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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!
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