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Chapter 1 | The impact of the crisis on the health system and health in Belgium
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income groups (fifth quintile) with regard to perceived unmet needs in health
care (Fig. 1.5). This huge disparity has been observed for several years. Before
the crisis, a marked downward trend was observed in perceived unmet needs
in all income groups as well as in the difference between the lowest and highest
income groups. In 2011, the perceived unmet needs started to increase again
in all income groups and the gap between the lowest income groups and the
highest income groups widened.
Fig. 1.5 Self-reported unmet needs by quintile of equivalized income, Belgium, 2004–
2011
6.0
5.0
First quintile Second quintile Third quintile
Fourth quintile Fifth quintile
4.0
% population
3.0
2.0
1.0
0.0
2004 2005 2006 2007 2008 2009 2010 2011
Source: Eurostat, 2013e.
4.3 Transparency and accountability
In 2003, the Belgian Health Care Knowledge Centre was established to
perform HTA and health services research for policy-makers, and to develop
clinical practice guidelines for health care providers. The aim was to increase
efficiency in health care and improve the transparency of the reasons behind
reimbursement decisions.
Current initiatives to increase transparency include a law to increase the financial
transparency of health care for citizens. The changing economic and political
climate has been one of the motives for this law. With the increasing pressure
on government budgets from the economic crisis and the financial problems
it has created for some groups of citizens, it is felt that it is unjustifiable that
there is an almost complete lack of transparency for patients in the financial
consequences of using health care. Moreover, to be able to allocate health
care budgets more efficiently and to ensure equity, it is important to have