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Belgium Health System Review Health Systems in Transition Vol. 9 No. 2 2007 Belgium Health system review Dirk Corens Editors: Sherry Merkur • Nadia Jemiai Willy Palm Editorial Board Editor in chief Elias Mossialos, London School of Economics and Political Science, United Kingdom and European Observatory on Health Systems and Policies Editors Reinhard Busse, Berlin Technical University, Germany Josep Figueras, European Observatory on Health Systems and Policies Martin McKee, London School of Hygiene and Tropical Medicine, United Kingdom and European Observatory on Health Systems and Policies Richard Saltman, Emory University, United States Editorial team Sara Allin, European Observatory on Health Systems and Policies Olga Avdeeva, European Observatory on Health Systems and Policies Anna Maresso, European Observatory on Health Systems and Policies David McDaid, European Observatory on Health Systems and Policies Sherry Merkur, European Observatory on Health Systems and Policies Bernd Rechel, European Observatory on Health Systems and Policies Erica Richardson, European Observatory on Health Systems and Policies Sarah Thomson, European Observatory on Health Systems and Policies Managing editor Giovanna Ceroni, European Observatory on Health Systems and Policies International advisory board Tit Albreht, Institute of Public Health, Slovenia Carlos Alvarez-Dardet Díaz, University of Alicante, Spain Rifat Atun, Imperial College London, United Kingdom Johan Calltorp, Swedish Association of Local Authorities and Regions, Sweden Armin Fidler, The World Bank Colleen Flood, University of Toronto, Canada Péter Gaál, Semmelweis University, Hungary Unto Häkkinen, Centre for Health Economics at Stakes, Finland William Hsiao, Harvard University, United States Alan Krasnik, University of Copenhagen, Denmark Joseph Kutzin, World Health Organization Regional Office for Europe Soonman Kwon, Seoul National University, Korea John Lavis, McMaster University, Canada Vivien Lin, La Trobe University, Australia Greg Marchildon, University of Regina, Canada Alan Maynard, University of York, United Kingdom Nata Menabde, World Health Organization Regional Office for Europe Ellen Nolte, London School of Hygiene and Tropical Medicine, United Kingdom Charles Normand, University of Dublin, Ireland Dominique Polton, National Health Insurance Fund for Salaried Staff (CNAMTS), France Sophia Schlette, Health Policy Monitor, Germany Igor Sheiman, Higher School of Economics, Russia Peter C. Smith, University of York, United Kingdom Wynand P.M.M. van de Ven, Erasmus University, The Netherlands Witold Zatonski, Marie Sklodowska-Curie Memorial Cancer Centre, Poland Health Systems in Transition Written by Dirk Corens, Centre for Health Economics and Hospital Policy, Universitair Ziekenhuis Brussel Edited by Sherry Merkur, European Observatory on Health Systems and Policies Nadia Jemiai, European Observatory on Health Systems and Policies Willy Palm, European Observatory on Health Systems and Policies Belgium: Health System Review 2007 The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Keywords: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration BELGIUM © World Health Organization 2007, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Please address requests about this to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/PubRequest) The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its partners. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies or any of its partners concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The European Observatory on Health Systems and Policies does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Printed and bound in the United Kingdom by TJ International, Padstow, Cornwall. Suggested citation: Corens D. Health system review: Belgium. Health Systems in Transition, 2007; 9(2): 1–172. ISSN 1817-6127 Vol. 9 No. 2 Health systems in transition Belgium Contents Preface ............................................................................................................ v Acknowledgements ......................................................................................vii List of abbreviations......................................................................................ix List of tables and figures ..............................................................................xii Abstract ....................................................................................................... xiv Executive summary ...................................................................................... xv 1. Introduction ................................................................................................ 1 1.1 Overview of the health system ....................................................... 1 1.2 Geography and sociodemography .................................................. 2 1.3 Economic context ........................................................................... 5 1.4 Political context .............................................................................. 6 1.5 Health status ................................................................................. 10 2. Organizational structure ........................................................................... 15 2.1 Historical background .................................................................. 15 2.2 Organizational overview .............................................................. 22 2.3 Decentralization and centralization .............................................. 34 2.4 Patient empowerment ................................................................... 35 3. Regulation and governance ...................................................................... 39 3.1 Regulation .................................................................................... 39 3.2 Performance assessment and health information management .... 45 4. Financing .................................................................................................. 53 4.1 Health care expenditure ................................................................ 53 4.2 Population coverage and basis for entitlement ............................. 54 4.3 Revenue collection and sources of funds ..................................... 61 4.4 Allocation to purchasers ............................................................... 68 4.5 Purchasing and purchaser–provider relationships ........................ 69 4.6 Payment mechanisms ................................................................... 70 iii Health systems in transition Belgium 5 Physical and human resources .................................................................. 85 5.1 Physical resources ........................................................................ 85 5.2 Human resources .......................................................................... 92 6 Provision of services ................................................................................. 99 6.1 Public health ................................................................................. 99 6.2 Patient pathways ......................................................................... 104 6.3 Primary and secondary ambulatory care .................................... 106 6.4 Inpatient care .............................................................................. 110 6.5 Emergency care .......................................................................... 113 6.6 Pharmaceutical care ................................................................... 114 6.7 Rehabilitation/intermediate care ...............................................
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