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28 Economic crisis, health systems and health in Europe: country experience
Hospital care
The Belgian Government has taken several measures to reduce OOP costs for
hospitalized patients. Three major measures were taken:
• protection against room (2010) and fee (2013) supplements charged by
hospital physicians for patients staying in a room with two or more beds,
independent of the qualification of the physician or the status of the patient,
except for non-contracted physicians in day care;
• better reimbursement of medical devices and implants (since 2008, but the
effects have been more pronounced since 2012); and
• increased transparency on the costs charged to patients (2013).
These measures have had an impact on patients' OOP costs associated with
hospitalization. There has been an increasing divergence between the cost
of a hospital stay in a single room and that for a stay in a room for two
or more people. Physicians and hospitals reacted to the tightening of the
regulation by increasing supplements where they were still allowed: between
2004 and 2011 fee supplements for the members of the Christian Sickness
Funds increased each year by 5.4%. Nevertheless, the overall cost of a stay
in a single room has remained more or less stable in recent years, because
the increase in fee supplements was compensated by a decrease in material
supplements (Crommelynck, Cornez & Wantier, 2013; Schokkaert & Van
de Voorde, 2013). There is, however, large variation among hospitals, with a
small fraction of hospitals charging fee supplements that amount to 400% of
the official tariff (Crommelynck, Cornez & Wantier, 2013; Laasman, 2013).
Hospitals charging large fee supplements are mainly located in Brussels and
to a lesser extent in the Walloon Region. For people without preferential
reimbursement, supplements in 2012 amounted to an average of €1100
in Flanders, €1490 in Wallonia and €2384 in Brussels. Fee supplements,
and to a lesser extent room supplements, were responsible for these
striking differences.
Population with preferential reimbursement
An analysis of the data of the Christian Sickness Funds showed that
between 2009 and 2011 15% more people became eligible for preferential
reimbursement (Christian Sickness Funds, 2012). The socialist sickness funds
made similar observations among their members. Since the economic crisis,
the proportion of members from the socialist sickness funds with preferential
reimbursement status, including those with Omnio-status, increased from
15% in 2006 to more than 23% in 2012 (Laasman, 2013). Assuming that the