Ongoing study - The Belgian system of compulsory health insurance combines relatively high out-of-pocket payments by patients with protection measures to guarantee financial accessibility. Due to a multitude of different types of out-of-pocket payments and of protection measures, the situation has become rather complicated for the NIHDI, the sickness funds, the providers and the patients. For instance, prescribed pharmaceuticals are assigned to one of 6 reimbursement categories, ranging from 100% to 0% reimbursement. The extent to which the criteria that are currently used to determine the reimbursement category are still consistent with the objective of cost-sharing for pharmaceuticals is increasingly questioned in Belgium. Moreover, in general, patients pay a different amount for identical services, and a clear view on the coherence of different protection mechanisms such as preferential reimbursement and Omnio, the lump sums for the chronically ill and the system of maximum billing is currently lacking.
The study aims at providing an overview of different co-payments and co-insurance rates and protection measures in the Belgian health insurance system. The general objective of the study is to make recommendations to simplify the current structure of co-payments and co-insurance rates and to increase the coherence with and between protection mechanisms. These recommendations will be based on a detailed analysis of the Belgian legal framework, an evaluation of the effects of out-of-pocket payments on outcome measures such as financial accessibility, a review of the literature on optimal cost-sharing designs and a quantitative data-analysis.
