DOCSLIB.ORG

Justice & Solidarity in Priority Setting in Healthcare

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Justice & Solidarity in Priority Setting in Healthcare JUSTICE & SOLIDARITY IN PRIORITY SETTING IN HEALTH CARE p. 1 JUSTICE & SOLIDARITY IN PRIORITY SETTING IN HEALTHCARE IDENTIFYING AND DISCUSSING THE ETHICAL AND SOCIETAL ISSUES IN RESOURCE ALLOCATION p. 2 JUSTICE & SOLIDARITY IN PRIORITY SETTING IN HEALTH CARE COLOPHON Justice and solidarity in priority setting in healthcare. Identifying and discussing the ethical and societal issues in resource allocation A joint publication of the King Baudouin Foundation and the Belgian Advisory Committee on Bioethics WRITERS AND EDITORS Lieven Annemans, Marc Bogaert, Yvonne Denier, Alain Denis, Ignaas Devisch, Felix Gurtner, Bjørn Hofmann, Richard Huxtable, Faraz Kermani, Frits Lekkerkerker, Christian Léonard, Joël Ménard, Mireille Merckx, Raf Mertens, Barbara Prainsack, Lise Rochaix, Karin Rondia, Harald Schmidt, Jochen Vollmann All contributors to the report are listed in Appendix 3. The report is the result of a workshop that took place in Brussels in December 2012. The Foundation gratefully acknowledges the stimulus received from all participants. FINAL EDITING Steve Judd and Dianna Rienstra COORDINATION KING BAUDOUIN FOUNDATION Brigitte Duvieusart, Pascale Prête, Gerrit Rauws, Tinne Vandensande BELGIAN ADVISORY COMMITTEE ON BIOETHICS Marc Bogaert, Yvonne Denier, Paul Schotsmans, Veerle Weltens GRAPHIC CONCEPT & LAYOUT Kaligram COVER ILLUSTRATION Jürgen Ovens (1623-1678), Justice Download this publication free of charge from www.kbs-frb.be Legal deposit: D/2893/2013/10 ISBN-13: 978-90-5130-810-5 EAN: 978-90-5130-8 ORDER NUMBER: 3142 June 2013 With the support of the Belgian National Lottery JUSTICE & SOLIDARITY IN PRIORITY SETTING IN HEALTH CARE p. 3 TABLE OF CONTENTS Foreword Gerrit Rauws ................................................................................................5 Introduction Paul Schotsmans........................................................................................................ 6 1 Reconciling evidence, excellence, effectiveness and emotions? – Raf Mertens ................................9 2 Taking solidarity seriously – can it help? – Barbara Prainsack ................................................. 21 3 Ten case studies - A springboard for discussion ............................................................ 31 Case 1 – Cancer treatment for patients with low life expectancy ........................................... 32 Zytiga and treating prostate cancer – Faraz Kermani Case 2 – Expensive and innovative treatments for rare diseases ........................................... 36 Myozyme and the treatment of Pompe’s disease – Frits Lekkerkerker Case 3 – Interventions for personal convenience:........................................................... 40 The case of growth hormone treatment for non-deficient children – Lise Rochaix Case 4 – Contraception for young girls A complex issue – Mireille Merckx ............................................................................ 44 Case 5 – Individual responsibility and lifestyle ............................................................. 47 Incentive programmes for losing weight – Harald Schmidt Case 6 – Medication when lifestyle change is an option .................................................... 52 Reflection on the use of statins for primary prevention of cardiovascular diseases – Christian Léonard Case 7 – Futile diagnostic tests ............................................................................. 56 Excessive use of X-ray imaging – Bjørn Hofmann Case 8 – Interventions at the boundaries of healthcare .................................................... 60 The case of psychotherapy – Felix Gurtner Case 9 – Expensive treatments with limited effectiveness .................................................. 64 The case of medications for Alzheimer’s disease- Joël Ménard Case 10 – Transition from therapeutic to palliative care The ethics of a decision to limit life-prolonging treatment – Richard Huxtable.................................. 68 p. 4 JUSTICE & SOLIDARITY IN PRIORITY SETTING IN HEALTH CARE 4 Personalized medicine and priority setting in future European healthcare – Jochen Vollmann.............. 75 5 A review of the societal and ethical issues – Marc Bogaert, Yvonne Denier, Ignaas Devisch, Karin Rondia ........ 87 European healthcare systems – core values ................................................................ 89 Solidarity Justice Responsibility Societal developments ....................................................................................105 Growing individualism, wish-fulfilling medicine and well-being Enhancement and technological push: from fate to risk management Preventive and predictive medicine Autonomy and shared decision-making Major challenges to current healthcare system............................................................115 The growing impact of lifestyle diseases Medicalization Financial issues 6 Lessons learned – Lieven Annemans, Marc Bogaert, Yvonne Denier, Alain Denis ................................127 Developing a conceptual framework Values and objectives Criteria Structures and processes Stakeholders Enablers and inhibitors Which way forward? ...............................................................................................159 Appendices 1. Glossary of terms .........................................................................................157 2. Programme of the workshop ..............................................................................159 3. Contributors – Biografical Information.....................................................................162 4. Composition of the KBF Advisory Committee . 168 5. Partners ..................................................................................................169 JUSTICE & SOLIDARITY IN PRIORITY SETTING IN HEALTH CARE p. 5 FOREWORD This publication is the result of a European workshop held in December 2012 in Brussels, as a joint initiative of the King Baudouin Foundation and the Belgian Advisory Committee on Bioethics. We brought together a diverse group of 30 ex- perts, coming from a variety of backgrounds and with different perspectives, for a very intensive two-day programme. All participants1 were invited to identify and discuss the societal and ethical values at stake in healthcare reimbursement decision making, starting from the current reality and specifically using exemplary cases that are on the agenda in several countries in Europe. This mapping and framing workshop is the first step in an ambitious project aiming to explore ways in which these decisions can be made more consistent with ethical reasoning and societal preferences. The rationale of this project is as follows: one of the models that define the objectives of a good healthcare system refers to accessibility, sustainability and quality. Increasing tensions exist between these three areas, as both healthcare needs and new technologies exceed affordable supply in Western healthcare systems. As a result, resource allocation decisions are inevitable. This raises two issues. The first is the willingness to pay for this system given that we are currently in an economic crisis. The second is distributive justice, or the distribution of resources within the system. These are a few of the criteria that are often used to evaluate decision-making mechanisms in the healthcare system. Our starting point is that the social and ethical aspects of medical and technological innovation should be discussed just as seriously as the scientific, technical and economic aspects. Decision-making processes within the health system should be sufficiently robust to deal with all of these aspects and dimensions. Individuals can then question whether this is the case in the current system in their countries. The central question facing this project is: How can we better integrate social values and preferences in current healthcare reimbursement decision-making? We are not calling for the construction of a completely new system. We are not utopians. A more operational question would be: How can we integrate new tools, new actors or new tasks within existing policy frameworks in Belgium or elsewhere? The main geographical focus of this project is Belgium, but similar questions and challenges arise in most European countries. As a result, we decided to open the discussion to what is taking place in neighbouring countries. We hope that this publication will be of use for those reflecting on these issues and help them to gain a deeper understanding of what is at stake. During the workshop 10 case studies were introduced and discussed, three keynote contributions were presented and four discussion panels were conducted.2 The participants covered issues related to both substance and governance. This publication is intended to offer insight into these issues. This is an ongoing process and we will be continuing to share new insights and improvements in practice. Gerrit Rauws Director of the Health Programme King Baudouin Foundation 1 For information on participants, see Appendix 3. 2 Appendix 2 contains the programme of the workshop. p. 6 JUSTICE & SOLIDARITY IN PRIORITY SETTING IN HEALTH CARE INTRODUCTION The Board of the Belgian Advisory Committee on Bioethics enthusiastically accepted the invitation to collaborate with the King Baudouin Foundation on this project. The Belgian Committee receives numerous requests for opinions on justice and solidarity in the Belgian healthcare system. Having issued a very wide-ranging opinion in the First Mandate
Load more

Recommended publications
  • Learning to Collaborate Interprofessionally in Health Care
    Learning to collaborate interprofessionally in health care Proefschrift voorgelegd tot het behalen van de graad van doctor in de medische wetenschappen aan de Universiteit Antwerpen te verdedigen door Giannoula Tsakitzidis Promotoren Prof. dr. Paul Van Royen Prof. dr. Herman Meulemans Co-promotor Prof. dr. Steven Truijen Prof. dr. Olaf Timmermans Faculteit Geneeskunde en Gezondheidswetenschappen Antwerpen 2018 Dissertation for the degree of doctor in Medical Sciences at the University of Antwerp Proefschrift voor de graad van doctor in de Medische Wetenschappen aan de Universiteit Antwerpen Learning to collaborate interprofessionally in health care Leren interprofessioneel samenwerken in de gezondheidszorg Giannoula Tsakitzidis Promotoren: prof. dr. Paul Van Royen prof. dr. Herman Meulemans prof. dr. Steven Truijen prof. dr. Olaf Timmermans Faculteit Geneeskunde en Gezondheidswetenschappen Antwerpen 2018 Jury Promotors: prof. dr. Paul Van Royen (UA, Medicine and Health Sciences) prof. dr. Herman Meulemans (UA, Social Sciences) prof. dr. Steven Truijen (UA, Medicine and Health Sciences) prof. dr. Olaf Timmermans (HZ University of Applied Sciences, The Netherlands) Chair: prof. dr. Benedicte De Winter (UA, Medicine and Health Sciences) Members: prof. dr. Johan Wens (UA, Medicine and Health Sciences) dr. Griet Peeraer (UA, Design Sciences) dr. Yvonne van Zaalen (Fontys University of Applied Sciences, The Netherlands) prof. dr. André Vyt (Ghent University and Artevelde University College) “Knowing is not enough; we must apply. Willing is not
    [Show full text]
  • SWOT Analysis of Healthcare in Argentina 16
    Global Longevity Governance Landscape 50 Countries Big Data Comparative Analysis of Longevity Progressiveness www.aginganalytics.com 50 Regions Practical Recommendations Countries with Low HALE and Life Expectancy and High Gap: 3 Recommendations United States Iran In death ratio some improvements are observed owing to The health system is one of the most complex systems with declining death rates from the three leading causes of death many variables and uncertainties. The management of this in the country -- heart disease, cancer and stroke. But in system needs trained managers. One of the current recent years, in United States costs of healthcare provision shortcomings is lack of those specifically trained for this have started to rise much more quickly with greater use of purpose. There is all high income inequality in the country. modern technological medicine. While spending is highest, Government should improve access in healthcare coverage the United States ranks not in the top in the world for its for the families with a low income. levels of health care. So, first of all, in order to improve HALE Turkey government should improve health insurance for poor Turkey faces a health care system inefficiencies. Infant population as there is big income inequality and reduce high mortality rate is relatively high and not all population had administrative costs for cost efficiency. The government health insurance, resulting in unequal healthcare access should focus on medical advances, some improvements in among different population groups. It is need to improve lifestyle, and screening and diagnosis. access for high-quality healthcare services and target the Estonia main causes of death through government initiatives.
    [Show full text]
  • Belgium 2016-2022 V.U
    Country Cooperation Strategy WHO - BELGIUM 2016-2022 V.U. / Ed. Resp. : Decoster Christiaan. Place Victor Hortaplein, 40/10, 1060 - Brussel/Bruxelles. Grafisch ontwerp/Conception graphique : Thierry Sauvenière Copyright: Pavel Parmenov - 123rf.com Country Cooperation Strategy WHO - BELGIUM 2016-2022 Chapter 1 Introduction It is the first time that Belgium and the World Health Organization (WHO) sign a Country Cooperation Strategy (CCS). The CCS is a medium-term strategic frame- work for cooperation among both partners and outlines a shared agenda with priority areas of work for six years. The CCS will guide WHO in its work with Belgium in line with WHO’s global health priorities, core functions and comparative advantages. The formulation of a stra- tegic agenda ensures that the main priorities continue to be addressed irrespec- tive of changes of government and ministry officials and ensures continuity in the programme of technical assistance delivered by the Organization. Further- more, this CCS highlights Belgium’s contribution to the global health agenda in general and to WHO in specific. In the past, Belgium has had a relationship with WHO through Biennial Collabo- rative Agreements (BCAs), which mainly focused on the contributions of Belgium to WHO. This is the first time that the two parties also define a strategic agenda for joint work. This CCS covers the period from 2016 to 2022. The CCS for Belgium was elaborated over a number of months. The process in- volved internal and external consultations and provided an opportunity for Bel- gium to evaluate the aims, objectives, targets and priorities in its various active policies, strategies and action plans.
    [Show full text]
  • Belgium ?’ Belgium Compared to Other Member States Is… ?’
    Introduction to the Belgian Health System Lieven De Raedt FPS Health, Food Chain Safety & Environment Intro Eurobarometer: Based on what you know, do you think that the quality of healthcare in (OUR COUNTRY) compared to other Member States is… ? Source: Eurobarometer (April 2010) Patient safety and quality of healthcare Intro EUROBAROMETER: ‘How would you evaluate the EUROBAROMETER: ‘Based on what you know, do you think that the quality of healthcare in overall quality of healthcare in Belgium ?’ Belgium compared to other Member States is… ?’ [Eurobarometer BE (Fieldwork 23/11‐01/12/2013)] Intro “From a citizen’s perspective, the assessment is quite positive: a large part (78%) of the Belgian population reports to be in good health, which is a better result than the EU‐15 average. The Belgian population also reports to be satisfied with their contacts with the health system, especially in ambulatory care. However, a more balanced image appears when examining the whole set of indicators.” (KCE Report 259C – Performance Report 2015) Content 1. Belgium for Beginners 2. Characteristics of the Belgian Health system 3. Performance of the Belgian Health system 4. Conclusion 1. Belgium for Beginners 1. Belgium for Beginners Geography, Socio‐demography, Economy • 11.250.585 inhabitants/ 30.528 km² • 3 official languages: Dutch ‐ French –German • Open market and primarily service oriented economy • GDP/capita > €36.000 • Considerable Pharmaceutical Industry 1. Belgium for Beginners Geography, Socio‐demography, Economy [DRAFT country profile Belgium –OECD; Observatorium;EC] 1. Belgium for Beginners Political and historical context • Constitutional monarchy with a parliamentary system of governance • Federal state • Legacy of strong “pillarization” (e.g.
    [Show full text]
  • Driving Value for Patients and the Belgian Healthcare System
    Driving value for patients and the Belgian healthcare system Pact for strategic investments Report of the Health Working Group1 September 2018 1 For an overview of the members of the Health Working Group, see Annex 1. 1 TABLE OF CONTENTS Executive Summary ................................................................................................................... 3 1. Context ................................................................................................................................... 8 An efficient, high-quality and widely accessible healthcare system ................................8 A world-renowned biopharma & medtech cluster ............................................................8 Opportunities and challenges ahead ................................................................................ 10 Figure 5: How worldwide trends will affect top-flight healthcare delivery in 2030 .............. 11 2. The patient at the very core of our healthcare vision for 2030 ......................................... 12 3. Reform and investment priorities ....................................................................................... 14 3.1. Having ambitious data governance and intelligent health information systems .. 14 Investment priority #1: Top-flight Electronic Health Record ........................................ 15 Investment priority #2: The data-for-health one-stop shop ......................................... 18 Investment priority #3: The data-for-health academy .................................................
    [Show full text]
  • Doctoraatsthesisdefinitief.Docx
    Studies on Communication Exchange in Healthcare in Flanders, Belgium Peter Vermeir 2017 PROMOTORS Professor Dr Dirk Vogelaers Professor Dr Dominique Vandijck Thesis submitted to fulfill the requirements for the degree of Doctor in Health Sciences Peter Vermeir Doctoraatsthesis Universiteit Gent Copyright © 2017 Niets uit deze uitgave mag worden verveelvoudigd en/of openbaar gemaakt door middel van druk, fotokopie, microfilm, of op welke andere wijze ook, zonder voorafgaande schriftelijke toestemming van de auteur. ISBN: Dit project werd mogelijk gemaakt door UZ Gent – Dienst Algemene Inwendige Ziekten De Pintelaan 185 9000 Gent Tekening op de cover werd gemaakt door één van mijn zonen, Arne. Arne heeft het Fragiele X-syndroom. Dit is de meest voorkomende genetische oorzaak van ontwikkelingsstoornissen en van een verstandelijke handicap. Ons bijzonder kind Een bijzonder kind.... Van de buitenkant zie je niets, Maar aan de binnenkant is er iets, Het is net of hij twee persoontjes is. Soms is het goed en soms is het mis. Andere mensen denken: dat is er een met pit. De wereld zit voor hem moeilijk in elkaar, Hierop reageert hij vaak. Het zijn al die prikkels die het zo moeilijk maken, Die in zijn hoofd de weg steeds kwijtraken. Dan is hij boos op de wereld om hem heen. En sluit hij zich af, is hij het liefst alleen. Hij drukt zich dan uit in zijn eigen taal. En dat maakt hem zo speciaal. Onze zoon Arne Studies on Communication Exchange in Healthcare in Flanders, Belgium Promotor Prof. Dr. Dirk Vogelaers Department of Internal Medicine, section of General Internal Medicine, Ghent University, Belgium Co-promotor Prof.
    [Show full text]
  • Belgiumissue
    WWW.TOGETHERMAG.EU MARCH 2012 #29 The Made in Belgiumissue IN THE LEAD Noémie Wolfs IN FASHION Céline De Schepper MAN AT THE TOP Elio Di Rupo GOURMET HEAVEN Brusselicious 2012 MOUNTAIN HOLIDAYS Kilimanjaro, Nepal and Mongolia The new AMPERA MONSIEUR AMPÈRE WOULD BE PROUD. Driving electricity further. www.opel.be environmental information (RD 19/03/2004): www.opel.be 1.2 L/100 KM 27 G/KM GIVE SAFETY PRIORITY OPELATL005 TogetherMagazine.indd 1 14/02/12 11:20 There is a place where the Star always shines. The Mercedes House is located on the prestigious Grand Sablon, in the heart of Brussels. Here, luxury and elegance set the tone: the perfect setting for “the Brand with the Star”. Come experience a moment of refinement in our restaurant, and enjoy the most exquisite gastronomy. Discover our art expositions, our concerts and our new boutique, where you will find the ultimate collection of items and accessories from Mercedes-Benz. The Mercedes House Brasserie, terrace, boutique, exposition, culture. Grand Sablon Rue Bodenbroek 22-24 - 1000 Brussels Tel.: +32 (0)2 400 42 50 - Fax: +32 (0)2 400 42 52 www.mercedeshouse.be Like us on Facebook ! Opening hours: Monday to Saturday: 10.00 – 20.00 - Sunday: 10.00 - 16.00 Bookings for restaurant: +32 (0)2 400 42 63 or [email protected] Publisher’s letter Much of the magazine this month, as the cover would suggest, is dedicated to all things Belgian here’s a lot happening on the creative front in Belgium, and gone are the days when Belgian artists, designers and musicians were obliged to seek fame and fortune elsewhere because the Trecognition their talent deserves wasn’t forthcoming at home.
    [Show full text]
  • Mental Healthcare 2
    KEY DATA IN HEALTHCARE Mental Healthcare Edition 2021 Colophon SUBJECT This report provides an overview of the function- ing of psychiatric hospitals (PH) and psychiatric departments of general hospitals (PDGH) through some key figures. EDITORIAL COMMITTEE The members of the Directorate-General for Health- care, in particular the ‘Data & policy information’ unit and the ‘Psychosocial health care’ unit . RESPONSIBLE PUBLISHER Tom Auwers, Galileelaan 5/2 – 1210 Brussels CONTACT INFORMATION Directorate-General Healthcare Galileelaan 5/2 – 1210 Brussel T. +32 (0)2 524 97 97 (Service Center Gezondheid) Any partial reproduction of this document is permit- ted provided that the source is acknowledged. This document is available on the website of the Federal Public Service Health, Food Chain Safety and Environment: www.health.belgium.be and www.healthybelgium.be Legal deposit: D/2021/2196/13 Mental Healthcare 2 IN HEALTHCARE KEY DATA MENTAL HEALTHCARE FOR ADULTS 6 1. Organisation of the care offering for adults 6 2. Hospital activities in PH and PDGH for adults 16 MENTAL HEALTHCARE 3. The most common primary diagnosis FOR CHILDREN AND in PH and PDGH for adults 21 YOUNG PEOPLE 26 4. Patient flows in PH and PDGH 24 1. Organisation of the care offering for children and young people 26 2. Hospital activities in PH and PDGH for children and young people 31 INITIATIVES FINANCING OF REGARDING PSYCHIATRIC ALTERNATIVES TO HOSPITALS 40 HOSPITALISATION 35 1. Decommissioning or freezing of beds 35 STAFF IN 2. First-line psychological function (FLP) 38 PSYCHIATRIC HOSPITALS 42 FORENSIC CARE 44 1. Internment 44 2. Specialised care for young people with psychiatric problems who are subject to a court order (For K) 49 Mental Healthcare CARE FOR ADDICTION 50 3 IN HEALTHCARE KEY DATA PREFACE In our first report, entitled Key“ data in healthcare – “Figures allow for general hospitals”, we presented: • Key data related to organisation: number of hos- analysis.
    [Show full text]
  • Haemoglobinopathies on the Move: Is Europe Ready?
    Haemoglobinopathies on the Move: Health and Migration Is Europe ready? Policy Perspectives AUGUST 2013 01 Contents Foreword and poor patient access to diagnosis have been proposed to EU countries and treatment. since 2009. However, little progress has been made with regards to the Although we recognise that notable development and establishment of European Union initiatives do exist to national programmes for the prevention reduce the psychological and economic of this specific group of rare diseases, Haemoglobinopathies (thalassaemia impact of rare diseases on patients highly influenced by global mobility flows Foreword and sickle cell disease) are genetic and society at large, we believe that and immigration, reflecting the increased a tailored, comprehensive, holistic diversity of our societies. Piel et al. disorders that in their severe forms are approach to haemoglobinopathies is not (2013) state “HbS [sickle haemoglobin] associated with chronic, life-impairing equally applied across the EU member will have an increasing effect on public 02 and -threatening diseases with inherent states. Furthermore, a clear effort to health systems. Our estimates can Collaborating Experts and Organisations ensure equal access to healthcare by help countries and the international serious health sequelae that can Collaborating Experts 02 Collaborating Organisations 04 migrant populations and ethnic minority communities gauge the need for lead to disability or even death. The groups is lacking. appropriate diagnoses and genetic World Health Organization (WHO) has counselling to reduce the number of In Europe, inside and outside mobility neonates affected”.3 Accordingly, the recognised that haemoglobinopathies flows and migration are broadly related need to act at the national level with the Key Facts and Figures about Haemoglobinopathies 06 represent a growing health problem in to demographic and socio-economic support of the EU is increasingly urgent, 71% of 229 countries (which account realities, and for this reason, their and is supported by recent research.
    [Show full text]
  • How Equitable Is the Belgian Health System?
    KCE REPORT 334 HEALTH SYSTEM PERFORMANCE ASSESSMENT: HOW EQUITABLE IS THE BELGIAN HEALTH SYSTEM? EQUALITY EQUITY 2020 www.kce.fgov.be KCE REPORT 334 HEALTH SERVICES RESEARCH HEALTH SYSTEM PERFORMANCE ASSESSMENT: HOW EQUITABLE IS THE BELGIAN HEALTH SYSTEM? NICOLAS BOUCKAERT, CHARLINE MAERTENS DE NOORDHOUT, CARINE VAN DE VOORDE 2020 www.kce.fgov.be COLOPHON Title: Health System Performance Assessment: how equitable is the Belgian health system? Authors: Nicolas Bouckaert (KCE), Charline Maertens de Noordhout (KCE), Carine Van de Voorde (KCE) Project facilitator: Nathalie Swartenbroekx (KCE) External experts: Ri De Ridder (Dokters van de Wereld), Erik Schokkaert (KU Leuven), Niko Speybroeck (UCLouvain), Sigrid Vancoreland (Landsbond der Christelijke Mutualiteiten (LCM)), Toon Vanheukelom (KU Leuven), Rudi Van Dam (FOD Sociale Zekerheid – SPF Sécurité Sociale), Tom Van Ourti (Erasmus University Rotterdam, the Netherlands) Stakeholders: The following administrations and public institutions have been consulted throughout the duration of the project. At the federal level: • RIZIV – INAMI: Pascal Meeus • FOD Volksgezondheid – SPF Santé Publique: Pol Gerits, Veerle Vivet, Harun Yaras • FOD Sociale Zekerheid – SPF Sécurité Sociale: Dirk Moens, Rudi Van Dam • Sciensano: Brecht Devleesschauwer, Françoise Renard At the regional level: • Vlaamse Gemeenschap (Vlaams Agentschap Zorg en Gezondheid): Erik Hendrickx • Région wallonne (Direction générale opérationnelle des Pouvoirs locaux, de l’Action sociale et de la Santé et observatoire wallon de la santé):
    [Show full text]
  • Re-Bel E-Book 10 | September 2011
    BELGIUM’S HEALTHCARE SYSTEM SHOULD THE COMMUNITIES/REGIONS TAKE IT OVER ? OR THE SICKNESS FUNDS ? Lead Piece and Reply by Erik Schokkaert & Carine Van de Voorde Comments by David Crainich Jan De Maeseneer Myriam De Spiegelaere Brigitte Dormont Johan C. Kips Fred Schroyen Erik Schut Re-Bel e-book 10 | September 2011 The Re-Bel initiative aims to rethink in depth, in an open, rigorous, non-partisan way, what the institutions of the Belgian federal state - or of whatever else this part of the world needs to become - can and must look like in the longer term, taking full account of the evolving European context. The Re-Bel initiative does not aim to produce one programme or manifesto to which everyone involved could subscribe. Its ambition is rather to provide a fertile intellectual environment in which new ideas and promising initiatives of all sorts can germinate and develop, with a concern for their relevance to a thorough reform of Belgium's institutions, but also to the institutional design of other complex polities, most obviously the European Union. The Re-Bel initiative involves scholars from all Belgian universities, runs a web site, publishes e-books and organizes workshops and public events. It intends to associate to its activities both foreign colleagues and the Brussels-based international community. The working language will usually be English. The Re-Be initiative is supported by the University Foundation, which will host all its activities. The University Foundation was founded in Brussels in 1920 at the initiative of Herbert Hoover and Emile Francqui. One of its missions, also central in the Re-Bel initiative, is to foster fruitful contacts and collaboration between academics of all Belgian universities.
    [Show full text]
  • BELGIUM a Multi-Stakeholder Perspective Report on 2005–2014 Developments
    Implementation of the National Roma Integration Strategy and Other National Commitments in the Field of Health BELGIUM A multi-stakeholder perspective report on 2005–2014 developments The information and views set out in this report are those of the author and do not necessarily reflect an official opinion of the EC or IOM. Neither they nor any person acting on their behalf may be therefore held responsible for any use of the information contained therein. Reproduction is authorized provided the source is acknowledged. This Progress Report from a multi-stakeholder perspective on the implementation of the NRIS (National Roma Integration Strategy) and other national commitments in respect to Roma Health was undertaken by IOM within the framework of the project “Fostering Health Provision for Migrants, the Roma, and Other Vulnerable Groups” (Equi-Health). The EQUI- HEALTH project is co-financed under the 2012 work plan, within the second programme of Community action in the field of health (2008–2013), by direct grant awarded to IOM from the European Commission’s DG for Health and Consumers (SANTE), through the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). The Equi-Health project is designed and managed by the International Organization for Migration (IOM) Regional Office Brussels, Migration Health Division (MHD). The Progress Report was produced under IOM MHD, RO Brussels guidance by Maria Krislova, and benefitted from peer-reviews and editing by Mariya Samuilova. We thank DJ Krastev for his copy-editing, proofreading, and general editing assistance. A special note of thanks is due to Belgian Federal Public Service, Health, Food Chain Safety and Environment for its support, facilitation of the research and co-financing; especially Hans Verrept, Head of the Intercultural Mediation and Policy Support Unit, Belgian Federal Public Service, Health, Food Chain Safety and Environment.
    [Show full text]