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Chapter 1 | The impact of the crisis on the health system and health in Belgium
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In 2001, a closed budget for pharmaceuticals was introduced. Between
2001 and 2005, a clawback system 11 and other contributions were in place
forcing pharmaceutical companies to contribute to the financing of public
pharmaceutical spending. In 2006, a single system of contributions (called
provisional funds) was installed, which was based on taxes on the turnover
of reimbursed pharmaceuticals (9.73% in 2006, 8.73% in 2007, 7.73% in
2008 and 2009, and 6.73% since 2010). Turnover taxes are reduced in some
specific situations (e.g. if pharmaceutical companies have invested in research,
development and innovation) or for specific pharmaceuticals, for example
orphan drugs and drugs in category Cx (contraceptives and antispasmodics)
(Gerkens & Merkur, 2010). The mechanism of provisional funds was
abolished in 2008 and replaced by a similar system of contributions based on
taxes on turnover, which are due in case of a budget overrun and cover up to
€100 million. Additional taxes on the turnover of reimbursed pharmaceuticals
have recently been implemented in response to the economic crisis. Examples
are a "crisis" tax of 1% since 2010 and a tax of 0.13% since 2013 (European
Observatory on Health Systems and Policies, 2014).
Provider payment reforms
Pharmacists
A new remuneration system was introduced in April 2010, mainly to reinforce
the intellectual role of pharmacists and partly to disconnect remuneration from
drug prices. The system where pharmacists received a percentage (with a ceiling)
of the retail price was replaced by a basic fee for intellectual services (a fixed sum
per package for reimbursable drugs, equal to €4.16 since 1 January 2014), and
an economic margin (for ex-factory prices smaller than or equal to €60, this
margin was 6.04% of the ex-factory price; for ex-factory prices above €60,
the margin was €3.62, plus 2% of the difference between the ex-factory price
and €60). A third part of the new remuneration system consists of some extra
fees, for example for INN prescribing of drugs in the reference pricing system
(€1.28 per delivery since 1 January 2014) and for advisory consultation services
for new inhaled corticosteroids for asthma (€19.13 per talk; introduced on
1 January 2014).
GPs
Although GPs are mainly paid on a FFS basis, the share of lump sum payments
increased from 2.6% in 2000 to 20% in 2010 (Verzekeringswereld, 2011).
Lump sum payments were introduced for managing the global medical file, for
coordinating care in the DMPs for patients with type 2 diabetes and chronic
11 If the sub-budget for pharmaceuticals is exceeded, pharmaceutical companies have to reimburse 65% (later increased
to 72%) of the budgetary deficit. The remainder is paid by the sickness funds (Gerkens & Merkur, 2010).