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Chapter 1 | The impact of the crisis on the health system and health in Belgium
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extension of eligibility for increased reimbursement in 2007 (introduction of
Omnio-status) had already had its complete effect in 2009, this observation
may indicate that the number of people in a problematic financial situation
is increasing. However, the take-up of Omnio-status was slow, as people were
not aware of their eligibility and had to submit a request to their sickness
fund on their own initiative. Therefore, it is unlikely that the measures taken
in 2007 have already shown their complete effect. Further increases in the
population eligible for increased reimbursement can be expected, also because
of measures to widen the eligibility criteria (e.g. extension of preferential
reimbursement entitlement to single-parent families in 2010 and to persons
entitled to a fund for domestic oil from the Public Welfare Centre in 2011)
and not simply because of the economic crisis. Moreover, a more proactive
policy to detect people who are eligible for preferential reimbursement will
be possible in the near future because of an exchange of information between
the RIZIV, the sickness funds and the fiscal authorities.
Postponing health care expenditure for financial reasons
According to the Health Interview Surveys conducted in 1997, 2001, 2004
and 2008 (Demarest et al, 1998, 2002; Bayingana et al., 2006; Van der
Heyden et al., 2010), an increasing number of households declared they
had to postpone health care (medical care, surgery, drugs, spectacles/contact
lenses, mental health care) during the previous 12 months because they could
not afford it. The share of respondents was relatively stable between 1997
and 2004 (around 9%), but increased to 14% in 2008 and returned to 9%
in 2013. These averages hide large differences due to age, education level,
household composition and region. For example, in 2008, 9% of households
in the group with the highest education level postponed health care versus
18% for those belonging to the group of lowest level, and 30% of singleparent
households reported to have postponed health care for financial
reasons. Currently (March 2014), a fifth Health Interview Survey is being
conducted.
More recent data from a large online survey in 2013 (21 957 respondents) on
the perception of health care by the Belgian population (Christian Sickness
Funds, 2013) showed a different picture. Of all respondents, 11% reported
that they had to postpone health care expenditure for financial reasons. In
addition, Eurostat data on income and living conditions highlighted in
Fig. 1.4 show that self-reported unmet need for financial reasons declined by
quintile of equivalized income (Eurostat (2013e). 13
13 Unmet need is defined as the share of the population perceiving an unmet need for medical examination or treatment.
Reasons include problems of access (could not afford to, waiting list, too far to travel) or other (could not take time,
fear, wanted to wait and see, did not know any good doctor or specialist, other).