Web-economic-crisis-health-systems-and-health-web

16 Economic crisis, health systems and health in Europe: country experience
GP services
Before December 2011, cost-sharing arrangements for GP office consultations
had a complicated structure. They depended on having a global medical record,
on eligibility for increased reimbursement of health care costs, on regular or
out-of-hours consultations and on GP qualifications. Since 1 December 2011,
all co-payments and co-insurance rates for GP consultations were replaced
by four co-payments, where the amount of the co-payment depends on the
eligibility for increased reimbursement and on having a global medical file. 8
Also since December 2011, extra fees for out-of-hours consultations are fully
reimbursed by the RIZIV. Although the new cost-sharing structure for GP
consultations was mainly motivated by reasons of administrative simplification
and not to increase financial accessibility to health care, the measure has
facilitated the expansion of the system of social third-party payments (see
Protection mechanisms, below) (Farfan-Portet et al., 2012).
Medical specialist services
Since 1 November 2010, co-insurance rates for specialist care (40%) are subject
to a ceiling of €15.50 for individuals not eligible for increased reimbursement.
Patients eligible for increased reimbursement have much lower co-payment levels.
Dental care
Since September 2005, co-payments have been waived for dental care services
for children under 12 years of age. In July 2008, this measure was extended to
children up to 15 years of age, and in May 2009 to children up to 18 years. In
addition, the age limit for those eligible to have their annual preventive dental
check-up reimbursed was raised to 63 years of age in 2012. The co-payment
waivers (since 2008) and the expanded check-up coverage have increased public
expenditure for dental services for these user groups (RIZIV, 2013d).
Pharmaceuticals
Before April 2010, co-insurance rates for drugs dispensed by community
pharmacies were determined by the drug category: 0% for drugs in category
A, 25% in category B, 50% in category C, 60% in category Cs and 80% in
category Cx. For patients entitled to increased reimbursement of medical
costs, the co-insurance rate for drugs in category B equalled 15%. In addition,
patient cost-sharing was capped for drugs in categories B and C to avoid large
amounts being paid as OOP payments. Due to the new remuneration system
for pharmacists, introduced in April 2010 (see section 3.3 on provider payment
reforms), the way the level of cost-sharing was calculated for outpatient drugs
8 The global medical file was introduced to increase the availability of medical, social and administrative patient
information and access to such information (Gerkens & Merkur, 2010). The ultimate aim of the measure was to
optimize primary care quality. The GP holds the file with the patient’s consent and shares relevant information with
other providers.