Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

KCE Reports 133 Special Solidarity Fund 83
7.5 CONCLUSIONS OF THE CHAPTER ON THE
INTERNATIONAL APPROACH
No mirror systems or comparable safety networks to the SSF exist in the countries
studied.
7.5.1 Costs of drugs at secondary care level (hospital care)
As in Belgium the health care system differentiates primary care and secondary care
(hospital care). Looking at the health care systems in the other countries that were part
of the international approach in this study, one notices a major difference with the
Belgian health care system on how costs of drugs and medical treatments are covered
at hospital level. In Belgium there a third-party payer system for inpatient care and
drugs, for which the sickness fund directly pays the provider while the patient only pays
co-payments. If there is no coverage of the costs by the health insurance system, the
costs are fully charged to the patient. There are some exceptions on these principles
were hospitals are not allowed to charge specific costs to the patients. For example
some antibiotics are paid at a flat rate to the hospitals and are not charged to the
individual patient.
In all countries studied, medicines are included in the overall hospital budget. They are
globally financed to the hospitals. In the Netherlands supplementary compensation
(extra budget) for the hospital can be granted for expensive or orphan drugs. In Spain
the hospital budget will be influenced by regional priorities (Autonomous regions) with
possible differences between the regions.
Such a system of (closed or semi closed) hospital budgets including costs of drugs and
medical devices leads to a different approach. It’s the hospitals’ responsibility to decide
on the use of (authorized) drugs and medical devices. The costs are not charged to the
patients. This could however lead to different approaches between hospitals and as such
to different outcomes for patients. The specialist doctors have a joint responsibility at
hospital level. Hospital care is not restricted to hospitalized patients but includes care to
extra muros patients that are treated by medical specialist doctors in the hospital
facilities.
7.5.2 Costs of drugs at primary care level
For primary care, costs of drugs delivered through the local pharmacies in the countries
studied, are subject to (differentiated) co-payment. This is the same as in Belgium. Only
drugs that are listed on the nomenclature code are reimbursed. In France there is no
co-payment for patients with chronic disease if their disease has been recognized
(ALD). In Spain the costs of drugs provided at the primary health care centers are not
charged to the patients, only drugs delivered by the local pharmacies are subject to copayment.
7.5.3 Reference centers for rare diseases
In both France as Spain health authorities foresee reference centers for treatment of
rare and chronic diseases. Costs of treatments and drugs are included in the reference
centers’ budgets. In the Netherlands some hospitals are specialized in treating rare
diseases. The health insurance companies contract these hospitals and as such influence
concentration of patients in specialized hospitals. In Belgium till now every medical
specialist can treat rare diseases and prescribe drugs or innovative treatments. The
results from the SSF sample however reveal that a small number of hospitals present a
large number of applications, which implies that “de facto” there is a kind of reference
centre system for rare diseases in Belgium. There is however no regulation with regard
to the systematic financing of the treatment in those particular hospitals.