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Country Report Belgium 2015

Significant news during 2015 were the following:

- Ongoing implementation of the 6th State Reform, which transfers health competencies and budgets to the communities and regions
- Presentation and launch of pilot projects aimed at setting up the future Belgian health system
- Further budget cuts
- Ongoing dispute between the French-speaking and the Dutch-speaking communities related to the workforce planning and especially to the setup of a numerus-clausus.

Mrs Maggie De Block, the current liberal minister of Social Affairs (also a general practitioner) supports the transition from the current system based on the reimbursement of individual acts towards an all-inclusive prospective financing for each pathology in the future. After taking office last October 2014 Mrs. De Block immediately expressed her intention to launch health-system reforms for the hospitals, despite physicians’ opposition. According to a survey published in March 2015, 88% of the physicians are against a reform of the health system financing.
The Minister started informal talks with key stakeholders in order to schedule her hospital system and financing reform. For now, she has presented her plan to reform the Belgian health-system. This plan focuses on cost efficiency, clustering of the medical acts according to their complexity, while improving the overall quality by setting up a pays-for-performance scheme. It will be implemented progressively, in association with all stakeholders. The health system reform steering committee met several times and received no less than 470 proposals from the key stakeholders to reshuffle the Belgian healthcare system. Some pilot projects were implemented such as projects aimed at reducing the length of postnatal hospital stay. In the meantime, the Minister presented the schedule to implement further digitalization of the sector. She also set up a working group in order to re-write the former AR N°78, the national legislation which regulates the statute of the healthcare professionals, as well as their duties and responsibilities.

As to the 6th State reform, infrastructure budgets and heavy medical budget were transferred to the communities, under the supervision of the Belgian Court of auditors. Not only budgetary problems are expected, but also heavy medical equipment allocation problems (MRI, Pet-Scans a.o.) since equipment allocation depends on local government.
At the end of 2015, there is still no agreement about the medical workforce planning and training. The “Raad van Staat”, Belgian highest administrative court, recently allowed French speaking students to pursue their studies taking the risk of being deprived of license to practice when they graduate. The physician register was published in May 2015. It should help the planning authority to assess the physician supply and to identify specialties in shortage in Belgium. Despite the rationale of the process, physician and health resource planning in Belgium becomes more and more a very sensitive political issue.

Dr B. Maillet