Health care system in Belgium

How Belgian patients can save 1 billion euro / year and the health insurance system 1,6 billion / year …

Belgium

Statistical information

30,528 sq km about 10,4 million inhabitants three official languages (Dutch, French and

German) life expectancy: 78,29 years average of 1,62 born children / woman. USD 33,000 / capita GDP 8,7 % of this GDP: spent on health expenses 2.269 USD per capita / year: spent for health

of which 71,2 per cent are public expenses.

Basic principles of the health care system A liberal view of medicine.

Most health care providers are self-employed, receive payment for each service provided and enjoy diagnostic and therapeutic freedom.

System of compulsory health insurance system (RIZIV), integrated in the Social Security System and financed predominantly through salary deductions. More than 99% of the population is covered by compulsory health insurance at the present time.

The freedom to choose both the health care provider and the (private or public) health care establishment, so also free access to specialist doctors.

Reimbursement conditions (1)

The subscription to one of the existing health funds is compulsory, but the choice among them is free. ANMC, National Alliance of Christian Mutualities is by far the largest with 45% of the population

As a general rule, patients pay the total cost of services and then get reimbursed by their Mutual health fund on the basis of a contractually determined amount.

The difference between the total cost and the reimbursement is a personal contribution.

Exception to this rule: third-part payment, mainly for hospitalisation costs, pharmaceuticals and individuals living in a particular social and financial insecurity

Reimbursement conditions (2)

Supplementary insurance policies: voluntaryoffered by Mutual health funds (non

profit) and private companies (profit) Essentially co-payments by patients

and additional charges private hospital room, rest and care homes…

Public health system in danger

Budget of RIZIV: 15,3 billion euroRise of 4% / year

Reimbursement of medicines: 2,7 billion euro: Rise of 7,8% / year: expenses

increasing twice as fast as the total cost of RIZIV

Other reasons (demography)

Why medicines bring the system in danger? (1)

High pricesHigher then the neighbouring

countries (France, Netherlands)• Zocor (cholesterol-lowering drugs: 26 and

35% higher) • NGO Orbi-Pharma: 15 tot 60 times

cheaper

Why medicines bring the system in danger? (2)

Low quality: most expensive medicines are not those scientifically proven to have the most benefit

Top 5 of the most expensive medicines for RIZIV (2002)

Name Therapeutic class Producer Net cost (in millionEuro)

1.Lipitor Cholesterol lowering drug Pfizer 70.9

2.Zocor Cholesterol loweringdrug

Merck Sharp&Dohme 44.4

3.Amlor Anti-hypertensivedrug

Pfizer 34.5

4.Cipramil Anti-depressant Lundbeck 33.2

5.Pravasine Cholesterol loweringdrug

Birstol-Meyers Squibb 26.8

Why medicines bring the system in danger? (3)

Imitations and “me toos”Most of the research is not to search

for new medicines, but to make imitations and adjustments of the product

To obtain admission of a new product: new medicine has an effect or it should be better than placebo and it’s safe

Why medicines bring the system in danger? (4)

“New” product: Lucentis (2.000 dollar)Same active component as Avantis

(cancer): 20 dollar Study of National Institute for Health

Care Management (NIHCM):153 or 15% of all 1.035 medicines,

admitted for sell by the American Food & Drug Administration (FDA) had more therapeutic value

Why medicines bring the system in danger? (5)

Irrational use of medicines and marketingDirect to consumer advertising for

medicines without prescription is legal• Producers of Neurofen, Alevem Daflon

and Venoruton are making super profits, but have no proven beneficial effect

Why medicines bring the system in danger? (6)

Valuable and life-saving medicines are withdraw from market when they become too cheap and more expensive alternatives are available (Furadantine, Penidur)

Doctors are object of publicity because they lack necessary information (pharmaceutical industry: 1 billion dollar or 1.000 times the amount for independent education)

A rational drug policy exists(1)

Based on the health system in New Zealand: kiwi-model (Pharmac: quality, effectiveness and price)

The new institute aims to realize The most efficient and accessible

health policyHighest health protection at the lowest

price

A rational drug policy exists(2)

Strategy of the new institute:Independent team of expertsScientific demand-driven analysesObjective, scientific criteria and

studiesPublic bidding or cross dealsReimbursed if it has a clear

therapeutic surplus value

Challenges (1)

implementation of the kiwi-model without vitamins (protest of pharm. industry, politicians and doctors)public bidding only for products

without patent (cholesterol-lowering drugs)

Compensation for products that don’t win, but patients pay more

Firms get reduction if they use less marketing and publicity

Challenges (2)

More and more coercive directives of the European Commission, where health a part is of the sector entreprisesTRIPS: prices rose with 12 to 200%Availability of cheaper generic

medicines slow down97 of patents are registered in rich

countries

Challenges (3)

Nationalization of the pharmaceutical industry is needed, but a national drugs policy on public tender as the kiwi-model would be a valuable step