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

KCE Reports 133 Special Solidarity Fund 201
9.16.2.7 Costs of medical treatments and drug provision payment
There is no cost sharing in access to primary or specialist care services in the public
sector. Hospitals in the National Health System are funded through a global budget
granted by the Regional Health Authorities.
Medication is provided by local pharmacies (ambulatory care) and hospital pharmacies
(hospital care and ambulatory hospital care provided by the medical specialists).
For medication that is purchased at the local pharmacies there is a system of copayment.
There are mechanisms to protect vulnerable groups of people.
• For people under 65 years of age who do not suffer from permanent
disability or chronic illness, 40% co-payment of the official price is
required
• For drugs for chronic diseases or serious diseases , (expanded to AIDS
patients) the co-payment level is set at only 10% of the cost with a
maximum of 2,64 € per drug prescribed (this amount can be actualized by
the Minister of health)
• All users of the civil servants’ mutual funds only pay 30% of
pharmaceutical costs
• Some groups of patients as pensioners, patients with disabilities, work
accidents and occupational disease don’t have to contribute at all. They
are excluded from co-payment.
Products that are provided to the patient in the primary health care centers are also
excluded from co-payment. For medication provided at hospital level there is no copayment.
They are part of the hospital budget.
Cost sharing in the area of pharmaceuticals, as well as medical aids and prostheses
(including hearing aids and corrective lenses) has been significant since the late 1990s.
At national level a decision has been taken (within the Interterritorial Council of the
NHS) that there should be no regional variations in cost sharing. However, since the
regions have introduced some changes in the coverage of services and entitlements
over the last years, it is a reality some differences exist.
Complementary benefits include prostheses, orthopedic products, wheelchairs, health
care transportation, complex diets and home-based oxygen therapy. Recently, children’s
hearing aids were also included in this package. In general, the user does not pay for
these complementary benefits, except for certain orthopedic products or prostheses.
Exclusion criteria for other benefits not covered by the public system include:
Lack of evidence on safety or clinical effectiveness, or evidence that the intervention has
been made redundant by other available procedures (for example, a negative list of
pharmaceuticals was introduced for the first time in 1993 and updated in 1998 excluding
all products of unproven clinical effectiveness from public funding); classification of the
intervention as a leisure activity, relating primarily to rest and comfort (e.g. sports,
aesthetic or cosmetic improvement, water therapy, residential centers..).