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UHC Belgium

Dr Ignace RONSE

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Plan

1. Health Coverage in Belgium2. UHC in Belgian Development

Cooperation

3. Support to Health Coverage inBelgian Development Cooperation

programme in Peru

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Health Coverage in Belgium

1. Organizing the system

2. Financing the system

3. Lessons learnt

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Organizing the system1. Belgian Federal Public Service Health, Food

Chain Safety and Environment: National HealthInsurance Institute

2. Mutualities: compulsory but active choice

3. Health services & professionals

(public or private but agreed tarification and noprofits allowed for the institutions)

Regular dialogue 1+2+3+health universities

99% is covered: very broad benefits package One single social (non commercial) system.

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Financing the system (2012)

1. GNI: 377 billion

2. State Budget: 150 billion

3. Health expenditure: 32 billion:

32 million consultations

5 million hospitalisations (means 5 day stay).

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Financing the system

The reimbursement of health services depends on type of service provided,

income and social status of the patients

accumulated amount of co-payments alreadypaid for that year.

For more vulnerable population groups,several measures were taken to ensure their

access to high-quality care.

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Financing the system (2012)

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Financing the system (2012)

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Historic perspective 1830-1945:

Voluntary insurances by mutualities

Progressive organisation and progressive advocacy 1945-

Compulsory adhesion

Solidarity through state financing

Equitable qualitative services requires a single andcontrolled system and a dialogue with the Human RH

Cooperation: criteria to achieve equitable access toqualitative health services funded on a base of solidarity

Voluntary cant achieve equity

Compulsory without trust cant achieve universality

Trust requires qualitative services and social dialogue

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Achieving equity?

Persistent health inequities:

Health is determined by a clear social gradient

and improves as socioeconomic statusimproves.

People in the weakest socioeconomic groups

live less long and spend fewer years in goodhealth.

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Lessons learnt

The Belgian Federal Public Service Health, FoodChain Safety and Environment participates in theJoint Equity action of the European Commission in

order to increase its capacity to tackle health

inequities more effectively. inform of the existing health inequities and their

most important determinants,

underline the importance of intersectoral /cross-governmental work to tackle healthinequities.

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Lessons learnt

Main results of the policy dialogue:

Implementation of Health in All Policies is needed to tacklehealth inequities

Creation of a Interdepartmental Working Group on healthinequities (Commission for Sustainable Development)

Development of a national action planon health inequities Translate the recommendations of the WHO Report on social

determinants of health and the health divide in the WHOEuropean Region to the Belgian context

Designate a contact person at all levels of government toincrease capacity building, raise awareness and improveinvolvement regarding health inequities

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UHC in Belgian Development Cooperation

Health in the Belgian Development

Cooperation

The Policy note on UHC

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Health in the Belgian Development Cooperation

1. GNI 377 billion (2012)

2. State budget 150 billion

3. Development Cooperation 1.8 billion (0.47% of GNI)

4. DGD 1 billion

Belgium is committed to spend 0.7% of its GNI todevelopment cooperation. About 13% of this share(which corresponds to 0.1% of its GNI) is aimed atstrengthening universal health coverage to contribute

to bridge the gap between the current national healthbudgets in the low income countries (25$ perinhabitant) and the needs (54$ per inhabitant).

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ODA contributions 2008 - 2012 from DGD

0

200.000.000

400.000.000

600.000.000

800.000.000

1.000.000.000

1.200.000.0001.400.000.000

1.600.000.000

10,06% 11,22% 12,19% 10,90% 14,25%

2008 2009 2010 2011 2012

Health in the Belgian Development Cooperation

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Policy Note:

Universal Health Coverage: contributing to

The r igh t to heal th and heal thcare services

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Plan

Definition

Challenge Role of the Belgian

Development Cooperation

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Definition

Equal access toessential qualityhealthcare services

Embedded within

social protectionand a range ofsocial and economiccriteria

WHR 2010

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Role of the Belgian Development

Cooperation

Support to elaborating and implementing

a strategic plan

- Trace the pathway of universal coverage- Intersectoral approach to influence the

social criteria of health

- Start from local analysis

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Role of the Belgian Development

Cooperation (continued)

Bridge the gap between the local, national

and international level

Facilitate the dialogue and bring together

policy makers, local actor and researchers

Keep up national budgets (for health care in

the South and for development in the North):

0.7%, innovative taxes)

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Coherent support to UHC programme in Peru

Expertise:1) Social and political consensus

2) Mutualities (active participation & democratic management)3) Scientific expertise.

Support to OMS

Support SIS: ensure access for the population to

comprehensive quality health care services with emphasis onthe most vulnerable population

- SIS-FIN: 13 500 000Technical support

- SIS-TEC: 6 500 000Budget support

Instit. Medecina Tropical (Universidad Cayetano Heredia) FOS

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Conclusion Achieving equitable access to qualitative health

services funded on a base of solidarity is not easy,requires a long process and is different in everycountry

Nevertheless there are some communalities:

Compulsory adhesion State participation in the financing is paramount Single social (non commercial) comprehensive

system

Control is necessary (quality, generics) Dialogue with civil society and Human

Resources

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Thank you for your attention!

Les agradezco mucho por su atencin!