Belgian report

In Belgium, doctors are working on a fee-for-service basis both in ambulatory sector and in hospital.

Every year or every other year, we negociate new fees. This system of agreement allows liberal practice to co-exist with social funding.

This system of agreement has been working for nearly fifty years. In the beginning, it was only an agreement on fees. For about twenty years, the agreement also became an agreement on budget. If the volume of services (medical acts) was too high, measures had to be taken during the period of the agreement.

Nowadays, volumes of prescriptions are also concerned.

This year, because of the crisis, the government intervenes even without any risk of exceeding budget. The system is really endangered and many doctors believe it has come to an end.

Other measures are taken to limit doctor’s freedom and patient’s as well. For instance, criteria to reimburse expansive medicines are very limited and introduce growing rationing.

Every medical act or every prescription are registered to make profile of every doctor.

Moreover, it has been decided that a part of the social security would be “defederalised” and next year, we will have new elections which could worsen the situation.

We have no idea of our future but we forsee new fights for our principles and ideals.

Dr Roland LEMYE

President of the Belgian Association of the Medical Trade Unions