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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 31 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
32 Economic crisis, health systems and health in Europe: country experience transparency about the complete financial consequences of using health care. The proposal to increase financial transparency encompasses many elements: the publication of the status of health care providers (whether they have signed the convention or not) on the web site of the RIZIV; a measure to regulate supplements charged for clinical biology, pathology–anatomical research and genetic tests; regulations regarding the information health care providers have to provide to patients about the cost of health care services, medical materials and devices; and regulations on presenting this information on health care service delivery certificates or similar documents. 4.4 Impact on health Mortality Cardiovascular diseases comprise the major cause of death in Belgium. Improved treatment strategies and preventive efforts have induced a significant decrease in cardiovascular mortality over the last decade. While in 2003 almost 345 per 100 000 population died of cardiovascular diseases, this number was reduced to 254 per 100 000 in 2009. More recent data are not yet available. The next most frequent cause of death is cancer, with mortality from cancer remaining relatively stable between 2003 and 2009, at around 228 per 100 000 population a year. The Cancer Plan (launched in 2008) with 32 specific initiatives organized into three main principles (actions on prevention and screening; actions on care, treatment and support; and actions on research, technological innovation and assessment) is expected to show its effects only in the longer term. Self-reported health Data on self-reported health by income quintile show that there is a huge gap between the highest and the lowest income groups: about 85% of the population in the highest income quintile report a health state of good or very good, while this proportion is about 59% in the lowest income quintile. This gap has remained stable since 2004. No marked changes have been observed as a result of the financial crisis. Self-reported health by education also shows a socioeconomic gradient (OECD, 2013c). Populations with low education show a lower self-reported health than highly educated population groups. The proportion of the population reporting their health as being good or very good has decreased for the low education group since 2008, whereas this proportion has remained stable for the groups with medium or high education. Finally, a difference in self-reported health is observed between men and women in Belgium (OECD, 2013b). The difference between both groups has steadily decreased since the early 2000s.
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32 Economic <strong>crisis</strong>, <strong>health</strong> <strong>systems</strong> <strong>and</strong> <strong>health</strong> in Europe: country experience<br />
transparency about the complete financial consequences of using <strong>health</strong> care.<br />
The proposal to increase financial transparency encompasses many elements:<br />
the publication of the status of <strong>health</strong> care providers (whether they have signed<br />
the convention or not) on the <strong>web</strong> site of the RIZIV; a measure to regulate<br />
supplements charged for clinical biology, pathology–anatomical research <strong>and</strong><br />
genetic tests; regulations regarding the information <strong>health</strong> care providers have<br />
to provide to patients about the cost of <strong>health</strong> care services, medical materials<br />
<strong>and</strong> devices; <strong>and</strong> regulations on presenting this information on <strong>health</strong> care<br />
service delivery certificates or similar documents.<br />
4.4 Impact on <strong>health</strong><br />
Mortality<br />
Cardiovascular diseases comprise the major cause of death in Belgium.<br />
Improved treatment strategies <strong>and</strong> preventive efforts have induced a<br />
significant decrease in cardiovascular mortality over the last decade. While in<br />
2003 almost 345 per 100 000 population died of cardiovascular diseases, this<br />
number was reduced to 254 per 100 000 in 2009. More recent data are not<br />
yet available. The next most frequent cause of death is cancer, with mortality<br />
from cancer remaining relatively stable between 2003 <strong>and</strong> 2009, at around<br />
228 per 100 000 population a year. The Cancer Plan (launched in 2008)<br />
with 32 specific initiatives organized into three main principles (actions on<br />
prevention <strong>and</strong> screening; actions on care, treatment <strong>and</strong> support; <strong>and</strong> actions<br />
on research, technological innovation <strong>and</strong> assessment) is expected to show its<br />
effects only in the longer term.<br />
Self-reported <strong>health</strong><br />
Data on self-reported <strong>health</strong> by income quintile show that there is a huge<br />
gap between the highest <strong>and</strong> the lowest income groups: about 85% of the<br />
population in the highest income quintile report a <strong>health</strong> state of good or very<br />
good, while this proportion is about 59% in the lowest income quintile. This<br />
gap has remained stable since 2004. No marked changes have been observed<br />
as a result of the financial <strong>crisis</strong>. Self-reported <strong>health</strong> by education also shows<br />
a socio<strong>economic</strong> gradient (OECD, 2013c). Populations with low education<br />
show a lower self-reported <strong>health</strong> than highly educated population groups. The<br />
proportion of the population reporting their <strong>health</strong> as being good or very good<br />
has decreased for the low education group since 2008, whereas this proportion<br />
has remained stable for the groups with medium or high education. Finally,<br />
a difference in self-reported <strong>health</strong> is observed between men <strong>and</strong> women in<br />
Belgium (OECD, 2013b). The difference between both groups has steadily<br />
decreased since the early 2000s.
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