Hoe universeel en billijk is de Belgische ziekteverzekering?

Abstract

How equitable and universal is the Belgian health insurance? Accessibility to and delivery of effective, high-quality and affordable healthcare are fundamental objectives that have shaped health policy and the universal healthcare coverage in Belgium. To what extent are access to and financing of healthcare in Belgium equitable? In general, the use of hospital care is in proportion to healthcare needs, and access can be considered equitable. However, inequity in the use of outpatient specialist care is important and increasing over time. When accounting for healthcare needs, we find that care use among high-income groups and individuals with a high educational attainment is substantially higher compared to financially vulnerable groups (individuals at risk of poverty, people with severe material deprivation, unemployed, singles). Also individuals who are entitled to an increased reimbursement, show a lower use of specialist care than expected based on their care needs. On the other hand, increased reimbursement is effective in improving the accessibility to GP care, while for other financially vulnerable individuals we find a lower use of GP care. The ability of a health system to realize an equitable access to care depends, among other things, on the user charges and the advance payments borne by the patient. In 2018, almost 4% of the households experienced catastrophic out‑of‑pocket payments, strongly concentrated among low-income households. Protection measures, such as the increased reimbursement, the mandatory third‑party payer arrangement and the system of maximum billing, reduce inequities, but there is room to improve and strengthen the financial protection against co-payments and supplements.