This document discusses the challenges facing Belgium's health care system. It notes that Belgium has an aging population, modest economic growth prospects, and rising health care costs that are outpacing GDP growth. To address these challenges, the document calls for reforms like increasing prevention and efficiency, promoting quality, integrating care across settings, making better use of health information and technology, empowering patients, and ensuring the right payment incentives are in place. It argues Belgium will need to adopt a more coordinated, evidence-based approach to health care that involves greater responsibility from all stakeholders.

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The Health-Care Challenge
Prof. Dr. Marc De Vos

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Where are we?
Health Care Challenge p.2

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The Belgian Health Care Challenge p.3
Financial
Government
Monetary
Economy
Welfare state
Demography
Demography
Democracy
Sociology
Banks
Debt
€ $ ¥
US NEU SEU China
EU US
Ageing
Immigration
EU US B
We!

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The Belgian Health Care Challenge p.4

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Quo vadis, België? p.5
60+
100+
x2
x10
80+ x3

6. 1/4
1/2 1/1

7. 1/3



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Quo vadis, België? p.8
100%
375%

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The Belgian Health Care System p.9A World in Transition p.9
The Reality
• Relative gradual decline
• Age of “austerity”
• Ageing: burden & competition
• Modest growth prospects
• Political “impotence”

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Health-Care Trends
Health Care Challenge

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HC-growth & GDP-growth 1980-2005: public expenditures
The Belgian Health Care Challenge p.11

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Out-of-pocket expenditure on health (2009, OECD)
In 2009, additional health insurance covered €1,8 billion expenditure on health and €7,4 billion was paid for
out-of-pocket in Belgium.

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The Belgian Health Care System p.13

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Cost to market of chemical/biological innovation
Health Care Challenge p.14

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Life Style
Health Care Challenge p.15
70%

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The Belgian Health Care Challenge p.16
€800 billion

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Average HC Cost (gender& age): Belgium
Health Care Challenge p.17
Men Women

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Persons in eldercare homes (2007=100)
Health Care Challenge p.18
NumberNumber IndexIndex
20072007 20202020 20502050 20202020 20502050
Flanders 62 008 94 820 197 892 153 319
Wallonia 46 254 63 287 131 448 137 283
Brussels 14 595 16 981 29 445 116 202
BelgiumBelgium 122 857122 857 175 088175 088 358 785358 785 143143 293293

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The Belgian Health Care System p.19
Health Care hits the wall 4%
7,5%
20%

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Policy Issues
Health Care Challenge

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The Belgian Health Care System p.21

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The Belgian Health Care System p.22
GOING FORECONOMIC GROWTH!
A new VISION forhealthcare
– More health but less healthcare: prevention and
lifestyle
– More healthcare with less means: efficiency,
effectiveness, supply, ICT etc.
– Different and more just healthcare with the same
means: accountability and value added across the
board
– More but different means : an open and societal
choice
– Grasping the opportunities of a HC economy

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1. Cost
2. Quality
3. Prevention
4. Integration
5. Information
6. Patients
7. Payment
8. Funding
9. Innovation
10.Goals
Effectiveness
Results
Primary & secondary
No barriers
Everywhere
Empowered - Responsible
The right incentives
Less is (not) more
Level playing field
Goals!
Instruments forChange

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Health Care Challenge p.24
Supply: HC MANAGEMENT
Froma vertical approach where everybody works
independently with separated budget – separated human
and technical resources - independent strategy to
maximize the turnover
Toward an integrated and horizontal approach, with a
global strategy , a coordinatorand a total exchange of
information

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Health Care Challenge p.25
Supply: promotion of QUALITY
Drastic measures to reduce - when necessary - the
nosocomial infections : benchmarking of the hospitals and
communication to the citizens
Accreditation of hospitals
Optimization of clinical pathways
Certification of websites forthe citizens-patients
Minimumlevel of activities regarding the international
standards
We only pay forquality and cost-effectiveness

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The Belgian Health Care Challenge p.26

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The Belgian Health Care Challenge p.27

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Expenditure on prevention: % of total HC (2008)
The Belgian Health Care Challenge p.28

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Preventive HC consumption peryear(B2011)
The Belgian Health Care Challenge p.29

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Health Care Challenge p.30
New roles forproviders and hospitals
To promote prevention, management of chronic diseases ,long
termvs. short termvision, choice of the best alternatives
More and more cooperation with each other
Partnership and sharing of knowledge with the patient who has
access to more and more information via internet
Extensive use of ICT and real time access to all types of
information
Use of clinical guidelines and standardized procedures
Adapted remuneration system– both doctors forand for
hospitals

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Health Care Challenge p.31
New Roles forSickFunds - Insurers
Informing and guiding the patient & promoting prevention
Promoting continuumof care and disease management
Quality and efficiency watchdog
More financial responsibility
ICT & data: the basis forrational steering

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Health Care Challenge p.32
New Roles forthe State
Cost-effectiveness across the board – ex ante and ex post
More steering, coordination and rationalisation
Integrated policies on prevention + detection + care
Different incentives forthe key actors: HC professionals
and patients

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Health Care Challenge p.33
Private Insurance?
Belgium today = US
Private insurance will be necessary:
– Cf. pension funding debate: economy v taxation
– Objective efficiency v. subjective value
Towards a societal and rational choice: two pillars?

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Health = Wealth: HC cost v Lost economic output
The Belgian Health Care Challenge p.34

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The Future?
Health Care Challenge

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The Belgian Health Care System p.36
Short term: bickering overbudget and austerity:
least resistance victims
Mediumterm: towards a coordinated strategy -
gradual
More institutional responsibility forthe key
players in healthcare
Less freedom, more steering – evidence based
More private HC realities and diversity

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The Care Challenge p.39

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The Belgian Health Care System p.40

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marc.devos@itinerainstitute.org
@devosmarc
www.itinerainstitute.org