Private expenditure on health and voluntary private health - PowerPoint PPT Presentation

Private expenditure on health and voluntary private health insurance Piet Calcoen

Expenditure on health in the European Union Curative care Pharmaceutical drugs 30% 40% 78,7% 15,3% 1,1% Dental care Therapeutic appliances 18% 4,9% 12% Voluntary private health insurance Public expenditure on health Out-of-pocket expenditure on health Other OECD, 2014

Every person should have access to health care on the basis of Equity versus need and not ability to pay (Oliver and Mossialos, 2004) personal autonomy People’s right to spend their money as they choose (Richards , 2008)

Nobel laureate Amartya Sen (2005) “It is impossible to imagine a situation where the rich could spend as much as they like on buying a villa, but could not spend their money in order to get something which affects them most, namely, their own health care. ”

26 % of Belgian households: « out-of-pocket expenditure on health is (very) hard to bear » Access to health care 46 % of Belgian households with chronically ill members need to postpone health care for financial reasons 25 % of cancer patients pays privately 2844 EUR per year or more « cancer poverty » Belgium; Belgian Health Interview Survey (2013); Samana, 2016; Rommel, 2015; Lewis, 2017

In how far are OECD Health Statistics on private expenditure on health for Belgium reliable? • General hospitals (2016) OECD 2 554 million EUR alternative calculation 1 293 million EUR • Residential long-term care facilities (2016) OECD 479 million EUR alternative calculation 2 174 million EUR OECD Health Statistics version 2018; RIZIV/INAMI, 2018; CM, 2017; National Accounts, 2017

Narrow versus broad definition Health expenditure as a share of GDP Belgium 10,0% Netherlands 10,4% 2,7% 0,8% Residential long-term care facilities OECD Health Statistics version 2018 (figures for 2016)

Recommendations

1. Private health insurance coverage of health expenditure other than hospitalisation costs, should be developed and promoted.

Most important components of private expenditure on health in Belgium (million EUR) General hospitals* 1293 Residential long-term facilities* 2174 Medical practices (ambulatory)** 1310 Dental practices (ambulatory)** 784 Psychologists, dietitians, fysiotherapists (ambulatory)*** 717 Pharmacies** 1866 Optical glasses and other vision products*** 357 Hearing aids*** 60 *Alternative calculations (figure for 2016) **OECD Health Statistics version 2018 (figure for 2016) ***Alternative calculations (figures for 2010)

2. Supplementary fees in hospitals need to be reformed.

Regulate (cf. Germany) Supplementary fees Create private convention Cut link with private room Replace by link with the convention status of the physician

Strict convention system: Only non-conventioned physicians are allowed to Alternatives charge supplementary fees. Conventioned physicians get substantial social security benefits (cf. France). Cf. the independent sector in the UK: Private practice two days per week (covered by private health insurance) + social security practice three days per week. Cf. ‘sector 3’ physicians in France: Physicians are free to set their fees but without reimbursement by mandatory basic health insurance.

3. Voluntary private health insurance can play a complementary role in providing access to new health technologies.

Access to new Waiting room function technologies ➢ second cochlear implant ➢ tantalum hip prosthesis ➢ robotic prostate surgery Not reimbursed by mandatory basic health insurance ➢ computerized artificial limb

Access to new health technologies (Belgium; Knack, 21 May 2014)

4. Dental care and physiotherapy can be excluded from mandatory basic health insurance - except for certain target groups- and covered by voluntary private health insurance.

Institut für Gesundheits- und Sozialforschung, Berlin, November 2018 “Kritik des Bundesrechnungshofs an fehlendem Nutzennachweis in der Kieferorthopädie” https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/5_Publikationen/Praevention/Berichte/IGES_Gutachten_ KfO .pdf

In the absence of coverage by mandatory basic health insurance, converting out-of-pocket spending into spending covered by PHI is a step forward.

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