Web-economic-crisis-health-systems-and-health-web
Web-economic-crisis-health-systems-and-health-web Web-economic-crisis-health-systems-and-health-web
Chapter 1 | The impact of the crisis on the health system and health in Belgium 25 concept of individual well-being, 12 it is of course also possible to evaluate the evolution of specific indicators reflecting the financial accessibility of the health care system. Equity in financing A popular aggregate evaluation criterion is the degree of progressivity of the health care financing mix. Progressivity measures were developed to evaluate to what extent health care financing adheres to the ability-to-pay principle. Table 1.5 illustrates how the overall financing mix of health insurance has been growing less progressive since 2006 in that income sources that are proportional to income (mainly social security contributions) are increasingly complemented with receipts from regressive income sources (mainly indirect taxes). However, in Belgium's system of global management, the calculated degree of progressivity of health care financing necessarily rests on arbitrary assumptions about the assignment of health care expenditure to different financing sources. Moreover, the share of PHI and the share and distribution of OOP payments are not captured by the measure of overall progressivity of the financing mix, although these are essential features of an equitable health system. Table 1.5 Equity in financing of health insurance in Belgium between 2006 and 2011 Financing source 2006 2007 2008 2009 2010 2011 Proportional receipts/total receipts (%) 71.1 71.0 72.0 70.6 69.4 64.8 Progressive receipts/total receipts (%) 18.9 19.0 18.0 17.3 17.2 19.4 Regressive receipts/total receipts (%) 10.0 10.0 10.0 12.1 13.4 15.8 Source: Vrijens et al., 2012. 4.2 Access to services and quality of care Since the early 2000s, several policy measures have been taken to stabilize OOP expenditure for health care and to reduce it for population groups with low income. In 2012, patients paid, on average, 6.54% co-payments on physician fees. When co-payments for partly reimbursed drugs are included, the share of co-payments as a proportion of total health care expenditure amounts to more than 8%. Maximum billing system Table 1.6 shows the number of patients and households who were reimbursed by the system of maximum billing because they exceeded their income-dependent 12 For a more elaborate discussion on the concept of well-being as a broader perspective on equity in health, see Schokkaert & Van de Voorde (2013).
26 Economic crisis, health systems and health in Europe: country experience co-payment limit as well as the total amount of reimbursements in the period 2008–2011. The figures clearly show the effect of the introduction of maximum billing for the chronically ill in 2009 on total maximum billing reimbursements. The decrease in the number of patients receiving such reimbursements in 2010 and 2011 can be explained by a change in the eligibility criteria. Before 2009, as soon as one person with preferential reimbursement in a household reached the co-payment ceiling, all the members of that household (living at the same address) became eligible for maximum billing reimbursements, independent of whether these other household members had preferential reimbursement status. Since 2009, only the household members with preferential reimbursement status are eligible for maximum billing reimbursements if the household has reached the copayment ceiling. Table 1.6 System of maximum billing in Belgium, 2008–2011, number of patients/households and total reimbursements 2008 2009 2010 2011 No. patients 1,123,204 1,173,327 1,101,393 1,088,409 No. households 630,339 643,343 610,091 602,282 Total reimbursements (thousands of e) 277,153 305,619 326,335 329,653 Source: RIZIV, 2012. The impact of the maximum billing system can be translated into a lower average co-payment for reimbursed products and services. For example, without the maximum billing system, the average of co-payments as a ratio of total expenditure for physician fees would have been 7.8% in 2012. The maximum billing system reduced the average co-payment pressure to 6.54%, representing a decrease of more than 16%. In addition, the average co-payment pressure for physician fees fell between 2007 and 2012, even independently of the maximum billing system (Table 1.7) mainly through increasing lump sum financing for physician services (e.g. for services provided within DMPs), the increasing number of patients with a global medical record and its associated benefits (e.g. lower co-payments for physician visits) and the systematic implementation of preferential reimbursement status for specific groups.
- Page 7 and 8: vi Economic crisis, health systems
- Page 9 and 10: viii Economic crisis, health system
- Page 11 and 12: List of abbreviations ACS Health in
- Page 13 and 14: List of tables and figures Tables P
- Page 15 and 16: xiv Economic crisis, health systems
- Page 17 and 18: xvi Economic crisis, health systems
- Page 19 and 20: xviii Economic crisis, health syste
- Page 21 and 22: xx Economic crisis, health systems
- Page 23 and 24: xxii Economic crisis, health system
- Page 25 and 26: xxiv Economic crisis, health system
- Page 27 and 28: xxvi Economic crisis, health system
- Page 29 and 30: Acknowledgements This book represen
- Page 31 and 32: Preface This book maps health polic
- Page 34: Part I Country case studies
- Page 37 and 38: 4 Economic crisis, health systems a
- Page 39 and 40: 6 Economic crisis, health systems a
- Page 41 and 42: 8 Economic crisis, health systems a
- Page 43 and 44: 10 Economic crisis, health systems
- Page 45 and 46: 12 Economic crisis, health systems
- Page 47 and 48: 14 Economic crisis, health systems
- Page 49 and 50: 16 Economic crisis, health systems
- Page 51 and 52: 18 Economic crisis, health systems
- Page 53 and 54: 20 Economic crisis, health systems
- Page 55 and 56: 22 Economic crisis, health systems
- Page 57: 24 Economic crisis, health systems
- Page 61 and 62: 28 Economic crisis, health systems
- Page 63 and 64: 30 Economic crisis, health systems
- Page 65 and 66: 32 Economic crisis, health systems
- Page 67 and 68: 34 Economic crisis, health systems
- Page 69 and 70: 36 Economic crisis, health systems
- Page 71 and 72: 38 Economic crisis, health systems
- Page 73 and 74: 40 Economic crisis, health systems
- Page 75 and 76: 42 Economic crisis, health systems
- Page 77 and 78: 44 Economic crisis, health systems
- Page 79 and 80: 46 Economic crisis, health systems
- Page 81 and 82: 48 Economic crisis, health systems
- Page 83 and 84: 50 Economic crisis, health systems
- Page 85 and 86: 52 Economic crisis, health systems
- Page 87 and 88: 54 Economic crisis, health systems
- Page 89 and 90: 56 Economic crisis, health systems
- Page 91 and 92: 58 Economic crisis, health systems
- Page 93 and 94: 60 Economic crisis, health systems
- Page 95 and 96: 62 Economic crisis, health systems
- Page 97 and 98: 64 Economic crisis, health systems
- Page 99 and 100: 66 Economic crisis, health systems
- Page 101 and 102: 68 Economic crisis, health systems
- Page 103 and 104: 70 Economic crisis, health systems
- Page 105 and 106: 72 Economic crisis, health systems
- Page 107 and 108: 74 Economic crisis, health systems
Chapter 1 | The impact of the <strong>crisis</strong> on the <strong>health</strong> system <strong>and</strong> <strong>health</strong> in Belgium<br />
25<br />
concept of individual well-being, 12 it is of course also possible to evaluate the<br />
evolution of specific indicators reflecting the financial accessibility of the <strong>health</strong><br />
care system.<br />
Equity in financing<br />
A popular aggregate evaluation criterion is the degree of progressivity of the<br />
<strong>health</strong> care financing mix. Progressivity measures were developed to evaluate<br />
to what extent <strong>health</strong> care financing adheres to the ability-to-pay principle.<br />
Table 1.5 illustrates how the overall financing mix of <strong>health</strong> insurance has been<br />
growing less progressive since 2006 in that income sources that are proportional<br />
to income (mainly social security contributions) are increasingly complemented<br />
with receipts from regressive income sources (mainly indirect taxes). However, in<br />
Belgium's system of global management, the calculated degree of progressivity<br />
of <strong>health</strong> care financing necessarily rests on arbitrary assumptions about the<br />
assignment of <strong>health</strong> care expenditure to different financing sources. Moreover,<br />
the share of PHI <strong>and</strong> the share <strong>and</strong> distribution of OOP payments are not<br />
captured by the measure of overall progressivity of the financing mix, although<br />
these are essential features of an equitable <strong>health</strong> system.<br />
Table 1.5 Equity in financing of <strong>health</strong> insurance in Belgium between 2006 <strong>and</strong> 2011<br />
Financing source 2006 2007 2008 2009 2010 2011<br />
Proportional receipts/total receipts (%) 71.1 71.0 72.0 70.6 69.4 64.8<br />
Progressive receipts/total receipts (%) 18.9 19.0 18.0 17.3 17.2 19.4<br />
Regressive receipts/total receipts (%) 10.0 10.0 10.0 12.1 13.4 15.8<br />
Source: Vrijens et al., 2012.<br />
4.2 Access to services <strong>and</strong> quality of care<br />
Since the early 2000s, several policy measures have been taken to stabilize OOP<br />
expenditure for <strong>health</strong> care <strong>and</strong> to reduce it for population groups with low<br />
income. In 2012, patients paid, on average, 6.54% co-payments on physician<br />
fees. When co-payments for partly reimbursed drugs are included, the share of<br />
co-payments as a proportion of total <strong>health</strong> care expenditure amounts to more<br />
than 8%.<br />
Maximum billing system<br />
Table 1.6 shows the number of patients <strong>and</strong> households who were reimbursed by<br />
the system of maximum billing because they exceeded their income-dependent<br />
12 For a more elaborate discussion on the concept of well-being as a broader perspective on equity in <strong>health</strong>, see<br />
Schokkaert & Van de Voorde (2013).
Change language