Transcript Health care system in Belgium

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
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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
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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)
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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)
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Supplementary insurance policies:
voluntary
offered 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…
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Public health system in
danger
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Budget of RIZIV: 15,3 billion euro
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Reimbursement of medicines: 2,7
billion euro:
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Rise of 4% / year
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)
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High prices
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Higher 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)
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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 million
Euro)
1.Lipitor
Cholesterol lowering drug
Pfizer
70.9
2.Zocor
Cholesterol lowering
drug
Merck Sharp&Dohme
44.4
3.Amlor
Anti-hypertensive
drug
Pfizer
34.5
4.Cipramil
Anti-depressant
Lundbeck
33.2
5.Pravasine
Cholesterol lowering
drug
Birstol-Meyers Squibb
26.8
Why medicines bring the
system in danger? (3)
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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
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Why medicines bring the
system in danger? (4)
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“New” product: Lucentis (2.000 dollar)
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Same active component as Avantis
(cancer): 20 dollar
Study of National Institute for Health
Care Management (NIHCM):
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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)
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Irrational use of medicines and
marketing
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Direct 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)
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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
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The most efficient and accessible
health policy
 Highest health protection at the lowest
price
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A rational drug policy exists(2)
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Strategy of the new institute:
Independent team of experts
 Scientific demand-driven analyses
 Objective, scientific criteria and
studies
 Public bidding or cross deals
 Reimbursed if it has a clear
therapeutic surplus value
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Challenges (1)
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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
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Challenges (2)
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More and more coercive directives of
the European Commission, where
health a part is of the sector
entreprises
TRIPS: prices rose with 12 to 200%
 Availability of cheaper generic
medicines slow down
 97 of patents are registered in rich
countries
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Challenges (3)
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Nationalization of the pharmaceutical
industry is needed, but a national
drugs policy on public tender as the
kiwi-model would be a valuable step