In conjunction with RIZIV (National Institute for Health and Disability Insurance) and WIV (Scientific Institute of Public Health), the Belgian Health Care Knowledge Centre (KCE), studied the performance of the Belgian health care system. The results of that study were compared to those of 14 other European countries. In quite a number of areas, such as the vaccination coverage for children, the survival rates 5 years after a breast cancer or colorectal cancer diagnosis, the relationship between patients and their general practitioner, the use of cheaper medication, etc., Belgium scores remarkably well. However, there is still some room for improvement in terms of breast and cervical cancer screening and the follow-up of patients suffering from diabetes. The study also brought to light that antibiotics are still being overprescribed and that Belgians are still at risk of being exposed to medical radiation. The rise in the average age of general practitioners and social inequality (e.g. people in lower social classes suffer worse health) are causes for concern.
Excellent vaccination coverage for children, quality of the health care provided and efficiency
The vaccination rate amongst children exceeds the European average. In terms of the quality of the care provided, our health system also scores remarkably well: the survival rates 5 years after a breast cancer or colorectal cancer diagnosis are excellent. Belgians furthermore have an excellent relationship with their general practitioner and 90% of respondents are happy with their experience of the health care system. No real evaluation was performed of the overall efficiency of our health care system, but indicators such as the increase in outpatient care and in the use of cheaper medication show that we are heading in the right direction.
To ensure that these excellent results are retained it is vital that efforts in these areas do not slacken.
Warning signs: the high suicide rate, obesity, the under-screening for certain cancers, social inequality...
In comparison with other European countries, Belgium has a very high suicide rate. At that, the number of people suffering from obesity is on the rise while the practice of engaging in physical activity is on the decline. Women within the target groups underuse the breast and cervical cancer screening services while those outside of the breast cancer target group (50-69 years) tend to avail of it all too readily. Aside from being counterproductive to public health, this also means that financial resources are not being spent as optimally as they might.
People in lower social classes often experience worse health: they do not live as long, often suffer worse health, are more inclined to suffer from obesity and even infant mortality is higher here. They also tend to adopt a less healthy lifestyle (diet, smoking, exercise). Furthermore, they are not as quick to participate in cancer screening and don’t enjoy the same follow-up as people from a higher socio-economic status when they contract diabetes.
…too many antibiotics, too great a variability in caesarean sections, too much medical radiation, insufficient follow-up of patients suffering from diabetes and too few general practitioners coming on stream
The over-prescription of antibiotics remains an issue where little headway seems to have been made, save in the case of children. The follow-up of diabetes patients in line with clinical guidelines leaves something to be desired. The number of caesarean sections continues to increase, with great variations between hospitals. Even though a slight decrease was recorded in 2011, exposure to medical radiation remains high. In spite of a continuous increase, the percentage of patients with comprehensive medical records (globaalmedisch dossier – GMD/ dossier médical global-DMG) remains on the low side.
Another worrying factor is that the average age of general practitioners continues to rise and that the quotas laid down by the Planning Commission (FPS Public Health) have not been filled for a number of years now.
A must: readily available health data…
Since the previous performance report from 2010, there has been a marked improvement in data availability. Though various inadequacies in the current data sources remain, and the researchers have issued a number of recommendations to address this situation.
…and improvement objectives
This report highlights a number of points that merit a more in-depth study. Policy makers were already aware of a number of the issues featured in this report and have already commissioned an additional study to establish which measures would need to be implemented.
The current report measures an existing situation, yet the ultimate objective is to demonstrably improve matters. To that end, our political leaders should define measurable objectives with due regard for the recommendations made in this report.
European initiative
This performance measurement is a more elaborate continuation of the first KCE-RIZIV-WIV report from 2010 (KCE report no. 128). The initiative features within the framework of the Tallin Charter, which all the European Member States signed up to in 2008. By doing so, the Member States undertook to regularly measure and evaluate the performance of their health care system.
The next Belgian performance report will be published in December 2015.
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