Belgian Health system. Salvador, December 3d 2012

Transcription

1 Belgian Health system Salvador, December 3d 2012

2 2 Belgium odifiez les styles du texte du masque

3

4 Belgium 4 11 millions inhab (2012) 353 hab/km2 3 communities (3 langages), 3 regions GDP per capita : 38200$ - 78% services, 22% industry, <1% agriculture (2010) GINI: 28* (Dan 25, USA 38, Bra 53**) Crude Bith Rate 12 (2011) Crude Mortality Rate 9 (2011) Infant mortality rate 3,5 (2010)

5 Belgium 5

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7 7 Social Security and Social protection in Health

8 Social security 8 «extended» Bismarck Model : «universal» social Insurance Based on employment; Contributions from employers and from workers graduated according to income, based on salaries Special insurance budget Obligatory and accessible for every citizen =/= Beveridge : public system based on taxes,

9 Social security 9 Illness incapacity - invalidity Professionnal sickness / work injuries Unemployment benefit Pension Family allowance Remunerated Holidays (20 days/year) Maternity (14 weeks)

10 10 + Social assistance: Minimum integration benefit Garanted benefit for old-age persons Garanted family allowance Disabled benefit

11 Social security 11 Financing: Employment Contributions 60-65% Taxes: State dotation «alternative financing» (VAT others)

12 Social security 12 Universal coverage Solidarity Equity : contribution according to revenues utilisation according to needs «security» Freedom Security peacefull society

13 BUT 13 For health care: also direct out-of-the pocket payments (28% of costs directly and indirectly): Co-payments Non reimbursed material or services also private insurance costs increase if sickness increase

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15 15 Health care system

16 Characteristics of the system 16 National Office of Social security National Institute for illness invalidity (disability) insurance (INAMI RIZIV) Mutual sickness funds (7) institutions, professionnals, + out-of-pocket payments

17 Actors 17 Mutual funds Administration of reimbursment Co-managers of the health protection Social and health services Complementary insurances Why? piece of history Voluntary sickness funds (villages, professions, sectors,.) since mid 19e 1944 universal system: 44% population were

18 Actors 18 GP : = 1/1000 Inhab 8500 FTE = 1/1300 inhab Specialists MD : = 2/1000 inhab Hospital based and ambulatory Other professionals nurses, physiotherapists, dentists, pharmacists, etc Hospital beds: 6,5 inhab Rest homes and nursing homes

19 Characteristics of the system 19 Public funding private workers : Sickness funds: private non profit Hospitals : private non profit OR public Physicians: self-employed GP s: solo professionals, in private office (at home), or groups (in development) SP s: in hospitals + private offices Nurses, physiotherapists: Salaried in hospitals

20 Characteristics of the system 20 With REGULATION Finances : reimbursed activities Supplementary financing Training programs (basic and continued) List of authorized and forbidden activities for professionnals Accreditation (with minimum basic training, and obligatory activities) Control of the professionnals and institutions

21 Characteristics of the system 21 IN CONSULTATION! Belgian specialty Social security budgets: consultation between employers, syndicates, and authorities Health insurance : consultation between sickness funds, professionnals, and authorities (administration INAMI) In commissions by sector: physicians, nurses, dentists, hospitals,

22 Characteristics of the system 22 «Cultural» values : Freedom of choice for the patient Freedom of installation Freedom of therapeutic decisions Good Patient-centredness But a few public-health concern

23 Effects on organisation 23 Effects: + Commitment of the professionnals + Quality of care + Motivation + Cultural adaptation (BUT patients?) - «NO System» system - informal coordination - measures above measures complexity

24 Effects on stasfaction 24 Satisfaction of population? moderated satisfied to very satisfied: GP s : 95% Dentists: 94% Specialised MD : 92% Home care: 92% Hospitals: 87%

25 Little detour 25

26 Public Purpose? 5 criteria s * 26 Social perspective concern for people s well-being, autonomy, human promotion, dialogue, taking to context into account Non-discrimation with regard to tace, gender, religion, political affiliation, social status, incomelevel, (sometimes positive discrimination for a kind of population or a specific disease with vertical program))

27 (a little bit) more than cure 27 Preventive services : Mother- child protection, Schools preventive medicine, work protection Vaccination Screening Health promotion? Prevention health education when disease

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29 29 Primary care

30 Family physician: base of the 1st line 30 GP are first contact professionnals Nurses, physiotherapists: only after physician s prescribing Dentists can also be directly contacted GP : 5 contacts / year/inhab 95% of population declares having a family physician 95% of population has been seen in 3 years No gate keeping

31 Missions of family physicians 31 Care of every person adressing a demand Accessibility : No discrimination for age, sex, social status, kind of health problem Integrated care Mainly to Cure Also prevention (1ary, 2ary, 3ary), palliative, rehabilitation Contributes to Continuity of care «from the cradle to the grave»

32 Organisation of GP s 32 Organisation of GP s: Majority: solo self-employed practitionners Increasing number of groupe practices Some multidiscipinary practices «Circles» : organisation of the family physicians, together on a defined territory To organise the permanence of first line care By rotation of the on call periods By special places «guard posts» Some other activities (training, )

33 Other actors 33 Nurses, physiotherapists, Solo or in at-home-service coordinations Specific centers Mental health Family planification Addictions Social help

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35 35 An alternative Community oriented Primary care centers

36 Primary care centers 36 Multidisciplinary : family physician, nurse, physiotherapist, receptionnist, Social worker, dietist, psychotherapist Health promotor Capitation for the majority Non lucrative private, Public accreditation With complementary financing

37 Primary care centers 37 Since increasing number since 1990 Today: 120 centers 3-8 new centers a year 5% of GP s, 30% of GP s <40 2% of population 15% in some places Members of federations (3) Our federation: 95 members With a charter, objectives, values

38 International perspective? 38 Willing to make an international network of community oriented primary care centers With common values and objectives: Quality of care Holistic care (medical, mental, social), People centred, Effectiveness, cost-effectiveness, continuity Multidisciplinary collaboration With a public purpose (see before) Accessible

39 39 Modifiez les styles du texte du masque Deuxième niveau Troisième niveau Quatrième niveau Cinquième niveau

40 40 Issues for tomorrow From my own opinion

41 41 Health issues : Ageing and chronic diseases Modifiez les styles du texte du masque Deuxième niveau Troisième niveau Quatrième niveau Cinquième niveau Complexity, co morbidities, holistic care

42 Health issues 42 Social inequalities on health Increasing after crisis? action on social inequalities! health promotion Mental health Health at work, and environmental health

43 Organisational issues 43 «shortage» of GP s and nurses And willing of better balance private /profess life Needs new concepts of care organisation Home visits more consultations Teams Evolution of tasks of each professional Place of new technologies:

44 Organisational issues 44 Greater role for the primary care «soft» gate keeping definition of tasks/roles/place of each professionnal betw 1st and 2d lines Transfer of financings from hospitals to primary care (ex mental health projects) Integration of prevention/health promotion with health care

45 Organisational issues 45 Vertical or Integrated?

46 And more 46 Universal Social security: to defend! Large scale solidarity, equity Marchandisation Place of the users / citizens in the system codecision?

47 Muito Obrigada