Cost sharing and protection mechanisms in health

KCE Reports 309C (2019)

The Belgian compulsory health insurance is not only an insurance scheme that reimburses health costs; it is also a solidarity system designed to reduce inequalities. It does this through two mechanisms: by income redistribution (high-income groups contribute more than low-income groups) and by cross-subsidies from low to high health risks. However, the Belgian health insurance system is also characterised by patient cost sharing, such as co-payments or supplements.  This personal contribution is, on average, 20-25% of total health costs.

A number of social protection measures were introduced to limit patient cost sharing in order to make health care more accessible to the most vulnerable groups. These measures are either targeted at specific categories of patients (for example, those with chronic illnesses), or at certain socioeconomic groups (for example, those entitled to an integration allowance for handicapped persons or to increased reimbursement of healthcare costs). At the request of the NIDHI [National Institute for Health and Disability Insurance], KCE has calculated the budgetary impact and the redistributive effect of the policy measures taken between 2012 and 2016 which have had an impact on patient cost sharing, and has assessed the impact of a series of hypothetical changes to the current protection measures.