Healthcare in Belgium

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University Hospital of Antwerp

Healthcare in Belgium is best depicted as a 3 legged table-like structure standing over the patient. The table-top is a primarily publicly funded healthcare and social security service, run by the federal government, which organizes and regulates the Healthcare. The first leg provides healthcare in the form of independant private practisioners and public, university and semi-private hospitals and care institutions, there are a few (commercially run for profit) private hospitals.[1] The second leg is the insurance cover provided to patients and the third leg is formed by the industry which covers production (and distribution of healthcare products) and research & development, although an important part of the research effort is done in universities and university-labs and -hopsitals.

Organization[edit]

Healthcare in Belgium is mainly the responsibility for the federal minister and the so called "FOD Volksgezondheid en Sociale Zekerheid / SPF Santé Publique et Securité Sociale" (in english "the Public Administration for Public Health and Social Security") for some matters responsibility is delegated to the autorities of the Communities however in practise these responsibilities are exercised by the Flemish Regional gouvernment, French (Walloon) Regional gouvernement and by the German-speaking Community gouvernement. Both the Belgian federal government as the Regional governments have their proper ministers for public health and a supportive administrative civil service.

Political and regulatory[edit]

Territorial Competence Administrative service
Federal
Legislative Federal Parliament
Executive Federal Minister of Public Health and Social Security [2][3] Maggie De Block (2014-2019)
Judiciary Administrative court : Council of State (Raad van State / Conseil d'État)

Appeals : Court of Labour (Arbeidshof / Cour du travail)
First Instance : Labour Court (Arbeidsrechtbank / Tribunal du travail)

Public Administration for Public Health, Food Chain Safety and the environment [4] (FOD Volksgezondheid, Veiligheid van de Voedselketen en Leefmilieu / SPF Santé publique, Sécurité de la Chaîne alimentaire et Environnement)

Public Health

MEDEX:[5] Department for Medical Expertise
  • Civil service staff, absences, accidents at work, work related diseases
  • Medical certification of Pilots & air traffic controllers
  • Medical certification of professional drivers
  • Medical certification of ship officers
  • Warvictims & Military victims in peacetime
  • Victims of violent crime
  • Ombudsservice
  • Medical evaluation centres
Superior Health Council:[6] Scientific advisory board
  • Psychiatric health care : behaviour issues, addiction, education in psychiatric healthcare, best practise in therapy
  • Environmental issues : Ionising radiation, sound & dustpollution
  • Chemical environmental issues : chemical agents, pollution agents, biocides and pesticides
  • Health and safety in nutrition and in the foodchain
  • Biohazards : (human) blood products, tissues and organs, infectous diseases, epidemiological control
  • Cosmetology
  • Public Health Genomics
Consultative bodies:[7] Commissions and consultations between public administration and healthcare institutions and organisations
National Council for Hospitals and Careinstitutions Nationale Raad voor Ziekenhuisvoorzieningen (N.R.Z.V.) Concertation and coordination advisory council between gouvernment and hospitals & careinstitutions
Multipartite structure Consultation advisory council constituted of :
  • professional organisations of :
    • physicians, Gp's and specialists,
    • nurses
    • other medical practitioners
    • hospitals and careinstitutions
    • medical insurers
  • the Government
  • Experts from
    • Public health, food chain safety and Environement
    • Institute for public sickness insurance and handicaps Rijksinstituut voor Ziekte- en Invaliditeitsverzekering (RIZIV)
    • Institute for knowledge about health care Federaal Kenniscentrum voor de Gezondheidszorg (KCE)
    • National Council for Hospitals and Careinstitutions Nationale Raad voor Ziekenhuisvoorzieningen (N.R.Z.V.)
    • Commission for control of the Healthcare budget and RIZIV
  • Inspectorate of Finance (From Treasury dept., public spending).
Joint Commission (De Nationale Paritaire Commissie Geneesheren-Ziekenhuizen"') Consultation and advisory commission Physicians - Hospitals
Commissions Workinggroups (Special Interest Commissions) on :
  • Telematica (application of digital technology)
    • Hospitaldigitisation
    • Healthnetworks
    • Communication 1st & 2nd-line care
    • Digital data communication of care practitioners
    • Personal health data management
    • Remote healthcare
  • Embryo in vitro
  • Antibiotics
  • Patientenrights
  • Euthanasia
  • Abortion
Federal Platforms Advisory boards for :
  • Palliative care
  • Psychiatric care
  • Coma patients
  • Hospital hygiene
  • Bloodtransfusion (BeQuinT)
Board of physicians : Medical practise, quality and evaluation advisory:
  • Cardiac Pathologies
  • Geriatrics
  • Specialised Emergency respons and care
  • Intensive care
  • Chronische Rhenal Insufficiency
  • Mother and newborn infants
  • Medical imaging and Radiation therapy
  • Reproductive Health
  • Oncology
  • Peadiatrics
Interministerial and intergouvernemental conferences Consultative and coordination between Ministerial Depts. of Federal and Regional gouvernements
  • Agriculture
  • Foodsafety
  • Scientific R&D Policy
  • Public health
    • General policy
    • Epidemic control
  • Drugspolicy
Committees Consultative committees
  • Belgian councelling Committee for Bio-ethics
  • Medical - pharmaceutical commmittee
  • Federal breastfeedingcommitteee
  • Commitee for medical utensils an machinery
Planning Commission Investigates th Demand for Care practitioners and plans the offer
  • Working group on physicians (GP) and specialists
  • Working group on fysiotherapists
  • Working group on dentists
  • Working group on nurses
  • Scientific working group
Scientific Institute of Public health :[8] Scientific expertise in public healthcare
Directorate Communicable and infectious diseases  : plays an important role within the Belgian, European and international networks of surveillance and respons to infectious diseases and food safety hazards.
  • detection
  • early and rapid identification
  • microbiological monitoring of communicable and infectious agents,
  • preventing and treating such diseases.
  • Food borne pathogens
  • Bacterial diseases
  • Viral diseases
  • Mycology and aerobiology
  • Immunology
Directorate Expertise, service provision and customer relations  : providing the logistical, technical and scientific support.
  • Biological standardisation : Assessment and checking of the quality of biological medicines for human use (vaccines and blood products) before market
  • Quality of medical laboratories : Assessment and checking of the quality of clinical biology laboratories and in vitro diagnostic medical devices
  • Biosafety and biotechnology & platform Molecular biology and biotechnology : Assessment of the risks linked to the use of genetically modified organisms (GMOs)
Directorate Food, medicines and consumer safety analytical chemical research to promote public health : to detect the presence of chemical substances in food, consumer non-durables and the environment; scientific research in the following domains:
  • Medicines
  • Consumer safety
  • Chemical residues and contaminants
Directorate Public Health and surveillance epidemiology and toxicology centre to provide reliable, practical and impartial information on the health of the Belgian population, inform the policy makers and population on factors that influence public health and public health policy.
  • risk factors that affect health and well-being
  • monitoring health problems illnesses that constitute a risk to public health
  • assess the impact of lifestyle on public health a
  • improve the quality of care
  • assess the risks of exposure to chemical substances and radiation
  • coordinating sharing an transmission of health information in Belgium
Belgian GLP Monitoring Programme Quality Assurance Bureau (QAB) of IPH has been the official GLP (Good Laboratory Practice) Monitoring Authority for Belgium since 1988
Federal Agency for medicines and health products.[9] is the competent authority for medicines and health products in Belgium

Safety of the food chain

Federal Agency for the Safety of the Food Chain (FASFC).[10] is the competent authority for safety of the food chain in Belgium

Environment

Federal agency ofr neuclear control [11] FANC monitors and controls the general public, workers an the environment against the dangers of radiation

Plants and animals

CODA-CERVA (Veterinary and Agrochemical Research Centre [12] proactive policy in terms of food production safety, animal health and public health, at both the Federal and international levels :
  • Scientific research
  • Expert advice
  • provision of services
    • Veterinary activities
      • Epidemic, endemic and emerging transmittable diseases in animals
      • Zoonotic and emerging infectious diseases threatening public health
      • Epidemiology : surveillance, risk analysis, and molecular epidemiology
    • Agrochemical activities
      • Contaminants and the quality of the environment in the framework of safe food production
Flemish Community
Legislative the Flemish parliament
Executive the Flemish Gouvernment, competent minister for welfare and social affairs : Jo Van Deurzen [13]
Judiciary none competent at this level
The competent administration is the Flemish Public service for Family-matters, Well-being and Health [14]
  • Health strategic competences
    • Public smoking ban, regulation an control, Assistance abandonning smoking
    • Regulations on sale of alkohol
    • Drug and alcohol abuse and addiction
    • Health risks in construction
    • Radiation of wireless antennae
  • Subsidizing
    • Schoolmilk and schoolfruit
    • Controle on food quality and industrial kitchens
    • Seksual health
    • prevention Hearing dammage
  • Help and assitance for
    • Psychological help
    • Violence and Abuse
    • Addiction
  • Healthcare
    • Prevention
    • Vaccination programs
    • Prevention in Hospuatla and care environments
    • Patientrights
    • Care insurance
  • care situations
    • Homecare
    • Psychiatric care
    • Care for the eldery
    • Palliative care
  • Handicap
    • Basic support budget (Basisondersteuningsbudget - BOB) and Personal assistance budget (Persoonsvolgende budget - PVB) financial support programs for the handicapped
    • Elderly support benefit
    • Assistance for people with limited mobility
    • Recognition as handicapped person / carer
    • Assistance with living for handicapped
    • Learning an working for the handicapped
    • Mobility issuers for the handicapped
French Speaking Community
Legislative the Parliament of the French-speaking Community
Executive [15] the Walloon gouverment Competent minister Joelle Milquet.
Judiciary none competent at this level
The competent administration is the "Direction de la Santé Publique de la federation Wallonie- Bruxelles" [16]
  • Health strategic competences : Public anti- Addiction programs smoking ban, Drug and alcohol abuse and addiction support
  • Schoolhealth and school kitchens
  • Healthcare Prevention, Vaccination programs
  • care situations  : Homecare Psychiatric care, Care for the eldery, care for the handicapped
German-speaking Community
Legislative the Parliament of the German-speaking community
Executive the gouvernment of the German-speaking community Competent minister for welfare and social affairs.
Judiciary none competent at this level

Provincial authorities
Legislative the Provincial Council : which is the elected body
Executive the Deputation or Provincial College and the Governor, who is appointed by the regional government, are the executive body, within that college one deputee has the responsibility for welfare and social affairs.
Judiciary none competent at this level
The Provicial authority for wellfare is competent for matters that transcend the local level or local competences.
  • Assistance of people with disabilities and special needs
  • Assistance with chronic care
  • Assistance with psychological care
  • Assistance for palliative care
  • Care for the elderly
  • Care for children taken into public care by the juvenile judge
  • Hygienic controle of industrial kitchens
  • Monitoring and registering of genetic birth defects

The provincial authority is also competent for catastrophy planning and management of the emergency services,

  • Ambulance services
  • Firefigthing services, including the Civil protection service
  • private subcontractors (towing services, salvage, lifting and transport services) in case of emergencies or catastrophies
  • Coordination of all emergency services (police, highway services, army) during catastrophies
Local authorities
Legislative City or Communal Council
Executive College of Mayor and Aldermen ; dedicated alderman for Social affairs
Judiciary none competent at this level
The Public Centre for Social Welfare is a local authority public service
  • in Dutch : Openbaar centrum voor maatschappelijk welzijn (OCMW),
  • in French Centre public d'action sociale (CPAS)
  • in German Öffentliches Sozialhilfezentrum (ÖSHZ).

In larger cities these public services manage large budgets, with a substantial administrative burden and run Hospitals, Clinics, Rehab-centers, Old-age pensioners residences and day care centres. The largest PCSW for example is the one in Antwerp it managed in 2013 a budget of 461 million Euros and paid benefits to people with no or very small incomes for a total of 125 million , the PCSW employs a workforce of over 1000 people,[17] the Hospitals and other care institutions are grouped into a separate organisation called ZNA [18] (Care Network Antwerp) hat employs another 7000 people, and had a budget of around 568 million euros in 2010.


Organisation of Care[edit]

Physicians[edit]

Private practise :

  • General Practitioners (family doctors)
  • Specialists
  • Expert and Assessment consultants

Clinical practise :

  • Specialists
  • Research clinicians

Hospitals[edit]

General structure :

  • ER : emergencies and trauma
  • Polyclinical consultations
  • Technical interventions
  • Nursing units
  • Specialised units
    • Neo-natal and Peadiatric clinics
    • Re-hab and recovery clinics
    • Geriatric clinics
    • Palliative care units
    • Psychological care clinics
  • Research units

Nursing[edit]

  • Nursing is hospitals
  • Nursing in research and polyclinical environment
  • Ambulant nursing (home care)

Pharmacy[edit]

  • Main street Pharmacies
  • Hospital Pharmacies
  • Distribution of Care products


Health Insurance[edit]

The government pays each mutual health association depending upon the number of registered members. Most of them are (historically) affiliated to a political institution, however there is no substantive difference between them as reimbursement rates are fixed by the Belgian government. Insurance funds do not cover 100 per cent of the patient's bills and typical reimbursement is between half to three-quarters of a typical doctor or specialist visit. Insured persons have a standardized credit card style SIS-cards which are needed in pharmacies and hospitals.

The first national law concerning the finance and provision of health care was enacted in 1894, with social insurance being introduced in 1945.[19]

Social security[edit]

Social security is given to people who need compensation for "social burdens" (disease, children, ...) or to people who do not have income at all, due to unemployment or as pensions. Pensions make up the largest portion of the National Institute for Disease and Invalidity Assurance (RIZIV/INAMI), which is the public institution which makes the financial reimbursements, and which is the core spending of the Belgian state. During the negotiations for the sixth state reform, it was agreed upon to transfer the responsibility for child benefits to the communities.

See also[edit]

References[edit]