UHC Belgium

Dr Ignace RONSE

Plan
1. Health Coverage in Belgium 2. UHC in Belgian Development Cooperation 3. Support to Health Coverage in Belgian Development Cooperation programme in Peru

Health Coverage in Belgium

1. Organizing the system

2. Financing the system

3. Lessons learnt

Organizing the system

1. Belgian Federal Public Service Health, Food Chain Safety and Environment: National Health Insurance Institute 2. Mutualities: compulsory but active choice 3. Health services & professionals (public or private but agreed tarification and no profits allowed for the institutions) Regular dialogue 1+2+3+health universities 99% is covered: very broad benefits package One single social (non commercial) system.

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).

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 already paid for that year. For more vulnerable population groups, several measures were taken to ensure their access to high-quality care.

Financing the system (2012)

Financing the system (2012)

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 and controlled system and a dialogue with the Human RH Cooperation: criteria to achieve equitable access to qualitative 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

Achieving equity?
Persistent health inequities: Health is determined by a clear social gradient and improves as socioeconomic status improves.

People in the weakest socioeconomic groups live less long and spend fewer years in good health.

Lessons learnt
The Belgian Federal Public Service Health, Food Chain Safety and Environment participates in the Joint 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 health inequities.

Lessons learnt
Main results of the policy dialogue: Implementation of Health in All Policies is needed to tackle health inequities Creation of a Interdepartmental Working Group on health inequities (Commission for Sustainable Development) Development of a national action plan on health inequities Translate the recommendations of the WHO Report on social determinants of health and the health divide in the WHO European Region to the Belgian context Designate a contact person at all levels of government to increase capacity building, raise awareness and improve involvement regarding health inequities

UHC in Belgian Development Cooperation

Health in the Belgian Development Cooperation

The Policy note on UHC

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 to development cooperation. About 13% of this share (which corresponds to 0.1% of its GNI) is aimed at strengthening universal health coverage to contribute to bridge the gap between the current national health budgets in the low income countries (25$ per inhabitant) and the needs (54$ per inhabitant).

Health in the Belgian Development Cooperation

ODA contributions 2008 - 2012 from DGD
1.600.000.000 1.400.000.000 1.200.000.000 1.000.000.000 800.000.000 600.000.000 400.000.000 200.000.000 0 10,06% 2008 11,22% 2009 12,19% 2010 10,90% 2011 14,25% 2012

Policy Note: Universal Health Coverage: contributing to The right to health and healthcare services

Plan Definition
Challenge

Role of the Belgian Development Cooperation

Definition
Equal access to essential quality healthcare services Embedded within social protection and a range of social and economic criteria

WHR 2010

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

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)

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 on the most vulnerable population - SIS-FIN: 13 500 000 Technical support - SIS-TEC: 6 500 000 Budget support Instit. Medecina Tropical (Universidad Cayetano Heredia) FOS

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 every country 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

Thank you for your attention!

Les agradezco mucho por su atencin!