Le financement des soins infirmiers à domicile en Belgique - KCE

KCE Report 122 Financing of Home Nursing 7
2 HOME NURSING IN BELGIUM
2.1 THE BELGIAN HEALTHCARE SYSTEM: OVERVIEW
The Belgian health system is a Bismarck type of compulsory national health insurance,
which covers the whole population and has a very broad benefits package 3 .
The Belgian health system is mainly organised on three levels, i.e. federal, regional and
community levels. Since 1980, part of the responsibility for health care policy has been
devolved from the federal Government to the community levels. The communities are
responsible for so-called person-related matters, such as healthcare and welfare. The
1980 Institutional Reform Act defines the person-related matters in the sphere of health
care policy as intramural and extramural curative health care and the policy regarding
health education, health promotion and preventive health care. In both cases, the law
provides important exceptions as a result of which the federal Government has kept
important powers. Interministerial Conferences (composed of the ministers responsible
for health policy from the federal and regional governments) have to facilitate
cooperation between the federal Government and the communities. They have no
binding decision-making power.
Since the Health Insurance Act of 9 August 1963, compulsory health insurance is
combined with a private system of health care delivery, based on independent medical
practice, free choice of service provider and predominantly fee-for-service payment.
The 1963 law endorsed the financing, reimbursement and organisation principles of
Belgian health care. Important elements introduced by this law are:
• Introduction of a fee-for-service system of reimbursement through a system
of medical nomenclature;
• Introduction of a system of conventions and agreements between sickness
funds and health care providers, setting the prices for medical services and
regulating their financial and administrative relationship.
All individuals entitled to health insurance must join or register with a sickness fund:
either one of the six sickness funds, including the health insurance fund of the Belgian
railway company, or a regional service of the public Auxiliary Fund for Sickness and
Disability Insurance 3 .
Patients participate in health care financing via co-payments. There are two systems of
payment: (i) a reimbursement system, for which the patient pays the full costs of
services and then obtains a refund for part of the expense from the sickness fund, which
covers ambulatory care; and (ii) a third-party payer system, for which the sickness fund
directly pays the provider while the patient only pays the co-insurance or co-payment,
which covers inpatient care and pharmaceuticals.
The National Institute for Sickness and Disability Insurance (NIHDI) is responsible for
the general organisation and financial management of the compulsory health insurance.
Its most important tasks are to prepare and implement legislation and regulation, to
prepare the budget, to monitor the evolution of health care spending, to control
whether legislation and regulation are correctly implemented by health care providers
and sickness funds and to organise the consultation between the different actors
involved in the compulsory health insurance 3 .
Within the NIHDI, besides other stakeholders, home nurses’ professionals’ associations
are represented in the Agreement Commission for home nursing. In other agencies
they are represented in different advisory bodies dealing with organisational issues.