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Chapter 1 | The impact of the crisis on the health system and health in Belgium
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three years) and the data from the National Health Survey (performed only
every four years; the most recent available data are from 2008). The technical
possibilities are huge; the decision taken in the 1980s to introduce a unique
registration number for all citizens created the theoretical opportunity to
couple several databases. This was combined with strict privacy regulations to
avoid misuse. Current discussions at the European level to abolish the unique
national registration number, in the context of new privacy guidelines, are a
threat to the possibilities currently available in Belgium to support evidencebased
policy.
A final challenge is related to the Sixth State Reform, whereby certain health
care responsibilities have been transferred to the communities. This fragmenting
of responsibilities between the federal and the regional level will be a challenge
for the implementation of integrated care. In addition, the Sixth State Reform
risks increasing overhead costs related to the administration of health care
reimbursements, and thus the efficiency of this administration.
5.4 Resilience in response to the crisis
Rapid change was not felt to be an urgent requirement in the wake of the crisis
in Belgium because of the reforms introduced at the beginning of the 1990s
and because there was no government for much of 2010 and 2011. Between
2008 and 2012, there was time to formulate policies that met stricter budgetary
limits and at the same time could guarantee accessibility to services and more
efficiency. When it became clear that the surplus in the health care budget
had to be used for other social security sectors, all stakeholders became aware
that greater efficiency measures were needed in the health care sector. This
mentality change may have long-term consequences, both for the responsible
and appropriate use of resources and for the acceptance of efficiency measures.
Technical measures have been taken to improve communication between
different official data sources, such as the data from the sickness funds, (clinical)
data registered at hospitals to allow them to obtain their annual budget, and
fiscal data. This offers efficient instruments for generating data that are directly
useful for policy-makers.
Belgium has invested in the monitoring of the health care budget since 1994,
and in 2010 investments were made to prepare an assessment of health system
performance (Vanthomme et al., 2010). A core set of 55 indicators was
identified, of which 40 would eventually be measured. After the publication of
the preparatory report in 2010, additional indicators were added that related to
health promotion, mental health care, general medicine, long-term care, endof-life
care, continuity of care, patient centredness and equity. In 2012, the first
Health System Performance Assessment report was published (Vrijens et al., 2012).