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

22 Economic crisis, health systems and health in Europe: country experience
Reductions in health sector salaries and changes
to working conditions
In 2012, in response to the crisis, the government decided to reduce the
amount paid to physicians through fee for service (FFS) by €60 million, to save
€122 million on the indexation of these fees and to reduce RIZIV reimbursement
to orthopaedists and some types of pharmacist by €8.5 million. As part of these
measures, indexation of fees for GPs and medical specialists was reduced to
1.5% (from 2.99%). In 2013, physicians unions and the government agreed
to make a saving of €105 million by limiting and reallocating the funding
available for indexation on a variety of health personnel and services (clinical
biologists, medical imaging, surgery, gynaecology services, and GP and specialist
consultations). In contrast to these reductions, in 2013 a social agreement was
established for the non-profit-making sector (see also section 1.3) in which a
budget of €40 million was put aside for financing the cost of 800 additional
full-time equivalent positions in the health care sector.
Pharmaceutical sector reforms
Policies to make drug prescribing, use and pricing more rational were
introduced. Table 1.4 summarizes the main policies affecting the prescribing,
pricing and reimbursement of pharmaceuticals in Belgium. The possibility
of generic substitution was introduced by law in 1993, but the royal decree
required to put the law into practice was not adopted until 2012. Since
May 2012, pharmacists have been required to treat a prescription for acute
treatments with an antibiotic or an antifungal as a prescription by international
nonproprietary name (INN), even if a specific brand is mentioned. However, a
physician can specify that a brand name drug be dispensed in cases of allergy or
intolerance or for therapeutic reasons. Moreover, since April 2012, community
pharmacists have been required to dispense a drug among the group of cheapest
drugs for every INN prescription. The group of cheapest drugs are those with
the same molecule, administration form and dosage and for which the public
price is within a range of 5% above the cheapest (European Observatory on
Health Systems and Policies, 2014). Since 2005, physicians have been allowed
to prescribe drugs by INN. Although this is not obligatory, physicians are
encouraged to do so by a quota system introduced in 2005 whereby GPs and
other medical specialists are required to prescribe a minimum percentage of
low-cost drugs, including drugs prescribed by INN. The minimum percentage
differs per medical specialty. Since January 2011, the percentage for GPs has
been increased from 27 to 50%.