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

24 Economic crisis, health systems and health in Europe: country experience
kidney failure, and for being on call. GPs are also paid a fixed amount per year
to use a software package for the global medical file (telematics premium). The
policy goals behind the gradual decline of FFS as the dominant remuneration
system are diverse. One of the objectives of the DMPs (introduced in 2009)
was to reinforce the role of GPs in the treatment and follow-up of patients with
a chronic illness. At the same time, the measure aims to increase patient access.
The lump sum payment for managing the global medical file is also meant to
reinforce the role of GPs.
Hospitals
The system of reference amounts was introduced in 2002 to detect and control
large variability in hospital practices for standard interventions provided
in inpatient settings (Van de Sande et al., 2010). The reference amount is a
standard by which the hospital is compared and is calculated as the national
average expenditure increased by 10%. Only expenditure on clinical biology,
medical imaging and other technical services (internal medicine, physiotherapy
and various medico/technical services) are included. If hospital expenditure
exceeds the reference amount, the expenditure surplus (difference between
hospital expenditure and median national expenditure) is paid back to the
RIZIV. In an attempt to increase efficiency of resource use, the system has been
expanded to day care and to services provided up to 30 days before the hospital
stay (since January 2013).
Information and communication technology
There has been a gradual elaboration of the e-health digital platform, set up in
2008 to permit an electronic exchange of secure data between all health actors.
Since 2009, the federal government has decided to invest in new software, such
as MyCareNet, to improve the monitoring of patients (e.g. patients' insurance
status, health status and right to increased reimbursement).
4. Implications for health system performance
and health
4.1 Equity in financing and financial protection
Equity
Earlier sections of this chapter have stressed that safeguarding an accessible
health care system of high quality has always been the first concern of policymakers
and stakeholders in Belgium. The overview of protection measures
that were taken since the crisis in 2008 illustrates this concern. Although we
believe that an evaluation of health policy in terms of equity should capture a