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Reimbursement mapping: BELGIUM

Reimbursement mapping: BELGIUM. 2011. Content. Key Economic Indicators Healthcare Overview Reimbursement Systems Market Access Funding Mechanisms HTA Decision makers, Acronyms and Links Austerity Measures 2011. Key Economic Indicators Belgium. Healthcare system overview.

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Reimbursement mapping: BELGIUM

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  1. Reimbursement mapping: BELGIUM 2011

  2. Content • Key Economic Indicators • Healthcare Overview • Reimbursement Systems • Market Access • Funding Mechanisms • HTA • Decision makers, Acronyms and Links • Austerity Measures 2011

  3. Key Economic Indicators Belgium

  4. Healthcare system overview • The health care system is managed by the federal government and for the disabled persons by the regions. The budget is fixed annually by the government (in October) and must be agreed by the parliament. All the salaried and self-employed workers are covered. • The medical devices industry (incl. consumables, capital goods and systems, implants and IVD) has a turn-over of 3,4 billion € (UNAMECs' annual report with the collaboration of the National Banque of Belgium). • Belgium has over 200 hospitals in all, and 70% belong to the private sector, the number of private sector beds is close to 65%. There is similar distribution pattern for acute care and specialty hospitals. 64% of acute care hospitals belong to the private sector and close to 36% are public.

  5. Reimbursement system • The reimbursement system is very complicated and based on the fee-for-service principle. • A lot of products are on the list and the maximum reimbursement price is fixed by the commissions of the Belgium national institute. • When a product is on the list, quite never is possible to get an increase of the price.

  6. Funding Mechanisms DRG system • In Belgium there is a uniform national application of the DRG-system in all the three regions and there aren’t local variants of it. • The DRG-system is based on the length of stay and the discrepancy between DRGs is mainly focused on activity. • For this reason, the same activity is reimbursed with the same fee in every hospital in Belgium and the system is homogeneous. • The impact of DRG on a hospital’s resources is 16% and the sickness funds do not have access to the DRG-information of the hospitals. Some medical materials are paid by the hospital budget which is calculated on DRGs but important medical equipment and installations are in most cases financed by surgeons and hospitals. • Sometimes, there is also a direct remuneration from the government within the hospital budget. The nomenclature in use is based on the APR-DRG.

  7. HTA • HTA Agency: KCE (national) set up in 2002 • HTA Proposer/ Initiator: Anyone can propose a topic • Technology Selection Criteria: • Important health issue or delicate socio-ethical problem; • Topics included in management plans of government; • Update of previous assessments • HTA aim: Informative • Type of Data required: Safety, Efficacy, Cost-effectiveness • HTA link to Funding and Reimbursement: INAMI2 may take KCE HTA reports into consideration for: • reimbursement tariff • product price • target population

  8. Links

  9. Austerity measures Hospital budget cuts (compared to the previous year) • The budget for 2011 is 25.8 billion €. Compared with 2010 this means an increase of 6% (4.5% increase by law + 1.5% increase = index). The government decided to transfer 1.1 billion € to the budget of social security. So the new healthcare budget for 2011 is 24.7 billion € or +/- 500 million € more than budget 2010. Price referencing (domestic and cross-border) • Prices are compared with those of Germany, the Netherlands or France for the implants. The companies have to introduce a price dossier for most of the implants with the prices of other countries.

  10. Austerity measures • The continuous growth in health care expenditure have resulted in Belgium – as in many other countries – in automatic fee cuts or non-indexing (inflation correction) to compensate for the anticipated or estimated expenditure exceeding the budget provided. • Consequently, the Belgian nomenclature has become an exclusive and preferred instrument for cost containment instead of a tool for the correct distribution of health care budgets among the different providers.

  11. BELGIUM

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