HCS 400 Belgium Paper

Running head: BELGIUM HEALTH CARE SYSTEM1

Belgium Health Care System

Chris Casciotti

Alvernia University

Dr. Lewis

11.17.15

BELGIUM HEALTH CARE SYSTEM 2

Abstract

Belgium has one of the best health care systems in Europe. They kept their people in

relatively good health. Not all systems are perfect but they have average age rate in the country.

The system is very different from the ACA that is in America. Everyone in Belgium has to have

health insurance and it is required by the state for everyone to have. It is a form of universal

health care and it is run by the Federal Public Service (FPS), similar to how the United Kingdom

does theirs. They have one of the best health care systems in Europe and it shows with the way

that their system is structured and put together.


Other countries do not put the focus of their funding to their health care. That does not

mean it is not a priority the money goes elsewhere plus, some countries have universal health

care that everyone can get access to. No payment is needed and it is run mostly through the

government. That allows for everyone to get care but, they may have a longer wait period for the

care they need.

Access to care is there for everyone and no copay is needed. One country that has a

system like this is Belgium. “If you're living and working in Belgium, you can be covered by the

Belgian healthcare system. The Belgian healthcare system is one of the best in Europe but you

have to have state and/or private health insurance to use it.” (Expatica, 2013) It shows that they

are more focused on a middle class society where everyone can gain access to care which means

their care is much better. (Gold, 2011)

They have a Ministry of Health that helps with getting the people the advance care that is

needed. Anyone in Belgium can get care but, they need to get other insurance to gain access to

the government insurance. Patients have the freedom to pick any place where they may need

treatment. Their access to care is very wide because it is mandatory for everyone in Belgium to

get health insurance. Patients usually pay the doctor upfront and then get a refund later from their

insurer. (Expatica, 2013)

. The Belgium healthcare system is divided into state and private sectors those sectors are

federal and federated entities. Federal takes care of the funding of the hospitals and the way that

they function. It also controls the pharmaceuticals companies and the regulation of the prices.

They make sure that the medications are at a fair price for the people to obtain it. The federated

entities look over how health care is promoted to the people. Their job is to make sure that the


information given to the people is easy to understand. This sector controls the care for the elderly

as well. (Segaert, 2013)

Healthcare Insurance and Social Security are together as one in Belgium. That means the

people need to setup their payment through their banks. It is very different because everything is

wrapped into one thing. Each part of Belgium is funded by the state and the hospitals have access

to government money. They have both by a mixture of state and non-profit hospitals which is

different but, everything is monitored and controlled by the state. (Expatica, 2013)

It may be a problem having the payment system through the social security system that

may cause a problem. This means the people have to regulated their spending and make sure that

they pay for their coverage. Having everything in one package is a good thing but once someone

can get in that account, it may cause a problem.

Most of the hospitals are under the supervision of the government but not necessarily run

by the government, they are funded by the state. Hospitals and general practices clinics are

private and typically managed by universities or religious organizations which are different from

many places. Each hospitals is split into a regular hospital or a religious hospital, this shows a

true sign of the church and the state being separated. (Gold, 2011)

The hospitals are on watch by the government to make sure everything is running

smooth. When a patient goes to a hospital they have a choice of what kind of hospital they want.

There is no difference in the care that is given; maybe the religious part is for people who have

specific religions. Maybe this is done so the people that are foreign or have a religion that refuses

certain treatment can get the treatment that they can have. It can eliminate some ethical issues


from happening. This may cause a problem though because some people may think they are not

being like everyone else. (Gold, 2011)

The system is structured through what Belgium calls Federal Public Service (FPS). Under

this title is the Ministry of Public Health, Food Chain Safety and Environment and the NIHDI or

National Institute for Health and Disability Insurance. (Segaert, 2013) They also have the health

care providers under their own category in their system. Health insurance is also a separate piece

of the system which is also paired with the Belgium Social Security System. The Ministry of

Public Health, Food Chain System, and Environment look at how the public is doing and see if

changes need to be made.

They look at how the public and make sure that they are getting fair prices for their care.

Their main focus is what happens every day and what happens to the people. If laws need to be

made to make things easier for people to access then, they will do so. The NIHDI puts more

focus on the management side of things; they regulate more of how things are run behind the

scenes. Health insurance is what they regulate and they make sure that everyone gets insurance.

Everyone has vast options to pick from and the NIHDI shows them which ones they can pick

from and each person gets a fair price. (Segaert, 2013)

The National Institute for Health and Disability Insurance is even split into sectors that

each does their own thing. They are three parts to the NIHDI: Management bodies, Insurance

bodies, and scientific bodies. They are all connected because their objective is to make sure that

health insurance is made easy for everyone to access. (Segaert, 2013) The General Council

consists of the government, the health insurance funds, and the government workers.


The Insurance Committee is the same as the General Council but, the presence of the

government is not as present. The Insurance Bodies are made up of the Agreements commissions

and Technical boards. They deal with what gets passed with the insurance companies. The

scientific bodies are made of the Scientific Board for Chronic Diseases, National Board for

Quality Promotion and Assessment Committee for Drug Prescription.

They look at what diseases are very relevant in the country and how to control them. The

scientific bodies look at the quality of care that is given to the patients. When there is a chronic

disease that many people have, they need to make sure these patients get the level of care to get

them better. (Segaert, 2013)

The last thing that this committee controls is pharmaceutical companies and the handing

out of prescriptions to patients. They have to make sure that the patients get the right prescription

and the right dose. With all of these committees and how the system is structured, it is much

regulated. Each part is being watched and run the way that the Belgium government wants it to

be run. At least, everyone can get coverage and access to care. (Segaert, 2013)

There was a study that was conducted in Flanders, Belgium that showed the Belgium

government that there is a need for palliative home care. The need was shown because of the

number of patients suffering from advanced cancer and severe non-malignant diseases

worldwide and in Belgium. Home care is needed to be a part of the jobs of the general

practitioner to provide home care as well as care at the office. Palliative home care teams

(PHCTs) are introduced and in charge of establishing home care for patients. (Pype & Symons,

2013)


One of the biggest problems that Belgium had regarding healthcare was the treatment of

human immunodeficiency virus (HIV) or the people that had it. This study identified physicians’

HIV testing practices and their barriers toward implementing provider-initiated HIV testing and

counseling for Sub-Saharan African migrants in Flanders, Belgium. (Loos & Debackaere, 2012)

There was a larger amount of Sub-Saharan African migrants that populated Flanders and many

of them have HIV.

They used this group of people to do a study about the spread of HIV. Their main goal

was to control the HIV and make sure more of the SAM’s did not get more infected. The way

they carried out the study was between October 2007 and December 2008, 66 physicians (45GPs

and 21 specialists in internal medicine) working in two Flemish cities where most SAM reside

were approached for recruitment. (Loos & Debackaere, 2012)

The study found out that the care of HIV patients in the areas like Flanders need to get

better at delivering care. HIV is a huge deal in areas like this and need to be monitored very

carefully. It is important for physicians to test people that live in these areas to make sure that

HIV is controlled. Three years there was another study that was done and through studies like

this, they have been able to control the AIDS epidemic.

This study was done early in 2015 and the continuum of HIV care of those diagnosed

with HIV living in Belgium and its associated factors. They look at how the outbreak of HIV

diagnoses 2007–2010 and HIV-infected patients in care in 2010–2011 were analyzed. They took

that information to see how it changed in 2015 to look at the change between the years.

(BREACH (Belgian Research on AIDS and HIV Consortium), 2015)


The two groups that they used were the men (MSM) - mainly of Belgian or European

nationality - and Sub-Saharan African (SSA) men and women. They were looking at the sexual

activity between the groups and the activity between males of each group. The results were a

total of 4117 individuals diagnosed with HIV between2007 and 2010 were analyzed for entry in

care. Of 11,781 patients in care in 2010, 112 patients died before end of 2011, leaving 11,669

patients analyzed for retention in care. (BREACH (Belgian Research on AIDS and HIV

Consortium), 2015)

This analysis was strongly dependent of a good match between HIV diagnosis data and

laboratory data through identifiers built on patients’ date of birth and initial. Each piece of data

was connected to one another because each study was compared to how it is in 2015. With the

migrants spreading in Belgium there is a better chance that new types of diseases may become

present in the country. This may cause a problem because they may have to control the

population and make sure not as many migrants get into the country. (BREACH (Belgian

Research on AIDS and HIV Consortium), 2015)

Belgium had made some advances with some screenings and 1998, Flanders, the Dutch

speaking part of Belgium, was one of the first regions in Europe to implement a Universal

Newborn Hearing Screening (UNHS) program. Many children between pre-school aged and kids

that attend primary school are deaf and this screening was made to get these kids help in

Flanders. (De Raeve & Lichtert, 2012) With the screening of these kids, Belgium had to find a

way to allow these kids an education.

They want these kids to still learn, they established a system that all children who were

hard of hearing received 2 hours of weekly support throughout their schooling. From 1996-1997


onward, this changed to 2 hours a week for a maximum of 2 years during primary school and

again a maximum of 2 years during secondary school. (De Raeve & Lichtert, 2012) Their plan

was to use interpreters to translate the information to the kids that were deaf.

They broke down each subject and put them into a different level that they can teach

these children. These levels are: a vocational level mainly focused on practical subjects; a

technical level, and a theoretical level. Each level teaches the deaf children basic skills and it

allows them to not be left out. Even with impairment, these children can get the education that

they need which is the most important thing.

Without the screening that they did in 1998, these children would not have the ability to

learn and receive an education. They do have special treatment but, they are allowed to still be

with the regular children in the classroom. They just have special help and interrupters help them

out so they can understand. (De Raeve & Lichtert, 2012)

The ACA is very different from the way Belgium has their health care. Even though here

in the United States we spend the most on health care, we are in the middle tier when it regards

to the type of care that we offer. We make new ways that people can get care but, we test them

over in Europe and if they work over there first before it can be in the States. It shows that we do

not want to put our own people through any type of new care.

It looks like we are doing well in the health care field regarding the amount of care that is

offered to everyone. One thing we are in the bottom tier is that people have a hard time accessing

the care and that we do not really live the healthiest lives in the world. Many countries around

the world are projected to live longer than us and another thing that plays into the life expectancy

is lifestyle. Everyone lives differently from one another and sometimes decisions can make life


better or worse for us. We rank in the lower tier when it comes to how efficient our care is and

the way that everyone can get care.

Not everyone can get the care that they need because they are not covered or they do not

enough money to afford the care. Even through the ACA has allowed for more people to be able

to have access to coverage, people are still not covered. The ACA has done the best it can to get

as many people to have access to care, Children are now covered and people that live in lower

income areas are able to get care. They do not have to always go to the emergency and get

charged large sums of money for something simple as a cold. The clinics allow them to get care

which will make life a little bit easier for them.

The access to care is hard because most of the country does not have very high health

literacy. The information given out needs to be said in more simple terms for people to

understand and this allows for them to get care. Anyone that has a chronic illness before they get

health insurance, they are now allowed to get care without being denied. People in the United

States have some diseases that are with them for their life and are not able to be cured.

Treatment is needed just to control it and before the ACA, people like this were not able

to get all coverage they need. This is a pro to the ACA because these people are a higher risk;

they are still able to get access to care. More preventable care is given so people can now look

and see if they are at risk for a disease, then control it from there.

The wider range of coverage is given to everyone so that people can see which type of

care that they need. At the same time, people can still be covered and they cannot afford it. The

ACA is not perfect but, it has done some great things for people that did not have insurance

before. It is not for everyone because only the people that make enough can get the care they


need. The United States wants to make profits off of their health care and the people that have

enough money can get the best kind of care. Maybe if there was a change in lifestyle there may

not be as many people that have health issues.

The cost of living also is high and many people try to save as much money as possible.

They buy the cheaper food which hurts them in the end because they are not able to get the

proper nutrients that they need. With people doing this they cannot afford enough food so that

they can eat the healthier items. This is a lifestyle choice and many people end up developing

health issues with this decision. It is not because of the ACA for this happening, the cost of

living is very high and people want to save as much money as possible.

We know that the life expectancy in the United States is 79 years of age. The life

expectancy in Belgium is 80 years old. Also, the mortality rate in Belgium is 10.76 deaths per

1000 population. The United States is 821 deaths per 1000 population. This shows that majority

of Belgium is relatively healthy because there are not as many deaths. It also means that the

lifestyle is very different from the United States as well. Not too far off from the United States

but, these two countries are different from one another. The structure and the way that the ACA

function is very different from what the FPS does for Belgium.

In conclusion, everyone in Belgium is required to have insurance and they also are

required to have private insurance as well. That seems like a hassle but, the access to care is easy

to access and people have a huge selection of insurance. In the United States many people are

uninsured or have insurance and are not able to pay for it. Belgium has everything broken down

and the power is equally distributed out to local and state hospitals. With the government at the

center of everything they are able to have control.


The U.S. system is very complex and the power is very unbalanced. It is very hard to

follow as well but, with the ACA many Americans are able to have coverage that they did not

have before. Both of these countries run their healthcare systems different from one another but,

they both have something in place that has control. Whether by the government for Belgium or

the Pharmaceutical companies in the United States, the ACA and the FPS are systems in place

that help run the healthcare system.


ReferencesBREACH (Belgian Research on AIDS and HIV Consortium). (2015). Good continuum of HIV care in Belgium

despite weaknesses in retention and linkage to care among migrants. Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, 1-15.

De Raeve, L., & Lichtert, G. (2012). Changing Trends within the Population of Children who are Deaf or Hard of Hearing in Flanders (Belgium): Effects of 12 Years of Universal Newborn Hearing Screening, Early Intervention, and Early Cochlear Implantation. Volta Review , 131-148.

Expatica. (2013). The Belgian healthcare system. Retrieved from Expatica: http://www.expatica.com/be/healthcare/healthcare/Healthcare-in-Belgium_100097.html

Gold, S. (2011, May 11). How European nations run national health services. Retrieved from The Guardian: http://www.theguardian.com/healthcare-network/2011/may/11/european-healthcare-services-belgium-france-germany-sweden

Loos, J., & Debackaere, P. (2012). 'It Is Not Easy': Challenges for Provider-Initiated HIV Testing and Counseling in Flanders, Belgium. AIDS Education & Prevention, 456-468.

Pype, P., & Symons, L. (2013). Healthcare professionals' perceptions toward interprofessional collaboration in palliative home care: A view from Belgium. Journal of Interprofessional Care , 313-319.

Segaert, C. (2013, November 13). The Health Care System in Belgium. Retrieved from Coopami: http://www.coopami.org/en/countries/countries/south_korea/projects/2013/pdf/2013112602.pdf


Documents

HCS 400 Belgium Paper