5% in real terms annually. Moreover, given the exceptional
situation in which there was a caretaker government in place for 541 days, this
protected the health insurance system from austerity measures until the end of
2011 when the health care budget for 2012 was decided.