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40 Economic crisis, health systems and health in Europe: country experience
The report highlighted that the strengths of the Belgian health system are related
to the vaccination rate in children, survival rates five years after a breast cancer or
colorectal cancer diagnosis, relational continuity with GPs and increases in the
prescription of low-cost drugs. Room for improvement was found in very high
suicide rates, the growing number of people who are overweight or obese, the
coverage rate of breast and cervical cancer screening in target groups, the high rate
of caesarean sections and the social inequalities in many indicators.
6. Conclusions
The financial and economic crisis did not have a huge immediate impact on the
Belgian health care system, mainly because of the measures to protect the health
care budget installed before the crisis. Because of the real growth cap applied
to the health care budget since 1995 and budget surpluses built up in previous
years, the Belgian health system was well prepared to buffer the effects of the
economic crisis. Budgetary margins were often used to improve accessibility
to health care. Accessibility and quality of care are, and have long since been,
the major objectives of health care policy, with respect for therapeutic freedom
and freedom of choice. Therefore, when it became necessary to start taking
economic measures, the focus was first on measures that would not be felt
immediately by patients. Misuse of the system and outliers in terms of volumes
of health care service provision were tackled first. Efficiency measures were then
taken. Measures taken in the pharmaceutical sector were very effective. Future
plans for efficiency measures will focus on evidence-based reimbursement (e.g.
fee-related real costs); appropriate use and financing of medical imaging, dialysis
and DMPs; efforts to promote primary care; and the further development of
integrated care for chronic diseases.
Resistance may be expected from stakeholders when efficiency measures reduce
therapeutic freedom and perhaps freedom of choice. In addition, changes in
financing, envisaged, for example, for the national fee schedule used in FFS
reimbursement, will be challenging, as it currently determines the income of
health care providers.
Moving towards more integrated care will require a mentality shift among
stakeholders. The Sixth State Reform will make this shift even more challenging,
as some health responsibilities are moved to the communities while others
remain a central government responsibility. Goodwill and communication
between the different levels will be indispensable.
Data technical measures have been helpful in the process of implementing
evidence-based policy changes. Several measures have been taken in the past
to facilitate communication between data sources. Involved stakeholders are