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

18 Economic crisis, health systems and health in Europe: country experience
of the vulnerable population was extended to other groups; the principle of
full reimbursement was replaced by increased reimbursement of medical costs
(preferential reimbursement) compared with the general population, and
eligibility for preferential reimbursement became means-tested. Some people
are entitled on the basis of a granted social benefit without conditions based
on income; such as people entitled to social integration revenue or social aid
from the Public Welfare Centre. Others are entitled on the basis of status as
long as their gross annual taxable income does not exceed a certain limit; these
include widows/widowers, orphans, pensioners, persons with disabilities or
those who have been unemployed for at least one year. Since 1 July 2010, the
group of people entitled to preferential reimbursement was extended to include
members of single-parent families and the age limit (over 50 years) for the longterm
unemployed was abolished. Since 1 July 2011, people entitled to a fund
for domestic oil from the Public Welfare Centre are also entitled to preferential
reimbursement of medical expenses.
Omnio-status
Already in 1994, the General Report on Poverty (King Baudouin Foundation,
1995) recommended that preferential reimbursement should be given to
individuals based on their income and not on social status. However, because of
budget restrictions, it was not until July 2007 that the government responded
to this report by generalizing eligibility for preferential reimbursement solely
based on income by creating the Omnio-status. All patients with a household
income below a certain threshold are entitled to Omnio-status and hence to
increased reimbursement of health care costs. While take-up of this status was
low in the beginning, at the end of 2012 almost 280 000 individuals were
registered. On 1 January 2014, eligibility criteria for Omnio-status and for the
increased reimbursement based on social status were synchronized.
Extension of the (social) third-party payment system
In general, a direct payment system applies to ambulatory care and the thirdparty
payment system applies to inpatient care and pharmaceuticals. To improve
access to health care, the (social) third-party payment system was extended to
ambulatory care on 1 July 2011 for some vulnerable population groups, such
as people in an occasionally precarious financial situation and people entitled to
preferential reimbursement or Omnio-status. Although this measure does not
change the amount of co-payments that must be paid, it increases accessibility
at the point of use.
Maximum billing system
The maximum billing system puts a ceiling on the total amount of co-payments
(excluding supplements and also some co-payments) to be paid during a