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Chapter 1 | The impact of the crisis on the health system and health in Belgium
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calendar year. The maximum share of co-payments as a proportion of total net
taxable household income varies between 2.4% and 3.9%, except for the very
poor (with a net taxable income below €11 500), where it can be larger than
3.9%, and the very rich, where it can be smaller than 2.4%. The system has been
expanded gradually since its introduction in 2002. For example, for chronically
ill patients, some non-reimbursed painkillers were included in the calculation
of the maximum billing ceiling. Since January 2009, the co-payment threshold
has been reduced by €100 for individuals who have exceeded the limit of €450
of co-payments for two consecutive years. These individuals are considered to
be chronically ill.
New status for patients with a chronic illness
In September 2013, the status of "chronic illness" was adopted by the
government. The status will be automatically assigned by the sickness funds to
patients with at least €300 of health care expenses (not only OOP) for eight
consecutive trimesters or who are entitled to the lump sum payment for the
chronically ill (Dutch, zorgforfait; French, forfait de soins). 9 Patients suffering
from a rare or orphan disease are also entitled to the new status. Patients
with the status of having a chronic illness are automatically eligible for the
lower maximum billing ceiling (as of 1 January 2013) and for third-party
arrangements (as of 1 January 2015).
Supplements
While the system of maximum billing offers protection against the
accumulation of co-payments to be paid, it does not include supplements (i.e.
extra-billing above the officially agreed tariff). Supplements in the hospital
sector are regulated and registered, but information on supplements charged
in an ambulatory setting by doctors who have not signed the fee agreement is
currently not available. However, a new law on transparency is in preparation
that will require physicians and dentists to mention the exact amount (including
supplements) that has been paid by a patient on the medical attestation to be
submitted to the sickness fund.
Hospitals and medical specialists can charge supplements on their fees, on the
price of the room and on implants and medical devices. In the last few years,
particularly since the onset of the crisis, the reimbursement level for implants
and medical devices has increased. In addition, the fee and room supplements
have increasingly been regulated, which is based on the room type. In 2010,
supplementary charges for two-person hospital rooms were abolished. Since
1 January 2013, patients in rooms with two or more people are almost fully
protected against fee and room supplements. The only exception is the possibility
9 Patients are entitled to this lump sum payment if the sum of their co-payments has exceeded a threshold in each of the
two previous years and they can prove that they have lost their ability to live independently to a major extent.