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14 Economic crisis, health systems and health in Europe: country experience
Breakdown of spending by sector in 2007 and 2011
The evolution of total RIZIV expenditure by health sector is presented in
Fig. 1.3. The data demonstrate the limited impact of the crisis on the subsectors
of health care. Expenditure on curative, rehabilitative and long-term nursing
care increased in relative terms compared with expenditure for pharmaceuticals
and ancillary services to health care. The impact was largest for pharmaceutical
expenditure because of the measures taken in this sector (see section 3.3).
3.2 Changes to coverage
Population entitlement
Since 1 January 2008, the entire population (almost) has been covered for
the same health services. Before that date, the benefits package for most selfemployed
people and their dependants did not include the so-called small health
risks. However, the decision to remove the distinction in coverage between the
self-employed and the rest of the population had already been taken before the
start of the crisis.
The benefits package
Insurance coverage is uniform for all insured people, who are entitled to the same
benefits package in the compulsory health insurance system, with some exceptions.
For example, since July 2007, active bandages and (some) painkillers are (partly)
reimbursed for chronically ill patients but not for the general population; in
addition chronically ill children under 18 who are treated in rehabilitation centres
receive compensation for travel costs (since May 2011). Since the outbreak of
the crisis, no measures have been taken to exclude or reduce health services
covered by compulsory health insurance. An exception is the health technology
assessment (HTA)-determined reduction in the number of conditions eligible for
reimbursed oxygen therapy (2012).
User charges
Belgium has a complex structure of patient cost-sharing. Two cost-sharing
arrangements coexist: for some services, patients pay a percentage of the price
or fee (co-insurance), for example, 25% of the drug price; for others, they pay
a fixed amount (co-payment), for example €6 for a general practitioner (GP)
consultation. In the period 2008–2013, a number of measures related to patient
cost-sharing were introduced. As can be seen from the measures listed in the next
sections, there has been an emphasis on trying to minimize financial barriers to
accessing health care and to protect vulnerable groups. Although most of these
measures were not necessarily a direct response to the crisis and were already being
considered before the crisis, they highlight the primary goal of policy-makers.