A Belgian cooperation platform Thomas Rousseau NIHDI - COOPAMI. Thomas Rousseau NIHDI - COOPAMI 2

Size: px

Start display at page:

Download "A Belgian cooperation platform Thomas Rousseau NIHDI - COOPAMI. Thomas Rousseau NIHDI - COOPAMI 2"

Rudolf Martin Burns
5 years ago
Views:

1 A Belgian cooperation platform Thomas Rousseau NIHDI - COOPAMI Thomas Rousseau NIHDI - COOPAMI

2 What i m going to talk about Social security Presentation: ti only on social security in the strict sense! focus on the Belgian health insurance! Social protection Social assistance

3 What i m not going to talk about

4 Usefull information Report of the European Observatory on Health Systems and Policies: GerkensS S, MerkurS S. Belgium: Health system review. Health Systems in Transition, Websites: National Institute for Health and Disability Insurance: ww.riziv.fgov.be The B. Health Care Knowledge Centre: FPS Social Security: E mail for questions: coopami@riziv.fgov.be

5 The Belgian I. PRESENT health insurance A snapshot of the most important features of the Belgian health insurance II. PAST A brief history of time III. FUTURE What are the challenges?

6 The Belgian I. PRESENT health insurance 1. The main features of Belgian health care system the 2. A universal and health insurance compulsory 3. The organization of the health insurance 4. The collective negotiation process in the health insurance

7 The Belgian health insurance I. PRESENT 1. The main features of the Belgian health care system

8 The main features of the Belgian health care system (1) A liberal view of medicine The patient has the freedom to choose High quality care A system of compulsory health insurance system Decision making based on negotiations

The main features of the Belgian health care system (2) Devided responsibilities for health care and policy Federal governement Regulation and financing of the

control Federated entities Health promotion and prevention Maternityand child health care Financingof hospital investment Local governements Controlling the

9 The main features of the Belgian health care system (2) Devided responsibilities for health care and policy Federal governement Regulation and financing of the compulsory health insurance Legislation covering different professional qualifications Financingof hospital budget Registration ofpharmaceuticals and their price control Federated entities Health promotion and prevention Maternityand child health care Financingof hospital investment Local governements Controlling the authenticity of the diplomas of health care providers Organization of on call duties for physicians during nights and weekend Organization of emergency care and public hospitals

10 The Belgian health insurance I. PRESENT 2. A universal and compulsory health insurance

11 A universal and compulsory health insurance (1) The three dimensions of universal coverage Height of coverage Breadth of coverage Depth of coverage

12 A universal and compulsory health insurance (2) A universal coverage (breadth: who is covered?) Almost the whole population lti is covered: > 99% The entitled persons: Salaried or self employed persons and civil servants The unemployed, the retired, the disabled, d student, orphans, etc. And their dependants (children, couples living together, etc.)

13 A universal and compulsory A compulsory insurance health insurance (3) 1. All working people have to pay social security contributions and equal a minimum amount 2. All entiteld persons must affiliate with a sickness fund (NO RISK SELECTION!) +pay a small flat rate premium

14 A universal and compulsory health insurance (4) Solidarity: from social insurance to social security (1) 1. Horizontal solidarity: between good and bad risks 2. Vertical solidarity: it bt between rich ihand poor Social contributions are related to the income and do not depend on the health risks!!!

A universal and compulsory health insurance (5) Salaried person NationalSocial Security Office Social contributions Sector Employee contribution tib ti (%) Employer s contribution tib ti (%) Total

15 A universal and compulsory health insurance (5) Salaried person NationalSocial Security Office Social contributions Sector Employee contribution tib ti (%) Employer s contribution tib ti (%) Total (%) Medical care 3,55 3,80 7,35 Invalidity benefits 1,15 2,35 3,50 Unemployment 0,87 1,46 2,33 Pensions 7,50 8,86 16,36 Family benefits 0,00 7,00 7,00 Accidents at work 0,00 0,30 0,30 Occupational ldisease 000 0, , ,00 TOTAL (= global contribution) 13,07 24,77 37,84 Source: FPS Social Security

16 A universal and compulsory health insurance (6) Solidarity: from social insurance to social security (2) 3. National solidarity: allthe citizens ar paying as a whole Subsidies from the federal Government

subsidies To reduce employer s contributions

17 A universal and compulsory health insurance (7) Social contributions Government subsidies Alternative financing 66% POOLING of ressources 10,3% 23,7% To limit government subsidies To reduce employer s contributions NationalSocial Security Office NIHDI Security PUBLIC Institutions

18 A universal and compulsory health insurance (8) The three dimensions of universal coverage Height of coverage Breadth of coverage Depth of coverage

19 A universal and compulsory health insurance (9) A broad coverage (Depth: what is covered?) Preventive and curative care required for maintaining and repairing a person s health The services that are covered are described in the nationally established fee schedule hdl (the nomenclature) lt ) Extremely detailed and lists more than 8000 services: consultations, visits, special technical provisions, dental care, nurse care, physiotherapy, implants, prostheses, For each service: an identification number, contractual fee and reimbursement rate Pharmaceuticalproducts on a positive listarecovered Intervention for a hospital stay or for treatment in a health care institution Excluded: Esthetic care, acupuncture, homeopathy, osteopathy, services p p y p y that do not meet the reimbursement criteria

20 A universal and compulsory health insurance (10) The three dimensions of universal coverage Height of coverage Breadth of coverage Depth of coverage

21 A universal and compulsory health insurance (11) Percentage of total expenditure on health according to source of revenue 43% 4,3% 19,5% Governement Patient Employer Private 75,9%

22 A universal and compulsory health insurance (12) Protection measures for lower socioeconomicgroups i A system of increased reimbursement widows, disabled persons, pensioners, orphans and some unemployed persons all persons under a fixed income limit Maximum Billing (MAB) Maximum Billing (MAB) System making sure each family does not have to spend more than a maximum amount on some health costs. Exact amount depends on the family income. Calculated yearly

23 A universal and compulsory Oh Other protection measures health insurance (13) Special Solidarity Fund Additional reimbursement for patients with a rare illness or who need a very specific treatment Fixed payments to patients who can be expected to have high medical expenditure For chronically ill patients For incontinence material For palliative treatment at home

24 A universal and compulsory health insurance (14) A system of reimbursement Insured / Patient the full fee Health care provider certificate Sickness fund Reimbursement = Official fee user charge

25 A universal and compulsory health insurance (15) A system of third party paying in some cases Insured / Patient Health care provider Co payment or user charge bill insurance allowance Sickness fund

26 The Belgian health insurance I. PRESENT 3. The organization of the health insurance

27 The organization of the health insurance (1) The NIHDI and the sickness ik funds play a crucial role in the Belgian health insurance NIHDI National union of sickness fund Sickness fund Socially insured person

28 The organization of the health insurance (2) NIHDI National union of sickness fund Sickness fund Socially insured person The National Institute for Health and Disability Insurance Since 1963 A public social security institution under the responsibility of the Minister of Social Affairs Extended management autonomy Management agreement Manages and supervises the compulsory health care and benefits insurance

29 The organization of the health insurance (3) NIHDI National union of sickness fund Sickness fund Socially insured person Tasks organizes the reimbursement of the medical costs in order to make high quality health care accessible to as many people as possible grants an appropriate replacement income in case of incapacity for work, disability, maternity, paternity or adoption elaborates with its partners the regulation concerning the health insurance organizes the negotiation between the different partners of the health insurance makes sure the activities of the health care providers and health insurance funds are properly financed informs, evaluates and inspects the health care providers, the health insurance funds and, in some cases, the patients (the socially insured persons).

30 The organization of the health insurance (4) NIHDI 2 types Private non profit making organizations with a public interest mission that are grouped into national associations according to their political or ideological background National union of sickness funds Sickness fund Socially insured person National Union of Christian Mutualities National Union of Neutral Mutualities National Union of Socialist Mutualities National Union of Liberal Mutualities National Union of the Free and Professional Mutualities Public health insurance funds Auxiliary Fund for Health and Disability Insurance Health Insurance Fund of the Belgian Railways Group NMBS SNCB

31 The organization of the health insurance (5) NIHDI National union of sickness funds Sickness fund Socially insured person The compulsory insurance package and the social contribution rates are identical for all funds Their role in the compulsory health insurance system Ensure the reimbursement of health care expenses and the provision of an alternative income in case of incapacity to work. Control of conformity with the legal rules (advisory physicians) Representatives for the patients collective negotiation process about fees, insurance coverage and regulatory structure Provide information to their members and the health care providers

32 The organization of the health insurance (6) NIHDI National union of sickness fund Sickness fund Socially insured person The right to information of the health care provider the sickness fund the NIDHI Free choice of health care provider (+ right to a second opinion) sickness fund

33 The Belgian health insurance I. PRESENT 4. The collective negotiation process in the health insurance

34 The collective negotiation process in The stakeholders the health insurance (1) Government Employers NIHDI Salaried employees and self employed workers Health care providers Sickness funds

35 The object The collective negotiation process in the health insurance (2) The global orientations on health policy and global budget General reglementation The reimbursed medical services the nomenclature The remboursement tariffs and fees

36 The collective negotiation process in the health lthi insurance (3) Negotiation bodies Minister of social affaires General management Committee for Health Care Insurance General Council Sectoral negotations Conventions and agreements commissions Preparatory negotations Technical councils Workgroups

37 The Belgian health insurance II. PAST 1. The story and history of social security in Belgium 2. The origins of insurance system the health 3. The main turning points in the history of the Belgian health insurance

38 The Belgian health insurance II. PAST 1. THE STORY AND HISTORY OF SOCIAL SECURITY IN BELGIUM

39 The story and history of social security in Belgium The history of social security in Belgium explained in 7 minutes

40 The Belgian health insurance II. PAST 2. THE ORIGINS OF THE HEALTH INSURANCE SYSTEM

Mutual assistance (employement tt type) Governement intervention National Unions of

41 The origins of the health insurance system A subsidized voluntary health insurance Mutual assistance Mutual insurance tion m alrevolut f capitalsi Industria Rise of Societies of Mutual assistance (employement tt type) Governement intervention National Unions of mutualities (ideological i l background) Sec cond Wor rld War insured Late 19th century 1940

42 The Belgian health insurance II. PAST 3. THE MAIN TURNING POINTS IN THE HISTORY OF THE BELGIAN HEALTH INSURANCE

43 The main turning points in the history of the Belgian health insurance (1) Social lsecurity Act of 28 December 1944 Who? Employers and Trade Unions What? A compulsory (health) insurance system for all salaried employees based on independent medical practice, free choice of health care provider by the patient, fee for service payment of providers and reimbursement Social security controlled with equal representation inindependentindependent public institutions by both the workers and the employers organizations National Fund for Sickness and Disability = workers, employers + sickness funids The compulsary system incorporates the sickness funds Free choice

44 The main turning points in the history of the Belgian health insurance (2) Health Insurance Act of 9 August 1963 NIHDI Health care providers in Management Commitee Negotation system of conventions and agreements bt between sickness ik funds and health care providers + tariff security Strike of medical corps No financial responsability Endager the professional secrecy Infringement to their therapeutic freedom Advisory rol in Management Committee Same reimbursement conditions for conventioned and non conventioned physicians

45 The main turning points in the history of the Belgian health insurance (3) Beneficiaries Carefree growth of health care maximization of quality without the pressure of limited resources increasing demand Increasing supply of health care Budgetary years cost containment ti twhile maintaining i i the basis principles (equity, freedom of choice and quality of care) controlling the supply of health care increasing the responsibility of the main actors selective measures

46 The Belgian health insurance III. FUTURE 1. The objectives of the Belgian health care system 2. The long run challenge: accommodating increasing expenditures

47 The Belgian health insurance III. FUTURE 1. THE OBJECTIVES OF THE BELGIAN HEALTH CARE SYSTEM

48 The objectives of the Belgian health care system Maintaining financial sustainability Increasing accessibility Assuring health care quality

49 The Belgian health insurance III. FUTURE 2. THE LONG RUN CHALLENGE: ACCOMMODATING INCREASING EXPENDITURES

50 The long run challenge: accommodating increasing expenditures (1) 5 Trends in health expenditure in Belgium, , ,5 3 2,5 2 Total health expenditure GDP 1,5 1 0,

Futur chalanges Increased health threatening lifestyles Men: 49% overweight 14% obese Women: 28% overweight 13% obese

51 The long run challenge: accommodating increasing expenditures (2) Factors dii driving health care spending in past decadesd Policy decisions to enlarge acces Demand for better quality health care linked to growing gincome levels Technology evolution Futur chalanges Increased health threatening lifestyles Men: 49% overweight 14% obese Women: 28% overweight 13% obese Increasing of chronic diseases Improved wellbeing and a better standard of living Growth and progress of new technologies and treatment

52 The long run challenge: accommodating increasing expenditures (3) Percentage of households that had to postpone medical care because of financial reasons, by income level 25,0% 20,0% 21,4% 23,1% 18,7% 15,0% 8,6% 10,0% 0% 8,6% 10,6% 10,6% 5,0% 0,0% < 750 euro euro euro euro > 2500 euro Total Source: KCE, 2010

Low expenditures High expenditures Growth

of the collective system Increasing cost

53 The long run challenge: accommodating increasing expenditures (4) What to do? Low expenditures High expenditures Growth of private alernatives Further extension of the collective system Increasing cost awareness of the players Increasing the efficiency Increasing the prevention Rewarding quality Improving the information system

54 We welcome your questions, suggestions, comments!

A Belgian cooperation platform Thomas Rousseau NIHDI - COOPAMI. Thomas Rousseau NIHDI - COOPAMI 2

A Belgian cooperation platform www.coopami.org Thomas Rousseau NIHDI - COOPAMI Thomas Rousseau NIHDI - COOPAMI 2 24-10-2013 The Belgian health insurance I. Basic principles of the Belgian health insurance