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20 Economic crisis, health systems and health in Europe: country experience
for medical specialists who have not signed the agreement to charge supplements
for day-stay care. However, the National Committee of Representatives of
Physicians and Sickness Funds recommends that medical specialists do not
charge supplements to patients with preferential reimbursement, chronically ill
patients and for day-stay care in oncology.
3.3 Changes to health service planning, purchasing and delivery
There also have been efforts to protect access to the health care system by
policies intended to control volume or prices. Such policies mainly have been
implemented in the pharmaceutical sector: 42% of all savings in 2012–2013
were realized in this sector (Gillis, 2014).
Policies affecting health system input prices
Pharmaceuticals
A wide variety of measures have been taken to reduce input prices, particularly
of pharmaceuticals (Table 1.4). Although these measures were part of ongoing
reforms, they have been intensified in recent years. They have contributed
to decreases in public pharmaceutical spending as a proportion of total
health spending.
Table 1.4 Pharmaceutical prescribing, pricing and reimbursement policies in Belgium
Policy
Measure a
Generic policy changes
Reference price level
Percentage reduction in the ex-factory price of the original drug of
31% (gradual increase since 2001)
Additional reductions for drugs in reimbursement category A (no
co-payment) (2012)
Generic substitution For acute treatments with an antibiotic or antifungal (May 2012)
Minimum prescription
of low-cost drugs
INN prescription
Price cuts
Linear price cuts
International price
comparison
Taxes
Increase of quota (2011)
Obligation to dispense a drug among the group of cheapest drugs
for every INN prescription (April 2012)
Reduction of reimbursement basis for old drugs since 2010; price
cut of 1.95% in April 2012 and April 2013
Reduction of prices in line with evolution of ex-factory prices in six
EU countries
Turnover taxes of maximum e100 million if there is budget overrun
(2008); crisis tax of 1% since 2010 and 0.13% since 2013
Notes: INN: international non-proprietary name; a The list of measures is not exhaustive.