De performantie van het Belgische gezondheidssysteem ... · 3. Op lange termijn de performantie van...

2013 www.kce.fgov.be

KCE REPORT 196 A

DE PERFORMANTIE VAN HET BELGISCHE GEZONDHEIDSSYSTEEM RAPPORT 2012

Het Federaal Kenniscentrum voor de Gezondheidszorg Het Federaal Kenniscentrum voor de Gezondheidszorg is een parastatale, opgericht door de

programmawet (1) van 24 december 2002 (artikelen 259 tot 281) die onder de bevoegdheid valt van de Minister van Volksgezondheid en Sociale Zaken. Het Centrum is belast met het realiseren van beleidsondersteunende studies binnen de sector van de gezondheidszorg en de ziekteverzekering.

Raad van Bestuur Effectieve Leden Plaatsvervangende Leden

Voorzitter Pierre Gillet Leidend ambtenaar RIZIV (vice-voorzitter) Jo De Cock Benoît Collin Voorzitter FOD Volksgezondheid (vice-voorzitter) Dirk Cuypers Chris Decoster Voorzitter FOD Sociale Zekerheid

(vice-voorzitter) Frank Van Massenhove Jan Bertels

Administrateur-generaal FAGG Xavier De Cuyper Greet Musch Vertegenwoordigers Minister van Volksgezondheid Bernard Lange François Perl Marco Schetgen Annick Poncé Vertegenwoordigers Minister van Sociale Zaken Olivier de Stexhe Karel Vermeyen Ri De Ridder Lambert Stamatakis Vertegenwoordigers Ministerraad Jean-Noël Godin Frédéric Lernoux Daniel Devos Bart Ooghe Intermutualistisch Agentschap Michiel Callens Frank De Smet Patrick Verertbruggen Yolande Husden Xavier Brenez Geert Messiaen Beroepsverenigingen van de artsen Marc Moens Roland Lemye Jean-Pierre Baeyens Rita Cuypers Beroepsverenigingen van de verpleegkundigen Michel Foulon Ludo Meyers Myriam Hubinon Olivier Thonon Ziekenhuisfederaties Johan Pauwels Katrien Kesteloot Jean-Claude Praet Pierre Smiets Sociale partners Rita Thys Leo Neels Paul Palsterman Celien Van Moerkerke Kamer van Volksvertegenwoordigers Lieve Wierinck

Controle Regeringscommissaris Yves Roger

Directie Algemeen Directeur

Raf Mertens

Programmadirectie Christian Léonard Kristel De Gauquier

Contact Federaal Kenniscentrum voor de Gezondheidszorg (KCE) Doorbuilding (10e verdieping) Kruidtuinlaan 55 B-1000 Brussel Belgium T +32 [0]2 287 33 88 F +32 [0]2 287 33 85 [email protected] http://www.kce.fgov.be

2013 www.kce.fgov.be

KCE REPORT 196 A HEALTH SERVICES RESEARCH

DE PERFORMANTIE VAN HET BELGISCHE GEZONDHEIDSSYSTEEM RAPPORT 2012 FRANCE VRIJENS, FRANÇOISE RENARD, PASCALE JONCKHEER, KOEN VAN DEN HEEDE, ANJA DESOMER, CARINE VAN DE VOORDE, DENISE WALCKIERS, CÉCILE DUBOIS, CÉCILE CAMBERLIN, JOAN VLAYEN, HERMAN VAN OYEN, CHRISTIAN LÉONARD, PASCAL MEEUS

COLOFON Titel: De performantie van het Belgische gezondheidssysteem. Rapport 2012

Auteurs: France Vrijens (KCE), Françoise Renard (ISP – WIV), Pascale Jonckheer (KCE), Koen Van den Heede (KCE), Anja Desomer (KCE), Carine Van de Voorde (KCE), Denise Walckiers (ISP – WIV), Cécile Dubois (KCE), Cécile Camberlin (KCE), Joan Vlayen (KCE), Herman Van Oyen (WIV - ISP), Christian Léonard (KCE), Pascal Meeus (INAMI – RIZIV)

Externe experten: Health Promotion Group : Luc Berghmans (Observatoire de la santé du Hainaut), Lien Braeckevelt (WVG Vlaanderen), Christian De Bock (CM), Léa Maes (UGent), Myriam De Spiegelaere (ULB – Observatoire de la santé Bruxelles), Stephan Van Den Broucke (UCL), Chantal Vandoorne (ULg), Alexander Witpas (WVG Vlaanderen) Mental Healthcare Group: Joël Boydens (CM), Robert Cools (CGG - De Pont), Raf De Rycke (Broeders van Liefde), Pol Gerits (FOD Volksgezondheid – SPF Santé Publique), Jean-Pierre Gorissen (FOD Volksgezondheid – SPF Santé Publique), Bernard Jacob (SPF Santé publique – FOD Volksgezondheid), Gert Peeters (UZ Leuven), Jean-Paul Roussaux (Cliniques Universitaires St-Luc) Continuity of Care and Patient Centeredness Group: Corinne Boüüaert (Maison Médicale Bautista Van Schowen), Xavier de Béthune (CM), Veerle Foulon (KU Leuven), Mirco Petrovic (UZ Gent), Luc Seuntjens (het Artsenhuis), Anne Spinewine (UCL de Mont-Godinne), Johan Van der Heyden (WIV - ISP), Annelies Van Linden (Domus Medica), Johan Wens (UA) Long term care Group: Daniel Crabbe (RIZIV – INAMI), Jan Delepeleire (KU Leuven), Johan Flaming (UZ Leuven), Margareta Lambert (UZ Brussel), Jean Macq (UCL), Alex Peltier (MC), Luc Van Gorp (Katholieke Hogeschool Limburg), Isabelle Vanderbrempt (SPF Santé publique – FOD Volksgezondheid ) End of Life Group: Joachim Cohen (VUB), Marianne Desmedt (UCL), Rita Goetschalckx (RIZIV – INAMI), Johan Menten (UZ Leuven), Kathleen Kleemans (VUB), Birgit Gielen (CM)

Acknowledgements: Greet Haelterman (FOD Volksgezondheid - SPF Santé publique), Willem Alvoet (FOD Volksgezondheid - SPF Santé publique), Marie-Noëlle Verhaegen (FOD Volksgezondheid - SPF Santé publique ), Hans Verrept (FOD Volksgezondheid - SPF Santé publique ), Isabelle Coune (SPF Santé publique - FOD Volksgezondheid), Luc Nicolas (SPF Santé publique – FOD Volksgezondheid), Dirk Moens (FOD Sociale Zekerheid – SPF Sécurité Sociale), Elke Van Hoof (Kankercentrum – Centre Cancer), Elisabeth Van Eycken (Stichting Kankerregister – Fondation Registre du Cancer), Xavier Ledent (INAMI – RIZIV), Pierre Bonte (INAMI – RIZIV), Olaf Moens (VIGeZ), Sadja Steenhuizen (VIGeZ), Stefaan Demarest (WIV – ISP), Béatrice Jans (ISP – WIV), Natacha Viseur (ISP – WIV), Viviane Van Casteren (WIV – ISP), Nathalie Bossuyt (WIV – ISP), Xavier de Béthune (MC), Johan Hellings (ICURO)

Externe Validatoren: Ann-Lise Guisset (WHO), Irene Papanicolas (London School of Economics and Political Science), Niek Klazinga (Academisch Medisch Centrum – Universiteit van Amsterdam)

Stakeholders: De volgende administratieve overheden en organisaties zijn gedurende het project geconsulteerd tijdens interadministratieve vergaderingen: op federaal niveau (FOD Volksgezondheid, FOD Sociale Zaken, RIZIV, WIV) en op niveau van de deelstaten: de Vlaamse Gemeenschap en het Vlaamse Gewest (Vlaams Agentschap Zorg en Gezondheid), de Federatie Wallonië-Brussel (Direction générale de la Santé), de Duitstalige Gemeenschap (DGOV Ministerium der Deutschsprachigen Gemeinschaft), het Waalse Gewest (Direction générale opérationelle des Pouvoirs locaux, de l’Action sociale et de la Santé et observatoire wallon de la santé), het Brussels Hoofdstedelijk Gewest (Observatorium voor de Gezondheid)

Belangenconflict: Elke andere directe of indirecte relatie met een producent, verdeler of zorginstelling die zou kunnen opgevat worden als een belangenconflict: Gert Peeters (UZ Leuven – UPC) (Administratief manager van het UPC - UZ Leuven), Joël Boydens (MC; Groep Emmaüs vzw – lid bestuurscomité)

Layout: Ine Verhulst, Sophie Vaes

Disclaimer: • De externe experten werden geraadpleegd over een (preliminaire) versie van het wetenschappelijke rapport. Hun opmerkingen werden tijdens vergaderingen besproken. Zij zijn geen coauteur van het wetenschappelijke rapport en gingen niet noodzakelijk akkoord met de inhoud ervan.

• Vervolgens werd een (finale) versie aan de validatoren voorgelegd. De validatie van het rapport volgt uit een consensus of een meerderheidsstem tussen de validatoren. Zij zijn geen coauteur van het wetenschappelijke rapport en gingen niet noodzakelijk alle drie akkoord met de inhoud ervan.

• Tot slot werd dit rapport unaniem goedgekeurd door de Raad van Bestuur. • Alleen het KCE is verantwoordelijk voor de eventuele resterende vergissingen of onvolledigheden

alsook voor de aanbevelingen aan de overheid. Publicatiedatum: 25 januari 2013 Domein: Health Services Research (HSR) MeSH: Delivery of Health Care; Health Promotion; Health Services Accessibility; Quality of Health Care; Efficiency,

Organizational; Healthcare Disparities; Social Justice; Benchmarking; Belgium NLM classificatie: W84 Taal: Nederlands, Engels Formaat: Adobe® PDF™ (A4) Wettelijk depot: D/2012/10.273/110 Copyright: De KCE-rapporten worden gepubliceerd onder de Licentie Creative Commons « by/nc/nd »

http://kce.fgov.be/nl/content/de-copyrights-van-de-kce-rapporten

Hoe refereren naar dit document? Vrijens F, Renard F, Jonckheer P, Van den Heede K, Desomer A, Van de Voorde C, Walckiers D, Dubois C, Camberlin C, Vlayen J, Van Oyen H, Léonard C, Meeus P. De performantie van het Belgische gezondheidssysteem Rapport 2012. Health Services Research (HSR). Brussel: Federaal Kenniscentrum voor de Gezondheidszorg (KCE). 2012. KCE Report 196A. D/2012/10.273/110.

Dit document is beschikbaar op de website van het Federaal Kenniscentrum voor de Gezondheidszorg.

KCE Report 196A De performantie van het gezondheidssysteem i

VOORWOORD

Ons tijdvak wordt vaak enigszins pejoratief geassocieerd met een performantie-cultus. Maar binnen het domein van de gezondheid en de gezondheidszorg staat het onderzoek naar de performantie wel hoog aangeschreven, en biedt het een soort van geruststelling. Wie zou er immers klagen over een kwaliteitsvol, doeltreffend, efficiënt, toegankelijk en billijk zorgsysteem? Wat zou men kunnen verwijten aan gezondheidspromotie die actief de ongelijkheden in gezondheid doeltreffend aanpakt en bijdraagt aan een gestage verbetering van dat gezondheidsniveau?

Voorliggend rapport biedt u een snapshot van deze performantie aan de hand van 74 indicatoren, die op een nauwgezette manier werden samengebracht door de onderzoekers van het KCE, van het Wetenschappelijk Instituut Volksgezondheid en van het RIZIV. Hun werk werd ondersteund en verrijkt door de inbreng van tientallen experten uit de academische wereld en het middenveld. De leden van de administratie en de politieke overheid hebben actief alle productiestappen van dit rapport gevolgd. Wij willen ieder van hen hartelijk danken voor deze betrokkenheid die de geloofwaardigheid van het resultaat ten goede komt en de toe-eigening door alle betrokken partijen zal vergemakkelijken.

We laten u de sterke punten van ons systeem ontdekken, zoals de perceptie van de eigen gezondheidstoestand door onze medeburgers of de vaccinatiegraad bij kinderen. Toch mag men de inspanningen waar men nu tevreden over is niet laten verslappen. Ook mag dit de aandacht niet afleiden van domeinen waarin nog ruimte voor verbetering is, zoals de opsporing van bepaalde kankers of het uitstellen van gezondheidszorgen om financiële redenen. Men moet ook waakzaam blijven voor de vele ongelijkheden tussen socio-economische groepen of regio’s.

De rigoureuze manier waarop elke indicator is ontwikkeld, ontslaat de lezer niet van enige voorzichtigheid bij de interpretatie. De meest recent beschikbare data zijn soms meerdere jaren oud, zeker de data op basis van enquêtes. Men moet er ook rekening mee houden dat de effecten van een interventie op het vlak van de volksgezondheid vaak pas na geruime tijd zichtbaar worden in de cijfers. Denken we maar aan de maatregelen van de administratie en politieke overheid op het vlak van het medische zorgaanbod, de gelijkheid en billijkheid van de zorg. Om dus te kunnen besluiten dat we op koers zitten op de weg naar een optimale performantie, zullen we deze evaluatie regelmatig moeten herhalen. Zeer waarschijnlijk zullen in volgende versies nieuwe data geregistreerd moeten worden en zullen bepaalde indicatoren moeten worden aangepast of vervangen. Op vlak van gezondheid en gezondheidszorg, zoals in de andere domeinen van het menselijk streven, is weinig of niets eens en voor altijd verworven. Efficiëntie en billijkheid zullen dus altijd werkpunten blijven.

Raf MERTENS Algemeen Directeur

ii De performantie van het gezondheidssysteem KCE Reports 196A

SAMENVATTING INLEIDING Health system performance assessment (HSPA - Beoordeling van de performantie van het gezondheidssysteem) is een landgebonden proces om het gezondheidssysteem holistisch te beoordelen, een "check-up" te doen van het hele gezondheidssysteem. Deze beoordeling maakt gebruik van statistische indicatoren om het systeem te monitoren en koppelt gezondheidsuitkomstmaten aan de strategieën en functies van het gezondheidssysteem. Elke HSPA wordt ontwikkeld volgens de lijnen van een strategisch kader dat specifiek is voor het land. HSPA wordt ook specifiek genoemd in het Handvest van Tallinn dat werd ondertekend door alle landen uit de Europese regio van de Wereldgezondheidsorganisatie (WGO). De eerste Belgische beoordeling van de performantie van het gezondheidssysteem werd gepubliceerd in juni 2010. Het HSPA-rapport van 2012 tracht de toegankelijkheid, kwaliteit, efficiëntie, duurzaamheid en billijkheid van het Belgische gezondheidssysteem te monitoren, om zodoende te dienen als een bron van informatie voor beleidsmakers die bevoegd zijn voor de gezondheid en gezondheidspromotie in België.

KCE Report 196A De performantie van het gezondheidssysteem iii

DOELSTELLINGEN Strategische doelstellingen van het lopende Performantie beoordelingsproces 1. De gezondheidsautoriteiten informeren over de performantie van het

gezondheidssysteem en een draagvlak bieden voor beleidsplanning; 2. Een transparant en controleerbaar beeld schetsen van de

performantie van het Belgische gezondheidssysteem, in overeenstemming met het engagement in het Handvest van Tallinn;

3. Op lange termijn de performantie van het gezondheidssysteem in de loop der tijd volgen.

Algemene doelstelling van het rapport van 2012 Een reeks indicatoren voorstellen en meten voor alle domeinen en gekozen dimensies van het Belgische gezondheidssysteem, waarbij het aantal indicatoren beheersbaar blijft (in dit rapport zijn dat er 74).

Operationele doelstellingen van het rapport van 2012 1. De kernset van 55 indicatoren van het vorige rapport herzien, met een

speciale focus op de 11 indicatoren waarvoor er geen gegevens waren in 2010;

2. De kernset verrijken met indicatoren uit de volgende domeinen: huisartsgeneeskunde, geestelijke gezondheidszorg, zorg op lange termijn, palliatieve zorg, gezondheidspromotie; indicatoren toevoegen inzake patiëntgerichtheid en zorgcontinuïteit (twee subdimensies inzake kwaliteit); en tot slot indicatoren voorstellen inzake billijkheid in het gezondheidssysteem;

3. De geselecteerde indicatoren waar mogelijk meten, of hiaten in de beschikbaarheid van gegevens identificeren;

4. De resultaten interpreteren met het oog op een globale evaluatie van de performantie van het Belgische gezondheidssysteem door middel van verschillende criteria, waaronder een internationale benchmarking, indien nodig.

METHODES In de geïndexeerde literatuur en grijze literatuur werd uitgebreid gezocht naar nieuwe indicatoren in de hierboven vermelde domeinen/dimensies. Selectie van de meest relevante indicatoren gebeurde in samenwerking met externe experts van elk domein. In totaal werden er 74 indicatoren geselecteerd en gemeten. Voor elke indicator werden analyses gemaakt op nationaal niveau, op regionaal niveau (wanneer er gegevens beschikbaar waren), per sociodemografische status (indien van toepassing). De resultaten werden ook gebenchmarkt aan 15 EU-landen, en tot slot werd er een algemene evaluatie gemaakt. Bron van de gegevens Er werd zoveel mogelijk gebruik gemaakt van routinematig beschikbare gegevens (bijv. administratieve databanken, nationale registers of herhaalde enquêtes): de administratieve ontslaggegevens van ziekenhuizen (RHM - MZG), de EPS (échantillon permanent - permanente steekproef), databases van het RIZIV - INAMI (doc N, Pharmanet), het Belgische Kankerregister, het register van ziekenhuisinfecties, de Health Interview Survey (HIS) en vaccinatie-enquêtes.

iv De performantie van het gezondheidssysteem KCE Reports 196A

RESULTATEN Gezondheidstoestand (4 indicatoren) De vier indicatoren betreffende de gezondheidstoestand laten een positieve evolutie in de tijd zien. Het resultaat van de levensverwachting is iets lager in vergelijking met het EU-15 gemiddelde, terwijl de gezonde levensverwachting (dit zijn de resterende geleefde jaren vanaf een bepaalde leeftijd zonder activiteitbeperking op lange termijn) en de zuigelingensterfte op een middelmatige plaats staan. Het percentage van mensen die hun gezondheid als (minstens) goed beschouwen, is hoger dan het EU-15 gemiddelde.

Toegankelijkheid van de zorg (13 indicatoren) Met betrekking tot de financiële toegankelijkheid, ondanks een universele verzekeringsdekking en het bestaan van sociale zorgnetten (maximumfactuur, Omnio, Bijzonder Solidariteitsfonds), is er sprake van enige bezorgdheid (hoge mate van persoonlijke uitgaven van de patiënt, en in zekere mate uitgestelde contacten met de gezondheidsdiensten om financiële redenen). De toegankelijkheid van preventieve maatregelen toont uiteenlopende resultaten. De cijfers voor vaccinatiegraad tegen griep bij ouderen en kankerscreening (met sociale en enkele regionale verschillen) zijn middelmatig, terwijl de vaccinatiegraad bij kinderen goed is. Een ander aspect van de toegankelijkheid is de beschikbaarheid van het aanbod aan gezondheidszorgpersoneel met betrekking tot de behoeften. Er werden aanzienlijke inspanningen geleverd om gegevens over de aanbodzijde beschikbaar te maken, maar er is nog te weinig informatie over de behoeften aan personeel.

Zorgkwaliteit: Doeltreffendheid (7 indicatoren), Aangepastheid (8), Veiligheid (6), Continuïteit (7), Patiëntgerichtheid (3) De kwaliteit werd onderverdeeld in 5 subdimensies. De doeltreffendheid liet een gemengd beeld zien. Ze scoorde erg goed qua overlevingskansen bij kanker, maar er is wel bezorgdheid op het vlak van de geestelijke gezondheid, want België telt het op een na hoogste aantal zelfdodingen in Europa (met zeer grote regionale verschillen), en kent een toenemend niveau van onvrijwillige ziekenhuisopnames. Er zijn meer indicatoren en gegevens nodig om de doeltreffendheid in de geestelijke gezondheidszorg te beschrijven. De aangepastheid van de zorg is vrij teleurstellend, met hoge en stijgende cijfers voor borstkankerscreening buiten de doelgroepen, een matige opvolging van de richtlijnen (antibiotica, diabetespatiënten), een stijgend aantal keizersneden met grote variabiliteit tussen de ziekenhuizen. De veiligheid van de zorg toont bemoedigende resultaten, met afnemende trends wat betreft de blootstelling aan medische straling, de ziekenhuisbacterie MRSA, ziekenhuismortaliteit na een heupfractuur, en stabiele incidentie van postoperatieve sepsis en het voorschrijven van anticholinerge antidepressiva aan bejaarden. De incidentie van doorligwonden neemt echter toe. De continuïteit en coördinatie van de zorg geeft gemengde resultaten, met een goede relationele continuïteit met dezelfde arts, een gemiddeld en toenemend cijfer voor multidisciplinaire raadpleging voor kankergevallen, maar een lage dekking van het globaal medisch dossier en een hoge heropname in psychiatrische ziekenhuizen. De patiëntgerichtheid kon slechts deels worden beoordeeld. Er werd een hoge tevredenheidsgraad over de gezondheidszorg vastgesteld, maar ook een toenemende trend om thuis te sterven. Er moeten meer gegevens worden verzameld over dit onderwerp.

KCE Report 196A De performantie van het gezondheidssysteem v

Efficiëntie van het gezondheidssysteem (3 indicatoren) De efficiëntie van het gezondheidssysteem toont gemiddelde tot goede resultaten met een stijging in het voorschrijven van goedkope medicijnen, het gebruik van het daghospitaal voor chirurgische ingrepen en een daling van de verblijfsduur voor een normale bevalling. De positieve boodschap moet echter worden gematigd door de ongeschiktheid en dus verspilling van middelen, zoals blijkt uit een aantal indicatoren, waaronder de bovengenoemde mammogrammen buiten de doelgroep.

Duurzaamheid van het gezondheidssysteem (6 indicatoren) De duurzaamheid van het gezondheidssysteem laat enkele resultaten zien die vragen doen rijzen met betrekking tot het gebrek aan vervanging van de huidige cohort van huisartsen. Er zijn gegevens nodig over de behoefte aan verpleegkundigen, gekoppeld aan gegevens over de evolutie van het aanbod van verpleegkundigen.

Billijkheid (analyses van alle indicatoren per socio-economische status en 2 contextuele indicatoren) De billijkheidsdimensie werd benaderd op twee complementaire manieren. Ten eerste werden ongelijkheden in gezondheidstoestand, levensstijlfactoren en het gebruik van gezondheidszorg geanalyseerd per socio-economische status. Er werden sterke ongelijkheden waargenomen in de gezondheids- en levensstijlindicatoren. Ook werden er ongelijkheden waargenomen voor kankerscreening en voor de opvolging van chronische patiënten. De meeste ziekenhuisgebaseerde indicatoren konden echter niet worden onderzocht per sociale status in dit werk, en de conclusies zijn nog grotendeels onvolledig qua ongelijkheden in de zorgverlening en kwaliteit. De billijkheid werd ook benaderd aan de hand van twee indicatoren die dit probleem op macroniveau benadrukken. De progressiviteit van de financiering van de gezondheidszorg neemt af, wat een evolutie is naar minder billijkheid. De Gini-index komt overeen met het niveau van ongelijkheid in de globale verdeling van de inkomens in België, en blijkt samen te hangen met een lagere globale gezondheidsstatus. Hij is relatief laag, maar neemt alsmaar toe, wat wijst op een minder gelijke verdeling van de inkomsten in België.

Gezondheidspromotie (15 indicatoren) Tot slot werd de gezondheidspromotie vooral benaderd aan de hand van conventionele gezondheids- en levensstijlindicatoren, aangevuld met een aantal indicatoren met betrekking tot het gezondheidsbeleid, gezonde leefomgeving en individuele vaardigheden. Door de zeer beperkte beschikbaarheid van geschikte indicatoren en gegevens buiten de conventionele gezondheid/levensstijlindicatoren, kon er slechts een fragmentarisch overzicht worden gegeven. De meeste gezondheid/levensstijlindicatoren wijzen op een middelmatig nationaal cijfer in vergelijking met de EU-15 landen, maar er werden belangrijke regionale/sociale verschillen waargenomen. We wijzen op het probleem van obesitas/overgewicht dat een vrij hoge en stijgende trend met grote verschillen laat zien. De tabaksconsumptie daalt, maar met grote sociale en regionale verschillen. De consumptie van groenten en fruit is veel lager dan de dagelijkse behoeften, maar gaat erop vooruit. Het gebrek aan sociale steun vertoont ook belangrijke sociale en regionale verschillen, en baart vooral zorgen bij ouderen. België staat op een middelmatig niveau op de internationale Tobacco Control Scale Policies. Sommige complexe indices hebben tot doel de kracht van het lokale beleid inzake gezondheidspromotie in verschillende settings te meten (scholen, gemeenten, bedrijven), maar ze zijn alleen beschikbaar in Vlaanderen en zijn moeilijk te interpreteren zonder een grondige analyse.

vi De performantie van het gezondheidssysteem KCE Reports 196A

DISCUSSIE EN CONCLUSIE Aan de hand van 74 indicatoren geeft dit rapport een breed beeld van de performantie van het Belgische gezondheidssysteem. Het wijst in bepaalde richtingen voor beleidsmaatregelen en doet vragen rijzen voor de verdere opvolging of voor verder onderzoek. Voortbouwend op de eerste HSPA, die de haalbaarheid beoordeelde om een tool op te stellen voor het meten van de performantie van het Belgische gezondheidssysteem, vormt dit rapport een aanzienlijke verbetering van de vorige tool: het is meer omvattend en zorgt voor een update van de voormalige reeks indicatoren met meer relevante indicatoren. Bovendien maakt het in sommige gevallen de meting van de evolutie mogelijk. Voormalige hiaten in de basisgegevens werden ook opgevuld, zoals de zuigelingensterfte of cijfers over patiënten die kanker overleven. Niet alle domeinen van de zorg of specifieke patiëntgroepen kwamen echter in gelijke mate aan bod. De indicatoren geven waarschuwingssignalen met betrekking tot de status van het gezondheidssysteem op het vlak van toegankelijkheid, kwaliteit, efficiëntie, duurzaamheid en billijkheid. In sommige gevallen zijn de beleidsmakers al op de hoogte van de problemen, en gaven ze opdracht voor aanvullende analyses om te weten welke actie ondernomen moet worden. In andere gevallen zijn deze signalen nieuw voor de beleidsmakers, en moeten ze dus grondiger geanalyseerd worden. In ieder geval moet de uitgebreide en gestructureerde manier waarop indicatoren worden voorgesteld ervoor zorgen dat er gemakkelijker prioriteiten gesteld kunnen worden betreffende de nodige acties en/of verdere studies. België is niet het eerste land dat deze uitdaging aangaat. Met de ondertekening in 2008 van het Verdrag van Tallinn inzake gezondheidssystemen, hebben de lidstaten zich er formeel toe verbonden om de performantie van het gezondheidssysteem te monitoren en te evalueren. Verschillende buurlanden met jaren ervaring in het meten van de performantie van gezondheidssystemen dienden als voorbeeld voor dit rapport, zoals het Nederlandse Performantierapport. Een van de tekortkomingen die het nut van de performantiemeting belemmert (en die ook werd vastgesteld in eerdere Nederlandse performantierapporten), is de lage beschikbaarheid van up-to-date gegevens. Het regelmatig

actualiseren van administratieve gegevens en het dynamisch publiceren van resultaten op een website is één van de pistes die moet worden onderzocht. Met de Europese Richtlijn betreffende de toepassing van de rechten van patiënten bij grensoverschrijdende zorg wordt dit engagement een gemeenschappelijke bezorgdheid onder de lidstatena. Vanaf de implementatie van de Richtlijn in de nationale wetgeving in oktober 2013 zullen de lidstaten ervoor moeten zorgen dat patiënten uit een andere lidstaat relevante informatie kunnen krijgen over de veiligheids- en kwaliteitsnormen om een weloverwogen beslissing voor grensoverschrijdende gezondheidszorg te maken. In deze context legt dit rapport niet alleen de basis van een toekomstige systematische beoordeling van de performantie, maar kan het ook worden beschouwd als een eerste stap op weg naar de verantwoordelijkheid van België om veilige, kwaliteitsvolle, toegankelijke en efficiënte gezondheidszorg voor zowel Belgische als buitenlandse patiënten te verzekeren.

a Richtlijn 2011/24/EU van het Europees Parlement en de Raad van 9 maart

2011 betreffende de toepassing van de rechten van patiënten bij grensoverschrijdende gezondheidszorg, Publicatieblad L 88/45, 4 april 2011

KCE Report 196A De performantie van het gezondheidssysteem vii

AANBEVELINGENb

Algemene aanbevelingen voor de politieke verantwoordelijken Het concept performantie hangt impliciet samen met het bereiken van doelstellingen. Terwijl het huidige rapport vooral een ‘vaststelling’ van de situatie is, moet het grote belang ervan worden gezocht in het uiteindelijke doel, nl. ‘een verbetering’ van de situatie. De politieke verantwoordelijken zouden derhalve meetbare doelstellingen moeten vooropstellen en termijnen vastleggen om die te realiseren, rekening houdend met de hierna volgende aanbevelingen. Positieve bevindingen (te behouden) en negatieve bevindingen (aandachtspunten): Over het algemeen wordt aanbevolen dat de betrokken instellingen en instanties zich baseren op de hierna volgende bevindingen, zodat ze op dezelfde koers kunnen doorgaan in de domeinen met positieve bevindingen, ofwel van koers kunnen veranderen om de situatie te verbeteren in de domeinen waar aandachtspunten werden gesignaleerd. Positieve bevindingen (te behouden): • Gezondheidstoestand: de 'gerapporteerde' of 'waargenomen' gezondheidstoestand,

gemeten via de gezondheidsenquêtes (Wetenschappelijk Instituut Volksgezondheid) is beter dan het Europese gemiddelde.

• Dekking van de preventieve maatregelen: de vaccinatiegraad bij kinderen is beter dan het Europese gemiddelde.

• Zorgkwaliteit: o Effectiviteit van de curatieve zorg: zeer goede resultaten voor de overleving op 5 jaar

na borstkanker of na colorectale kanker in vergelijking met de andere Europese landen.

o De indicatoren tonen aan dat de Belgen een zeer goede en continue relatie met de huisarts onderhouden en dat ze erg tevreden zijn (meer dan 90 %) over hun contacten met de gezondheidszorg.

• Efficiëntie: een verbetering van de efficiëntie kan worden afgeleid uit het stijgend percentage opnames in dagziekenhuis en een toenemend gebruik van goedkopere geneesmiddelen.

b Alleen het KCE is verantwoordelijk voor de aanbevelingen aan de overheid.

viii De performantie van het gezondheidssysteem KCE Reports 196A

Aandachtspunten voor het oriënteren van het toekomstige gezondheidszorgbeleid: • Gezondheidstoestand:

o De zeer hoge percentages van zelfdoding in vergelijking met het Europese gemiddelde vragen om opheldering.

o In vergelijking met het Europese gemiddelde stelt men vast dat het percentage personen met overgewicht of obesitas stijgt en dat het nemen van lichaamsbeweging eerder laag scoort.

• Dekking van de preventieve maatregelen: De dekkingsgraad in de doelgroepen van de opsporing van borstkanker en baarmoederhalskanker is laag in vergelijking met het Europese gemiddelde. De dekking van de georganiseerde opsporing van borstkanker is onvoldoende om efficiënt te zijn. Een ander aandachtspunt is de hoge opsporingsgraad van borstkanker buiten de doelgroepen van de georganiseerde screening en deze neemt toe voor leeftijdscategorieën van 40-49 jaar en 70-79 jaar, hetgeen contraproductief is in termen van volksgezondheid en het gebruik van de collectieve middelen.

• Sociale billijkheid/ongelijkheid: Vergeleken met personen uit een hogere klasse hebben personen met een socio-economisch lagere status (gemeten op basis van het opleidingsniveau of de toegang tot verhoogde terugbetaling van de gezondheidszorg) een slechtere gezondheidstoestand (levensverwachting, levensverwachting in goede gezondheid, zuigelingensterfte, obesitas), een minder gezonde levensstijl (voeding, roken, lichaamsbeweging), een minder goede dekking van de opsporing van kanker, een minder goede opvolging voor diabetici, minder sociale ondersteuning en ze overlijden vaker in het ziekenhuis dan in hun eigen woning.

• Zorgkwaliteit: o (Onaan)gepaste zorg: uit meerdere indicatoren blijkt dat de medische praktijk niet altijd

aangepast is. Bijvoorbeeld: De eerste keuze van de voorgeschreven antibiotica komt te weinig overeen met de

aanbevelingen en er is geen verbetering merkbaar doorheen de tijd (behalve bij kinderen).

Het percentage diabetische patiënten dat op de juiste manier volgens de aanbevelingen wordt opgevolgd, is onvoldoende.

Hoewel het niveau enigszins lager ligt dan het gemiddelde van de andere Europese landen is het percentage keizersneden hoog. Men ziet ook bij niet-gecompliceerde zwangerschappen een grote variabiliteit tussen de ziekenhuizen.

KCE Report 196A De performantie van het gezondheidssysteem ix

o Veiligheid van de zorg: blootselling aan straling van medische oorsprong: hoewel lichtjes gedaald in 2011, blijft het niveau erg hoog in vergelijking met het Europese gemiddelde.

o Zorgcontinuïteit: sommige indicatoren wijzen erop dat in dit domein zwak gescoord wordt. Bijvoorbeeld:

Ondanks een constante stijging is het percentage patiënten dat over een globaal medisch dossier (GMD) beschikt nog te laag.

Het percentage heropnames in de psychiatrische ziekenhuizen is relatief hoog vergeleken met het Europese gemiddelde.

• Duurzaamheid van het systeem: Het gezondheidssysteem steunt op een eerstelijnszorg waarin de huisartsgeneeskunde een belangrijke schakel vormt. Verontrustend is dat de gemiddelde leeftijd van de huisartsen blijft stijgen, en dat de quota die werden voorzien door de Planningscommissie sinds enkele jaren niet ingevuld geraken. Wanneer deze tendens zich doorzet, zal dit snel leiden tot problemen voor de werking van de eerstelijnszorg.

Verbetering van de informatiesystemen voor de gezondheidszorg De kwaliteit van de gegevens en de snelheid waarmee ze beschikbaar worden gesteld zijn essentieel voor de relevantie van de indicatoren die erop gebaseerd zijn. • Termijn van de ter beschikking stelling van de gegevens

o Voorzetten van de inspanningen teneinde geactualiseerde gegevens over te maken aan de internationale organisaties (OESO, Eurostat, WGO)

o Ervoor zorgen dat de administratieve databanken (Minimale ZiekenshuisGegevens) sneller ter beschikking worden gesteld.

• Gegevens per zorgdomein: o Geestelijke gezondheidszorg: hervormen van de Minimale Psychiatrische Gegevens

teneinde deze aan te passen aan de internationale normen (identificatie van unieke patiënt) en aan de evolutie binnen de sector. Dit vraagt een herziening die toelaat om het ganse zorgtraject van de patiënten, ook buiten het ziekenhuis, te volgen.

o Langdurige zorg: zorgen voor een gedegen beschikbaarheid op nationaal niveau van de gegevens die worden verzameld in het kader van het project BelRai om het meten van de verschillende geselecteerde indicatoren mogelijk te maken.

o Mondhygiëne: oververtegenwoordigen van de groep kinderen van 12 jaar in de enquête over mondhygiëne teneinde de internationale indicatoren correct te kunnen

x De performantie van het gezondheidssysteem KCE Reports 196A

berekenen. o Zorg bij het levenseinde: verbeteren van het gebruik van bestaande gegevens

(Kankerregister en het netwerk van Huisartsen Peilpraktijken) o Volksgezondheid: aanvullen van de databank van geneesmiddelengebruik teneinde

over de totaliteit van de informatie te kunnen beschikken, met inbegrip van de middelen die niet worden terugbetaald, maar waarvan de analyse essentieel is voor de volksgezondheid of de veiligheid van de patiënt (benzodiazepines, bepaalde ontstekingsremmers).

Aanbeveling voor het verzamelen van nieuwe gegevens of voor bijkomend onderzoek Sommige gegevens die nodig zijn voor het uitwerken van geselecteerde indicatoren moeten nog worden verzameld. • Op de vraag over de socio-economische ongelijkheid kunnen de administratieve

databanken slechts een gedeeltelijk antwoord geven. Bepaalde gegevens ontbreken volledig (bijvoorbeeld, socio-economische status in de ziekenhuisgegevens, etniciteit), andere zijn weinig nauwkeurig of hebben weinig onderscheidend vermogen (Omnio/Verhoogde terugbetaling).

• Financiële toegankelijkheid: verbeteren van de enquête over het budget van de huisgezinnen teneinde alle financiële lasten van de patiënten die samenhangen met hun gezondheidszorg te registreren en een analyse per socio-economisch niveau mogelijk te maken.

• Wat “Patiëntervaring" betreft, zullen gegevens beschikbaar zijn dankzij de volgende gezondheidsenquête van het WIV (deze gegevens zullen betrekking hebben op de huisartsen en op alle specialisten zonder onderscheid). Het is echter nuttig gegevens te verzamelen volgens het type specialisme (in alle zorglijnen).

• Gezondheidspromotie: o Er zijn geen gegevens beschikbaar over het "gezondheids-alfabetisatie-graad" (‘health

literacy’) in België. In het bijzonder wordt aanbevolen dat België deelneemt aan de Europese onderzoeken inzake de ontwikkeling van hulpmiddelen voor het meten van health literacy, met het oog op toekomstige gegevensverzameling.

o Gezondheidsbevordering in de leefomgeving: er bestaan talrijke gegevens in Vlaanderen met betrekking tot gezondheidsbevordering in bepaalde leefomgevingen (scholen, gemeenschappen, bedrijven). Deze worden verzameld door middel van de enquêtes van het VIGeZ (Vlaams Instituut voor Gezondheidspromotie en Ziektepreventie). Aanbevolen wordt dat de andere gewesten eveneens gegevens zouden verzamelen over de leefomgevingen, in functie van hun behoefte aan

KCE Report 196A De performantie van het gezondheidssysteem xi

beleidsondersteunende informatie. o Ten slotte wordt ook aanbevolen om na te gaan of men in het volgende rapport de

indicatoren voor gezondheidsbevordering specifiek in het domein van de gezondheidszorg op kan nemen.

Aanbevelingen voor het volgende performantierapport (voorzien voor december 2015) • Ten aanzien van FOD Volksgezondheid, RIZIV en WIV

o Berekenen van de indicatoren waarvoor de gegevens nog niet beschikbaar zijn, maar die het wel zullen zijn tegen het volgende rapport (project over de ambulante zorgtrajecten, project BelRAI, ervaring van de patiënten in de gezondheidsenquête, prevalentie van ziekenhuisinfecties, termijn voor de registratie van nieuwe geneesmiddelen).

o In de toekomst is het voor een goede opvolging aangewezen om de meest recente beschikbare resultaten op te nemen. De indicatoren moeten bij voorkeur routinematig worden gemeten door de instellingen/administraties, respectievelijke beheerders van de administratieve databanken. De resultaten zullen overgemaakt worden aan de teams die belast zijn met de actualisering van het rapport, volgens een termijnplanning en een stramien dat nog moet worden gepreciseerd.

o Opvolgen van de internationale evoluties (OESO, WGO, Eurostat) teneinde de Belgische indicatorenset aan te passen indien nodig.

• Ten aanzien van de onderzoeksequipes o Identificeren van nieuwe indicatoren voor weinig gedocumenteerde thema's (probleem

van beschikbaarheid van verpleegkundig personeel, bijvoorbeeld). o Actualiseren van de evaluatie van de performantie via de meest recente data. o Analyseren van de globale coherentie (vooral voor het versterken van de dimensies

met betrekking tot efficiëntie en duurzaamheid) en het actualiseren van de indicatorenset in het licht van nieuwe evidentie of nieuwe prioritaire thema's.

KCE Report 196

TABL

6

LE OF COONTENTLISTLISTLIST

11.11.2

1.3

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Belgian

TS T OF FIGURES ..T OF TABLES ...T OF ABBREVIA

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KCE Report 196

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ENDIX 2. LISTENDIX 3. LIST

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OBAL LEVEL ........health system at a........................................................

HEALTH SYSTET SHORTCOMIN..................................................

ED IN THE 2012 MAIN OF CARE ORS COMPAREABLE IN A NEAR

.........................

ALTH SYSTEM? ...................................................................................

PROMOTION? .................................................................................................................................................................................................................................................................................................................................................a global level? .............................................................EM PERFORMANGS ....................................................................REPORT, CLAAND DIMENSIO

ED TO THE 2010R FUTURE ................................

KCE Report

.......................... 9

.......................... 9

........................ 10...................... 10........................ 10........................ 10........................ 10........................ 11........................ 11........................ 11...................... 12........................ 12........................ 12........................ 12........................ 12........................ 12........................ 12........................ 12........................ 12........................ 13

ANCE ...................... 13...................... 13...................... 13

ASSIFIED ON ................ 130 REPORT ... 13...................... 14...................... 14

t 196

97 97 04 04 04 07 07 12 16 19 20 20 20 20 22 27 27 27 28 30

30 34 35

35 39 44 47

KCE Report 196

LIST OF F

6

FIGURES FiguuFiguuFigurFigurFigurFigurFigurcompFiguroveraFigurFigurFigurcompFigurcompFigurFigurwith dFigurby yeFigurFigur(2004FigurFigurinternFigurFigurFigurconta

Belgian

ur 1 – Conceptueeur 2 – Indicator vare 3 – The concepre 4 – Life expectare 5 – Infant mortare 6 – Number of pre 7 – Out-of-pockparison .................re 8 – Percentageall (b)) within the lare 9 – Breast cancre 10 – Percentagre 11 – 5-year relaparison (2004) .....re 12 – Suicide ratparison .................re 13 – Percentagre 14 – Employmedisability: internatire 15 – Mammogrear and region .....re 16 – C-sectionsre 17 – Defined da4-2010) and internre 18 – Chemothere 19 – Expositionnational comparisore 20 – Mean incidre 21 – Percentagre 22 – Percentagact with a GP with

n Health System

el kader ter evaluaan billijkheid: Gini-ptual framework toancy at birth: interality rate: internatipractising physiciaket expenditures (............................ of women (aged ast two years, by cer and cervical cae of children cove

ative survival after............................tes (number per 1............................e of involuntary c

ent rates by healthional comparison am coverage of w............................

s per 1000 live birtaily dosage of antnational compariserapy near end-of-n to medical radiaton ........................dence of Healthcae of population we of hospitalisatioin 1 week after di

Performance

atie van de perfor-coëfficiënt na belao evaluate the perrnational comparisonal comparison .ans (per 1000 popas a percentage o............................50-69) who had aregion (2006-201ancer screening: iered by main vaccr breast, cervix an............................100 000 populatio............................ommittals in psych condition, as a r(2002) ................

women aged 40-49............................ths: international idepressants per on (2000-2010) ..-life for patients wtion per inhabitant............................are Acquired MRSith a global medic

ons for the elderly scharge, by regio

mantie van het Beasting en overdrarformance of the Bson (2000-2010) ..............................pulation): internatof total health exp............................a mammogram (w0) ........................international comcinations (2000-20nd colorectal canc............................n) per region (199............................

chiatric hospitals, batio of the employ............................9 years and of wo............................comparison .........1000 population p............................

with cancer, by plat (most 20 exams............................

SA, per 1000 admcal record (GMD –

(aged 65 and oveon (2003-2009) .....

elgische gezondhachten, in België eBelgian health sys........................................................ional comparison

penditures): intern............................

within program (a) ............................parison (2000-20009): internationacer for females: int............................99-2008) and inte............................by region (2000-2yment rate of all p............................omen aged 70-79 ........................................................per day: by region............................ce of death ........., expressed in mS............................issions (1994-201

– DMG), by regioner) followed by a ............................

eidssysteem ..... 1en gewesten....... 3stem ................... 4.......................... 5.......................... 5.......................... 5ational .......................... 6or .......................... 610) ..................... 6l comparison ..... 6ternational .......................... 7rnational .......................... 7

2009) .................. 7people .......................... 7years, .......................... 7.......................... 7

n .......................... 7.......................... 8

Sv): .......................... 810) ..................... 8n (2006-2009) .... 8

.......................... 8

5

14 37 47 55 56 59

61

63 64 65

71

72 73

74

76 78

79 80

82 84 87

88

6

FigurFigurFigurinternFigurFigurFigurFigurFigurFigurFigurpromFigurregioFigurFigurFigurconsu30 mFigurFigurand in

Belgian

re 23 – Degree of re 24 – Percentagre 25 – Percentagnational comparisore 26 – Average lere 27 – Age distribre 28 – Medical anre 29 – Acute carere 30 – Health expre 31 – Total healtre 32 – The Nutbeotion ...................

re 33 – Percentagn (1997-2008), anre 34 – Diagnosticre 35 – Rate of there 36 – Percentagumption, (c) consuin of physical activre 37 – Internationre 38 – Gini coefficnternational comp

n Health System

satisfaction with he of low-cost mede of surgical one-on ........................ength of stay for abution of GPs (200nd nursing graduae bed days per capenditures in Belgth expenditures as

eam’s framework a............................ge of the adult pond international coc rate of HIV by ree new HIV diagnoe of the populatiouming at least 2 frvity per day, by re

nal comparisons ocient before and aparison .................

Performance

healthcare servicedication delivered -day hospitalisatio............................

a normal delivery: 00-2004-2009) ....ates (per 100 000 pita, international

gium by main funcs a % of GDP: intand selected indic............................pulation (aged 18omparison (2000-egion, for all casesosis per 100 000 inon (a) smoking daruits and 200 vegegion (1997/2001-on the Tobacco Coafter taxation and ............................

es, by type of servin ambulatory set

ons on all surgical ............................international com............................pop): internationa comparison ........

ction in the Systemernational compacators to measure............................

8 years or older) w2008 ....................s (a) and for Belginhabitants: Internaily, (b) with probleetables daily, (d) -2008) ..................ontrol Scale in Eutransfers (1998-2............................

vice (2008) ..........tting (DDDs) (200 hospitalisations: ............................

mparison ...........................................al comparison (20............................

m of Health Accouarison ...................e performance of h............................

with obesity (BMI ≥............................an cases only (b)ational compariso

ematic alcohol performing at leas............................

urope (2010) ........2010): Belgium ............................

KCE Report

.......................... 900-2010) ............. 9 .......................... 9.......................... 9.......................... 9

010) .................... 9........................ 10

unts (2010) ....... 10........................ 10health ........................ 10≥30), by ........................ 10) (1985-2010) .. 11on ..................... 11

st ........................ 11........................ 11

........................ 12

t 196

91 94

95 96 97 99 00 02 03

06

08 10 11

13 18

29

KCE Report 196

LIST OF T

6

TABLES TabeTabeTabeTabeTabeTabeTabeTabeTabeTabeTabeTabevan hTableTable(/100TableTable65 yeTableTableTableTableTableTablegraduTableTableTableTable

Belgian

l 1 – Indicatoren dl 2 – Indicatoren tl 3 – Indicatoren tl 4 – Indicatoren tl 5 – Indicatoren tl 6 – Indicatoren tl 7 – Indicatoren tl 8 – Indicatoren tl 9 – Indicatoren tl 10 – Indicatorenl 11 – Overzichtstl 12 – Indicator va

het gezondheidssye 13 – Life expecte 14 – Number of 0 population) (20

e 15 – Out-of-pocke 16 – Number of ears and older, pee 17 – 5-year relate 18 – Exposition e 19 – Percentagee 20 – Evolution oe 21 – Mean age oe 22 – Progressionuation according te 23 – Percentagee 24 – Total healthe 25 – Alcohol cone 26 – Offer of phy

n Health System

die de globale gezter beoordeling vater beoordeling vater beoordeling vater beoordeling vater beoordeling vater beoordeling vater beoordeling vater beoordeling van van gezondheidstabel van socio-ecan billijkheid: progysteem.................ancy at birth (201practising physici10) .......................ket expenditures (accredited beds i

er region, 2010 .....tive survival by stato medical radiati

e of cancer patienof place of death oof practising GPs n between 1996 ato type of specialise of GPs using rech expenditures acnsumption habits fysical activity in se

Performance

zondheidstoestanan de toegankelijkan de doeltreffendan de aangepasthan de veiligheid vaan de continuïteit ean de patiëntgerican de efficiëntie vaan de duurzaamhespromotie ............conomische ongegressiviteitsindicat............................0), and Healthy Lians, estimation o............................(2003-2010) ........n homes for the e............................age, period 2004-on per inhabitant ts who had a MO

over time in Flande(2000-2009) .......

and 2008 of gradusation ..................commended softwccording to the Syfor the populationecondary schools

d beoordelen ......kheid van de gezodheid van de zorgeid van de zorg ...

an de zorg ...........en coördinatie vahtheid van de zoran de zorg ...........eid van het gezon............................

elijkheden .............toren van de publ............................

Life Years at age 2of Full Time Equiva........................................................

elderly and nursing............................-2008: Belgium ....(expressed in nb C – COM, per regers and Brussels ............................

uates in medicine ............................

ware to maintain thstem of Health Ac

n (aged 15 or oldes in Flanders ........

............................ondheidszorg .......

...................................................................................n de zorg ............rg .....................................................

ndheidssysteem ..........................................................ieke financiering ............................25 (2008), by sex alent, and density........................................................g homes per 100 ........................................................mSv): Belgium (2

gion, (2005-2008)(1998-2007) ...................................in the two years f............................heir patients’ medccounts (2003-20er) (1997-2008) ................................

.......................... 1

.......................... 2

.......................... 2

.......................... 2

.......................... 2

.......................... 2

.......................... 2

.......................... 2

.......................... 3

.......................... 3

.......................... 3

.......................... 3and region ........ 5

y .......................... 5.......................... 6population .......................... 6.......................... 7

2004-2011) ........ 8 ......................... 8.......................... 9.......................... 9following .......................... 9

dical records .... 1010) ................... 10........................ 11........................ 11

7

18 21 23 24 25 27 28 29 30 32 34

36 54

58 61

66 70 82 89 92 98

98 01 02 12 16

8

TableeducaTableeducaTableTable

Belgian

e 27 – Life expectational level and ce 28 – Health expeational level and ce 29 – Inequalitiese 30 – Progressivi

n Health System

ancy at 25 years concentration ineqectancy at 25 yeaconcentration ineqs expressed with aity indicators of th

Performance

by sex and educaquality indices (CIars by sex and eduquality indices (Beabsolute difference financing of the

ational level, absoII) (Belgium 2001)ucational level, abelgium 2004) .......ce, relative differen public healthcare

olute difference to ) ..........................bsolute difference ............................nce, and summare system (2005-20

KCE Report

highest ........................ 12 to highest ........................ 12

ry measures ..... 12011) ................. 12

t 196

22

23 25 29

KCE Report 196

LIST OF A

6

ABBREVIAATIONS

Belgian

ABBREVIATIONADL ADQ AIDS BIM – RVV

BMI CAP CII CM – MC DDD DGSIE – ADSEI

DMFT DTP EARSS ECDC ECHIM EMA EPS ER EU EU – SILC FOBT FPS FTE GDP GMD – DMG GMR

n Health System

N DEFINITIActivities Average Acquired Bénéficia(verzekerBody MaCommunConcentrChristelijkDefined DDirection StatistiekDecayedDiphteriaEuropeanEuropeanEuropeanEuropeanEchantilloEmergenEuropeanEuropeanFaecal OFederal PFull TimeGross DoGlobaal MGlobal M

Performance

ION of Daily Living Daily Quantity Immunodeficienc

aire de l’Intervenrings)tegemoetkoss Index

nity Acquired Pneuration Index of Ineke Mutualiteiten –Daily Dose

générale Statistk en Economische, Missing, Filled T - Tetanos - Pertun Antimicrobial Ren Centre for Disean Community Hean Medical Agencyon Permanent – P

ncy Room n Union n Union Statistics

Occult Blood Test Public Service e Equivalent omestic Product Medisch Dossier –edical Record

cy Syndrome ntion Majorée –ming

umonia equalities – Mutualités Chrét

tique et Informate informatie Teeth ussis esistance Surveillaase Control and Palth Indicators Moy Permanente Steek

on Income and L

– Dossier Médica

Rechthebbende

tiennes – Christian

tion économique

ance System Prevention nitoring

kproef

Living Conditions

l Global

en op de Verho

n Sickness Funds

– Algemene Di

9

oogde

s

rectie

10

Belgian

GP HAI HBSC HCQI Hib HIS HIV HLY HSPA IMA – AIM IMR ISCED LE LOS MAB MMR MOC – COM MRPA – ROB MRS – RVT MRSA NSIH OECD ONE – KG OOP OR PA PAF PPP PSI

n Health System

General PHealthcaHealth BeHealthCaHaemophHealth InHuman ImHealthy LHealth SyIntermutuInfant MoInternatioLife ExpeLength ofMaximumMeasles MultidisciMaisons Maison dMethicillinNational OrganisaOffice NaOut-of-PoOdds RaPhysical PopulatioPurchasinPatient S

Performance

Practitioner re Acquired Infectehaviour in Schooare Quality Indicathilus Influenzae Bterview Survey mmunodeficiency Life Years ystem Performancualistic Agency - Inortality Rate onal Standard Claectancy f Stay

m Billing System - Mumps - Rubelliplinair Oncologisde Repos pour Pe

de Repos et de Son-Resistant StaphSurveillance of In

ation for Economicational de l'Enfancocket tio Activity

on Attributable Frang Power Parities

Safety Indicator

tions ol-aged Childrentor

B

Virus

ce Assessment nterMutualistisch

assification of Edu

a h Consult – Consersonnes Agées -oins – Rust- en Vehylococcus Aureusfections in Hospit

c Co-operation ance – Kind en Gezi

action s

Agentschap – Ag

cation

ultation Multidisci- Rustoorden voorerzorgingstehuiss tals d Development (On

KCE Report

gence InterMutual

plinaire d'Oncologr Bejaarden

OESO – OCDE)

t 196

iste

gie

KCE Report 196

6

Belgian

PYLL RAI RHM – MZG RIZIV – INAMI

RR SE SHA SP SPMA SSF THE UK UPC VIGeZ WHO WIV – ISP

n Health System

Potential Resident Résumé Rijksinstitmaladie-iRelative Socio-ecoSystem oSpecialisStandardSpecial STotal HeaUnited KiUsual ProVlaams InWorld HeWetenschof Public

Performance

Years of Life LosAssessment InstHospitalier Minimtuut voor ziekte- invalidité- NationaRisk onomic

of Health Accountsst Physician dized Procedures Solidarity Fund alth Expendituresingdom ovider Index nstituut voor Gezoealth Organisationhappelijk InstituutHealth

st rument

mal - Minimale Zieken invaliditeitsver

al Institute for Hea

s

for Mortality Analy

ondheidspromotien t Volksgezondheid

kenhuisgegevensrzekering – Institualth and Disability

ysis

e en Ziektepreven

d – Institut de Sa

ut national d’assurInsurance

tie

anté Publique- Ins

11

rance

stitute

12

SYNTTHESE

Belgiann Health System

1

1DbwdinTue

WEgvtoteo

NBsoingrobzoDdBw

Performance

1 ACHTERKADER

1.1 AchtergroDe eerste Belgbeoordeling van dwerd gepubliceerddelen. Ten eerste nternationale ervaTen tweede werd uiteindelijk gemetevolutie in de loop

Wat is een HealthEen HSPA igezondheidssystevan het volledige got de strategischee berekenen diontwikkeld volgens

Na de publicatie vBelgische HSPA systematische evopdrachtgevers vndicatoren in spgezondheidszorg, ondom het levens

behandeld in hetzorgcontinuïteit, onvoldoende verteDaarom moestendimensies te beooBelgische gezondweer.

RGROND, EN DOELS

ond ische Health Sde performantie d in juni 2010.1 Hwerd het Belgisch

aringen die aan deen set van 55 in

ten konden wordp van de tijd en vo

h System Performs een landgem holistisch kagezondheidssystee planning van heie een “signaals een strategisch

van dit eerste rappom het project

valuatie van hetvroegen ook om pecifieke domein

huisartsgeneeskseinde, aangeziet eerste rapport.

patiëntgerichtheiegenwoordigd. n nieuwe indicaordelen. Het huidigdheidssysteem 20

CONCEPTSTELLING

System Performavan het gezond

Het rapport bestonhe HSPA-kader ue Belgische contendicatoren geseleen. De sterke eorgestelde acties

mance Assessmgebonden procn worden beoord

eem. Dit instrumeet gezondheidssysfunctie” hebbenkader dat landspe

port vroegen de overder te zette

t Belgische gezode indicatorense

nen: gezondheidskunde, zorg op ln deze domeinenTenslotte werde

id en billijkhe

atoren worden vge rapport over de012 geeft de res

KCE Report

TUEEL GEN

ance Assessmenheidssysteem (Hnd uit twee belanuitgewerkt op basiext werden aangeecteerd, waarvan en zwakke punte

werden besproke

ent (HSPA)? ces waarmee deeld, een "checnt beoogt bij te drsteem door indica. Elke HSPA wecifiek is.2

opdrachtgevers vaen met als doelondheidssysteemet uit te breidenspromotie, geestange termijn en

n onvoldoende ween drie dimensiesid) beschouwd

voorgesteld om e performantie vasultaten van dit

t 196

nt of HSPA)

grijke s van

epast. er 40 n, de en.

het ck-up" ragen

atoren wordt

an de l een

m. De n met telijke

zorg erden s (nl.

als

deze an het

werk

KCE Report 196

Het Handvest vperformantie v

In juni 2008 onlanden die WereldgezondhTallinn Charter ondertekende vvan het gezobevorderen vanperformantie vmeetbare result

1.2 Concepvan he

Het conceptuee

6

van Tallinn (2008van de Europese

ndertekenden de behoren tot

heidsorganisatie on Health Syste

verbintenissen heeondheidssysteem:n transparantie evan de gezondhtaten".3

ptueel kader tet Belgische gezel kader wordt wee

8): een internatioe gezondheidssys

53 ministers van de Europe

(WGO) het Hanms for Health aneft de derde betre "de lidstaten

en het afleggen vheidssystemen d

er evaluatie vanzondheidssysteergegeven in Figu

Belgian

onale verbintenisstemen te meten

volksgezondheidese regio vandvest van Tallind Wealth”. Van dekking op de perfoverbinden zich van rekenschap door de publica

n de performaneem uur 1.

n Health System

s om de n.

d van de an de nn “The

de zeven ormantie tot het over de

atie van

ntie

Performance 13

14

Figuur 1 – Con

Noot: In dit rappobesproken in het

nceptueel kader t

ort is er geen specihoofdstuk over gez

ter evaluatie van

ifiek hoofdstuk gewizondheidspromotie.

Belgian

n de performantie

wijd aan niet-medisch

n Health System

e van het Belgisc

he determinanten v

Performance

che gezondheids

van gezondheidsind

ssysteem

dicatoren. Indicatoreen van levenswijze

KCE Report

worden weergegev

t 196

ven en

KCE Report 196

1.3 DoelsteDe systematgezondheidssysHSPA-rapportekunnen wordenZe moeten onoperationele su1.3.1 Strate

SysteHet HSPA-proc1. De gezond

gezondheid2. Een trans

performantmet het en

3. Op lange ttijd volgen.

1.3.2 Algemvan 2

Een reeks vangekozen dimenaantal indicatorVier operatione1. De kernset

speciale fogegevens b

a Het aanta

kosten vorichtlijnen;tandvullingpersonen baarmoedresidentië

6

ellingen van dittische evaluatiesteem is een co

en belangrijke mn gedefinieerd alsderscheiden wor

ubdoelstellingen vegische doelstellm Performance

ces streeft drie stradheidsautoriteiten dssysteem, en eesparant en contie van het Belgisgagement in het Htermijn de perform

mene en operatio012

n indicatoren voornsies van het Beren beheersbaar bele doelstellingen wt van 55 indicatoreocus op de 11 beschikbaar ware

al praktiserende veroor chronisch zieke; screening voor gen op de leeftijdtussen 45-75 jaar

derhals); vroegtijdigle zorg en bij risicop

t rapport e van de pontinu proces w

mijlpalen zijn. Strs de doelstellingerden van de spean het huidige raplingen van het pAssessment ategische doelsteinformeren over

en draagvlak biedentroleerbaar bel

sch gezondheidssHandvest van Talmantie van het ge

onele doelstellin

rstellen en metenelgisch gezondheblijft (in dit rapportwerden gedefinieeen van het vorigeindicatoren waa

ena;

rpleegkundigen; bijken; voorschriften in

colorectale kanked van 12 jaar; carr; 5-jaars overleving overlijden, incidepersonen.

Belgian

performantie vaaarbij de publicarategische doelstn van dit continu

ecifieke doelstellinpport. roces van Healt

ellingen na: de performantie

en voor beleidsplaeid schetsen v

systeem, in overeelinn; ezondheidssystee

ngen van het rap

n voor alle domeeidssysteem, waat zijn dat er 74). erd:

e rapport herzien, arvoor er in 201

komende ziektegeren overeenstemminger; cariës, tandverdiovasculaire scregspercentage (bors

entie van doorligwo

n Health System

an het atie van tellingen proces. ngen en

th

van het anning; van de enkomst

em in de

pport

einen en arbij het

met een 10 geen

elateerde g met de erlies en ening bij st, colon, onden in

2

3

4

HgBvkging

Performance

2. De kernset gezondheidspgezondheidsztoevoegen indimensies vabillijkheid in he

3. De geselectebeschikbaarhe

4. De resultatende performanvan verschilleindien aangew

Het HSPA-rappgezondheidssysteBelgië ook wordt gvan 74 indicatorkwaliteit, efficiëntgezondheidssystenformatiebron voogezondheid en gez

uitbreiden met promotie, hzorg, zorg op lanzake patiëntgeric

an kwaliteit), en et gezondheidssy

eerde indicatoren eid van gegevens interpreteren me

ntie van het Belgiende criteria, waarwezen.

port is een em op nationaagepositioneerd in ren probeert hetie, duurzaamheem te monitoor de verschillendzondheidspromot

indicatoren uit huisartsgeneeskunge termijn, palliatchtheid en zorgctot slot indicator

ysteem; waar mogelijk m

s identificeren; et het oog op eensche gezondheidronder een interna

rapport waaal niveau wordt

een internationaleet HSPA-rapportid en billijkheid

oren, om te de beleidsmakers tie.

volgende domende, geesttieve zorg; indica

continuïteit (twee ren voorstellen in

meten, of hiaten

n globale evaluatiessysteem door mationale benchma

rin het Belgopgevolgd en we context. Door m

de toegankelijkd van het Belgkunnen dienen die bevoegd zijn

15

einen: telijke

atoren sub-

nzake

in de

e van middel arking

gische waarin middel kheid, gische

als n voor

16

2 STERKHET BGEZO

2.1 Hoe deDe resultaten domein en/of hoofdstuk gewijDeze synoptisc• In de eers

evaluatie vintegratie versus nainternationaof socio-ecdat deze ev

• In de kolomvergeleken(internation

• De volgenresultaten informatie vworden geverzamelinnodig.

• Vervolgensweergegevbeschikbarbelang van

b De term E

decemberlidstaten zGriekenlaZweden e

KE EN ZWABELGISCHENDHEIDSS

e synoptische tvan de 74 indicdimensie. Aan

jd. che tabellen bevatte plaats toont evan de resultatevan verschillendtionale doelstelliale benchmarks, conomische ongevaluatie niet volle

m “België” wordt dn met de resultatenale benchmarkinnde kolom identi

die beschikbaavoor beleidsmakeenomen op basisng van meer rec

s wordt, indien mven (stijging, dare jaren. Er is geen de wijzigingen.

EU-15 verwijst naar r 2003, vooraleer dezijn Oostenrijk, Belgnd, Ierland, Italië

en het Verenigd Kon

AKKE PUNE SYSTEEM abellen lezen?atoren worden h

gezondheidspro

tten volgende infoen pictogram, waen van de indicde criteria: waardngen (wanneer tendensen over v

elijkheden. Er diedig mogelijk is vo

de waarde van de n van de landen vg), en weergegevificeert het jaar

ar zijn voor Beers, bijv. om te voos van verouderd

cente gegevens

mogelijk, een ruwaling, en stabielen evaluatie van d

de 15 lidstaten vane nieuwe lidstaten bgië, Denemarken, F, Luxemburg, Ned

ninkrijk.

Belgian

NTEN VAN

? hieronder besprokomotie is een s

ormatie: aar mogelijk, eencator, gebaseerdde op nationaaldie bestaan) of

verloop van tijd, reent opgemerkt te or alle indicatorenindicator voor Be

van de EU-15b ven met een kleurc

van de meest elgië. Dit is beorkomen dat beslde gegevens en aan te moedigen

we tendens overl), over de laade omvang of het

n de Europese Uniebij de EU kwamen. Finland, Frankrijk, Dderland, Portugal,

n Health System

ken, per specifiek

globale op de niveau f versus egionale worden

n. elgië

code. recente

langrijke issingen om de

n indien

r de tijd tste vijf t klinisch

vanaf 31 Deze 15

Duitsland, Spanje,

•

•

BEgeZdKgeE

c

Performance

De laatste ktoepassing, eeconomischeWallonië en Blezer de grootMet betrekkinworden gehouhet Brusselsgebied, terwijvan stedelijke

Tenslotte woaangeduid me

Bron van de gegeEr werd zoveel mgegevens (bijv. enquêtes die Ziekenhuisgegevedatabanken van Kankerregister, gezondheidsenquêenquetes en de Economische infor

Afhankelijk

gebaseerd oterugbetaling

kolommen gevenen als gegevens

status (laag of Brussel). Voor deztte van de relatiev

ng tot de vergelijkuden met de specgewest bestaat

l de twee anderee, voorstedelijke eorden gebieden et een .

evens mogelijk gebruik

administratieve regelmatig h

ens (MZG), dhet RIZIV (

het register êtes (HIS – H

databank van rmatie (ADSEI).

van de gegeven

op ofwel het opleid van gezondheidszo

subgroepanalysbeschikbaar zijn

f hoog)c en per ze subgroepanalyve verschillen naa

king tussen de gecifieke context vanimmers alleen u

e gewesten bestan landelijke gebiewaar bijkomend

gemaakt van roudatabanken, na

herhaald wordee EPS (perm

(doc N, Pharmvan nosocom

Health Interview de Algemene D

nsbron is de sodingsniveau, ofwel orguitgaven.

KCE Report

ses weer (indienn) per geslacht, s

gewest (Vlaandyses helpen kleurear waarde te scha

ewesten moet rekn het Brussels geuit één enkel steaan uit een mengeden.

onderzoek nod

utinematig verzamationale registeren): de Min

manente steekpmanet), het Belmiale infecties,

Survey), vaccinDirectie Statistie

cio-economische het recht op verho

t 196

n van socio-deren, en de atten. ening

ewest: edelijk gvorm

dig is

melde rs of imale

proef), lgisch

de natie-k en

status oogde

KCE Report 196

Legende voor

Globale evaluat

Zeerresu

Slec

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§ Kwintielen word£ Referentiegroepbeste resultaten. Fictieve voorbeelvoeding in lage s

6

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De beste re

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slecht: 20% rokersgroep versus 26% i

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ale vergelijking

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18

2.2 GezondWe beschrijvenkunnen wordeninterventies inzandere determiDe vier indicatoresultaat van de15-gemiddelde levensverwachtjaren vanaf e

Tabel 1 – Indic

Indicator

Levensverwac

Levensverwac

Zelfevaluatie g(% in goede gezondheid)

Percentage zu(aantal levendgeboort i Levensverwachii Internationale veiii Kleurcodering v(zoals voor alle a

dheidstoestandn 4 indicatoren ovn beschouwd alszake gezondheidsnanten van de ge

oren laten een pose levensverwacht

(0,7 jaar ondting in goede gezeen bepaalde l

catoren die de glo

chting (jaren)

chting (op 25 jaar

gezondheid of in zeer goed

igelingensterfte overlijdens/1 00

tes)

hting volgens socio-evergelijking is gebasvoor socio-economi

andere indicatoren),

d ver de globale gezs algemene en ussysteem/gezondhezondheid. sitieve evolutie in ting is iets lager inder het EU-15-gzondheid (gedefileeftijd zonder

obale gezondhei

Globaal B

8

r) 4

de 7

00

3

economische statusseerd op de levensvische verschillen in maar op de grootte

Belgian

zondheidstoestanltieme resultatenheidspromotie, na

de tijd zien (Taben vergelijking met gemiddelde), ternieerd als de resactiviteitsbeperkin

idstoestand beoo

België Meest recentgegeve

80,0 2010

1,0 ii 2008

76,8 2008

3,5 2010

s verwijst naar de leverwachting in goede

levensverwachtinge van de absolute ve

n Health System

nd. Deze van de

aast alle

el 1). Het het EU-

rwijl de sterende ng), en

zmdmgjapdu

ordelen

te ens

Tendens in de loopvan de tijd

Stijging

Stijging

Stijging

Daling

evensverwachting ope gezondheid bij de

g en levensverwacherschillen: geel (1 to

Performance

zuigelingensterfte mensen dat hun dan het EU-15-gemmannen en vrougezondheid op 25aren van beperkinparameters zijn slde gewesten betuitzondering van d

p

M V Sla

77,4 82,6 MV

41,3 41,2 MV

79,5 74,3 5

4,2 3,4

p de leeftijd van 25 e geboorte. hting in goede gezoot 2 jaar verschil), o

op een middelmgezondheid als (middelde. Er worduwen, behalve v jaar. Vrouwen lev

ngen en zij ervareechter voor de latreft, zijn er betede kindersterfte.

Sociaal aag

Sociaalhoog

M:47,6i

V: 54,0 M:55,0V: 59,9

M:27,7 V: 28,9

M:46,3V: 47,1

57,4 85,7

jaar.

ondheid is niet gebaoranje (2 tot 6 jaar v

atige plaats staan(minstens) goed den grote verschilvoor de levensvven langer dan m

en hun gezondheidagere socio-econoere uitkomsten v

l Vlaanderen

80,9

M:43,7 V: 42,3

78,6

4,0

aseerd op de groottverschil), rood (meer

KCE Report

n. Het percentagebeschouwt, ligt hllen vastgesteld tu

verwachting in gmannen maar met d als minder goedomische groepenvoor Vlaanderen,

Wallonië Brus

78,5 80,0

M:37,4 V:39,1

M:38V:40

73,7 74,3

3,1 4,6

te van het relatiever dan 6 jaar verschil

t 196

e van hoger ussen goede meer

d. Alle . Wat , met

ssel

0

8,5 0,6

3

risico l).

KCE Report 196

2.3 ToeganToegankelijkhegemakkelijk toefysieke toegabeschikbaarheieen gezondhekwaliteitsvol enDertien van degezondheidssysbeschikbaar pedekkingsgraadresidentiële zorouderen en tijdi2.3.1 Besch

verpleEr werden veegeven van hverpleegkundigdeze twee indiresultaten bescbeoordeeld workomen aan de g2.3.2 FinanOndanks het bevan veel socsolidariteitsfondgezondheidszolenzen, geesteredenen. Dit pnegentig. Bovepatiënt 19% vaanzienlijk hoge

6

nkelijkheid vanid wordt gedefiegang hebben toang (geografiscd van gekwalificeidssysteem is e efficiënt gezondhe 74 indicatoren steem en zijn ersoneel in gezo

van preventierg voor ouderen, igheid van palliatiehikbaar personeeegkundigen l inspanningen g

het beschikbaar en) in België. Diticatoren waarvoochikbaar waren. Mrden of dit persongezondheidsbehociële toegankelijestaan van een unciale vangnettends) verklaarde 14rgen (medische

elijke gezondheidpercentage is toeendien vertegenwovan de totale uer is dan het EU-1

de zorg inieerd als de

ot de gezondheidche verspreidineerd personeel.4

een noodzakelijkeheidssysteem.

beoordelen de gegroepeerd in

ondheidszorg, finve maatregelenbeschikbaarheid

eve zorg op het eel: praktiserende

eleverd om een r personeel (prt wordt bevestigd

or er in het vorigMet deze indicatorneelsbestand voldoeften van de popijkheid niversele ziekteven (maximumfact4% van de huish

zorg, chirurgie, dszorg) moesten egenomen sinds oordigen de persitgaven voor ge15-gemiddelde va

Belgian

mate waarin psdiensten in termg), kosten, tiDe toegankelijkh

e voorwaarde vo

toegankelijkheid verschillende t

anciële toeganken, toegankelijkhed van mantelzorgeeinde van het levee artsen en

betere raming te raktiserende artsd door de toevoege rapport geen vren alleen kan ecdoende is om tegeulatie.

erzekering en het tuur, Omnio, Bhoudens dat zij s

geneesmiddelenuitstellen om fihet einde van d

soonlijke uitgavenezondheidszorg, an 15%.

n Health System

patiënten men van ijd, en heid van oor een

van het thema's: elijkheid, eid van ers voor n.

kunnen sen en ging van volledige chter niet emoet te

bestaan Bijzonder sommige , bril of nanciële de jaren n van de hetgeen

2WzDhhlareMVzroddEspW(d

Performance

2.3.3 DekkingWat de dekkingsgzeker beter presteDe dekkingsgraadhet EU-15-gemiddhet bestaan van eaatste neemt sleekening. De versc

Men kan zich dus Voor de dekkingszijn er minder afwond het EU-15-g

de algemeen dekkingsgraad blijEr worden geen gscreening van coloprogramma in de FWat de griepvacc75%) niet behaal

de vaccinatie van

sgraad van prevgraad van preven

eren. d van borstkankersdelde (68,3%). Deen georganiseerdechts de helft vachillen tussen de vragen stellen bij

sgraad van screeijkingen tussen deemiddelde, maar aanvaarde Euroft ook stabiel in deegevens gepreseonkanker, aangezFranstalige gemecinatie van ouderld en stijgt de dekinderen betreft, d

ventieve maatregntieve maatregele

screening (60%) Deze verhoudingd borstkankerscrean de gescreendgewesten zijn bovde efficiëntie van

ning van baarmoe gewesten. De rblijven middelma

opese doelstellie loop van de tijd.

enteerd inzake de zien het nog te vrenschap te evalueren betreft, wordkkingsgraad maadoet België het go

gelen en betreft, kan B

is laag vergelekenbleef stabiel ond

eeningsprogrammde vrouwen voovendien erg opva

n het programma. oederhalskanker (resultaten situerenatig met betrekkining van 80%. . dekkingsgraad varoeg is om het nieren.

dt het WGO-streear heel geleidelijkoed.

19

België

n met danks a. Dit r zijn

allend.

(62%) n zich ng tot

De

an de euwe

efdoel . Wat

20

ToegankelijkheHet aantal bedtijdens de laatsen ouder). OveBrussel dan in VMantelzorgers, basisactiviteitengedurende minlangetermijnszoen ouder dat fu16,2% in Italië.totale gemiddeworden geplaaleven, maatschspecifieke stimuAangezien er mpatiënt zijn detoegankelijkheid

Tijdigheid bij pHet starten metin de terminatoegankelijkheidmet palliatieve gevallen overlepalliatieve forfaeerder op een over deze indverschillen).

eid van zorg op dden in residentste tien jaar (nl. 7er het algemeenVlaanderen.

gedefinieerd an van het dagelijknstens een uur peorgverlening.5 Hetungeert als mant. Het Belgische clde van de OESO

atst vermits dit cijhappelijke waardeulerende maatregmomenteel geen eze twee indicad van de zorg op

palliatieve zorg t palliatieve zorg w

ale fase bevinded van palliatieve

zorg te starten eden de patiëntenaitaire vergoedinglate start te wijzedicator te beko

lange termijn tiële zorgfaciliteite0 bedden per 1 0 is dit aantal ve

als personen dikse leven (Activitier week, zijn belat percentage van telzorger varieerdcijfer van 12,1% O-landen (11,7%)jfer beïnvloed woen en het al dan

gelen om mantelzogegevens zijn ov

atoren nog steedlange termijn te b

wordt soms uitgesen. Dit kan wijzzorg, of op het fte laat werd ge

n binnen de weeg (ingediend bij hen. Het zou nuttigomen (evolutie o

Belgian

en is constant g000 personen vaneel hoger in Wall

ie hulp bieden ies of Daily Livingangrijk onderdeelde populatie van

de van 8% in Zweis lichtjes hoger

). Dit moet in zijnordt door de mann niet aanwezig org te ondersteunver de behoeftends onvoldoende beoordelen.

steld tot de patiënzen op problemfeit dat de beslis

enomen. In 20% ek van aanvraag het ziekenfonds).g zijn om meer geover de tijd, re

n Health System

gebleven n 65 jaar lonië en

bij de g - ADL) l van de n 50 jaar eden tot dan het

n context nier van zijn van en.

n van de om de

nten zich men van

sing om van de voor de Dit lijkt egevens egionale

Performance

KCE Reportt 196

KCE Report 196

Tabel 2 – Indic Indicator

Pers

onee

lsbe

stan

d

Aantal (p- praktise- praktise

Fina

ncië

le

toeg

anke

lijkh

eid

Dekking bevolkingRemgeldgezondhUitgestefinanciël

Dek

king

van

pr

even

tieve

m

aatr

egel

en

Kankersc- Borst (%- BaarmoVaccinat- % DTP- % MMRGriepvac

zorg

op

lang

e te

rmijn

Aantal verzorgin

Mantelzo

Tijdigheid van paweek na de start v

i OESO-gegevenii nationale waardiii Waarde en inteiv Geen nationaleDTP-Hib (3) Difte

6

catoren ter beoorr

per 1 000 inwoners)erende artsen erende verpleegkun

verplichte ziektg (%) d en persoonlijke heidszorguitgaven) lde contacten met ge redenen (%)

creening % vrouwen 50-69 jaoederhals (% vrouwtiedekking kinderen

P-Hib (3) R (1) ccinatie (% 65+)

bedden in woonzngstehuizen (per 1

orgers (% bevolking

alliatieve zorg: ovan de palliatieve z

ns over het aantal vden gebaseerd op H

ernationale vergelijkie gegevens, waardeerie-Tetanus-Kinkho

rdeling van de to

):

ndigen

teverzekering van

uitgaven (% van

gezondheidsdienste

aar oud) wen 25-64 jaar oud)

zorgcentra en rus000 inw. 65+)

g 50+)

overlijdens binnenzorg (%)

verpleegkundigen onHIS (basis van interning gebaseerd op ge gebaseerd op éénoest (Pertussis)-Hae

Belgian

oegankelijkheid vGlobaal

n de

totale

en om

sten

n een

nvoldoende vergelijnationale vergelijkin

gegevens 2010. n enkele studie van emophilus Influenza

n Health System

van de gezondheBelgië Meest

recente gegeven

2,9 2010

9.9i 2009

99,0 2010

19,4 2010

14 2008

60,1

2010

61,8 2010 97,9

2009

94,5 2009 65,0 ii 2009

70,3 iii 2011

12,1 2007

(20,0) iv 2006

jkbaar. ng in OESO-Gezond

het Christelijk Ziekeae B (dekking met d

Performance

eidszorg

ns

Tendens in de tijd

stabiel

stabiel

stabiel

stijging

stabiel stabiel stijging stijging stijging

stabiel

dheidsgegevens), s

enfonds. derde dosis; BMR (1

M V Sociaal laag

27,0

48,6

48,9

63,5

socio-economische

1) Bof-Mazelen-Rod

Sociaal hoog

Vlaandere

4,0 11,0

62,9

64,9

64,2 61,0

98,3 96,8 46,3 65,8

58

ongelijkheden geba

dehond (eerste dosis

en Wallonië B

14,0 26

55,3

5

64,6 63 96,9

98

92,4 960,9 59

83 10

aseerd op EPS.

s).

21

russel

6,0

1,9 3,6

8,6 1,1 9,2

01

22

2.4 ZorgkwKwaliteit wordt voor het individuitkomsten en gangbare mediin 5 subdimzorgcontinuïteit2.4.1 DoeltrDoeltreffendheiuitkomsten worevidence-basedniet voor diegezijn dus uitkomsEr werden zevgezondheidzorgbaarmoederhalastma, en drieaantal zelfdodinalgemene gezohet tewerkstgezondheidsprohandicaps (zoagedwongen opnDe overleving nEuropese landevan de overleviZiekenhuisopnadiensten weersdoeltreffendheid

waliteit gedefinieerd als

du als voor de bwaarbij de verl

sche kennis en inmensies: doeltrt en patiëntgerichtreffendheid d wordt gedefinirden bekomen, od gezondheidsdieenen die er geen st (resultaats) indven indicatoren gg te beoordeles- of colorectalee nieuwe indicangen per 100 000ondheidstoestand tellingspercentageoblemen en het als musculoskelenames gerelateerna colon- en borsen. Er zijn, tot opngspercentages bames omwille vaspiegelen – zijn id) dan het EU-15-

"de mate waarinbevolking, de kaneende zorg in onzichten".6 Dit woeffendheid, aantheid.

ieerd als "de maop voorwaarde vaensten voor al wi

baat bij zouden icatoren. gekozen om de en: overlevings

e kanker, percenttoren voor gees

0 inwoners (dit is van de bevolking

e van persopercentage voo

etale aandoeningrd aan alle psychiastkanker is goed ip heden, nog geebeschikbaar. n astma – die teiets hoger (d.w.z-gemiddelde.

Belgian

gezondheidszorgns vergroot op geovereenstemmingordt verder ondervngepastheid, ve

ate waarin de gan een juist aanbe er baat bij heehebben". Alle ind

doeltreffendheid percentage na tage hospitalisatistelijke gezondheook een indicatorg), de verhoudingnen met ge

or personen met en), de verhoudatrische hospitalisn vergelijking met

en cijfers over de

ekorten in de amz. slechter in term

n Health System

g, zowel ewenste

g is met verdeeld eiligheid,

ewenste bod van

eft, maar dicatoren

van de borst-,

es door eidszorg: r van de g tussen eestelijke

andere ding van saties. t andere evolutie

mbulante men van

Bgvefadrezavhga(cv(s

Performance

Bij de indicatorgezondheidszorg vergelijking met echter ook afhaactoren. Daaromdoeltreffendheid vesultaten geven

zelfdodingen in arbeidsparticipatievergelijking met handicap, is moegegevens te verzafgelopen jaren, collocaties) toege

vastgesteld, moetDeze verschillen

stedelijke fenomen

ren over de dstellen we een zandere Europese

ankelijk van perm is het alleen van de geestelijk

aan dat gezamBelgië te verm

e van mensen mede arbeidspartic

eilijk te interpretezamelen. Een lahet percentage

enomen is. Het hot met de nodige v zouden immersnen eerder dan aa

doeltreffendheid zeer hoog aantae landen. Het asoonsgebonden maar een indire

ke gezondheidszomenlijke actie nodminderen. De twet geestelijke gezcipatie van menseren en toont deaatste indicator

gedwongen psyoogste percentagvoorzichtigheid ws kunnen toegesan regionale versc

KCE Report

van de geestl zelfdodingen va

aantal zelfdodingeen maatschapp

ecte indicator vaorg. Hoe dan oodig is om het aweede indicator

zondheidsproblemsen met een ane noodzaak om geeft aan dat iychiatrische opn

ge, dat in Brussel worden geïnterpreschreven wordenchillen).

t 196

telijke ast in en is

pelijke an de k, de

aantal r, de

men in ndere meer n de ames werd

eteerd n aan

Cur

atie

vezo

rgG

eest

elijk

ege

zond

heid

KCE Report 196

Tabel 3 – Indic

Indicator

Cur

atie

ve z

org

Relatief overlna 5 jaar - borstkanker

- baarmoederha

- colonkanker

Hospitalisaties (/100 000 inw.

Gee

stel

ijke

gezo

ndhe

id Zelfdoding

(aantal/100 000

Tewerkstellingspersonen met gezondheidssto

Onvrijwillige oalle hospitalisaties)

i Resultaten voor ii Laatste beschikiii Dit is het resultaiv Laatste beschikv Verhouding vanvi Resultaten van

6

catoren ter beoor

evingspercentage

alskanker

voor astma 15+)

0 inw.)

spercentage vaneen geestelijke

oornisv

pnames (% vanpsychiatrische

r colorectale kanker kbare gegevens vooaat van de OESO-Gkbare gegevens in On tewerkstellingsper

de laatste EU Labo

rdeling van de do

Globaal Bel

e 88,

69,

M:6V: 6

48,

18,

n e

0,7

n e

8

in OESO-Gezondhor België in OESO-GGezondheidsgegeveOESO-Gezondheidsrcentage van personour Force Survey.

Belgian

oeltreffendheid v

lgië Meest recente gegevens

,0 2008 ii

,8 2008 ii

62,3i 64,6

2008 ii

,4iii 2009 ii

,6 2008iv

7 2002vi

2009

heidsgegevens voor Gezondheidsgegeveens voor België, na sgegevens voor Benen met een geeste

n Health System

van de zorg

s

Tendens in de tijd

stabiel

stabiel

stijging

r België. ens: 2004 (dit was daanpassing voor lelgië: 2005 (dit was d

elijke stoornis met h

Performance

M V Sl

62,3 64,6

28 52

28 10

de basis van de inteeeftijd. Percentage vde basis van de inteet tewerkingstelling

Sociaal aag

Sociaahoog

ernationale vergelijkvoor België zonder aernationale vergelijk

gspercentage van al

al Vlaanderen

87,6

70,6

M:62,5 V: 64,5

17

8

king). aanpassing is 40/10king). lle personen met ee

Wallonië B

88,8

8

69,1 6

M:62,5 V: 64,9

MV

24 1

7 1

00 000.

en handicap.

23

Brussel

88,0

67,7

M:59,9 V: 64,3

14

14

24

2.4.2 AangeAangepastheidverleende gezorekening houbewijskracht doeltreffendheidzorguitkomstenEr werden achzorg te meten. voor die indicborstkankerscre(voor antibiotica

Tabel 4 – IndicIndicator

Mammogrammen- Vrouwen in de l- Vrouwen in de lAntibiotica (% amoxyclav) Correcte opvolgin

Keizersneden (pe

Voorschrijven hoeveelheid//1 00

- Antidepr- Antipsyc

Kankerpatiënten de laatste 14 dagi Van hen die thui* Volwassen diab

epastheid van zorg kan wo

ondheidszorg eendend met de (‘best-available

d en aangepast en zorgprocesse

ht indicatoren gesDe resultaten zij

catoren die vereening (niet in doa of voor opvolgin

catoren ter beoor

n buiten de doelgroeeeftijd van 40-49 jaeeftijd van 71-79 ja

amoxicilline v

ng van patiënten me

er 1 000 levendgebo

van (gemiddel00 inw) ressiva chotica

die chemotherapigen van hun leven (is overleden/of van

betespatiënten met

orden gedefinieerdn antwoord biedt

best beschikbevidence’)".

theid weerspiegeen. selecteerd om dejn in het algemee

rband houden melpopulatie) of he

ng van diabetici).

rdeling van de aa

ep (%) ar ar

vergeleken met

et diabetes (%)*

oortes)

lde dagelijkse

e krijgen tijdens %) hen die in het ziekeregelmatige onderz

Belgian

d als "de mate wop de medische

bare wetenschaHet verband elt het verband

e aangepastheid en niet al te besmet aangepastheet opvolgen van ri

angepastheid vaGlobaal België

35,5 20,8

44,9

54

193

68,4

10,5

(12%/ 23%)i

enhuis overleden, gzoeken van de retina

n Health System

aarin de e noden, appelijke

tussen tussen

van de t, vooral eid van chtlijnen

HtuTahgTbcgb

an de zorg Meest recente gegevens

Tein

2010

sta

2010 stij2008 sta

2008 sta

2009 stij

2010

stij

2010 stij2005

geen nationale gegea en bloedonderzoe

Performance

Het aantal keizerussen de ziekenhTwee indicatorenantipsychotica in dhet EU-15-gemidgeneesmiddelen nTenslotte werd ébehandeling op chemotherapie krigegevens zijn ecbenchmarking of te

ndens de tijd

M V

abiel

jging abiel 46,4 5

abiel 54 5

jging

jging 43,1 9

jging 10,8 1

evens, waarden gebeken (%).

rsneden neemt thuizen. n beschrijven hde algemene bev

ddelde ligt. Bovenog steeds. één indicator ge

het einde vaijgen tijdens de lachter moeilijk teendens over de tij

V Sociaal laag

Sochoo

28,6

36,

16,2 23,1,1 44,4 49,

5 48 58

2,8

0,3

baseerd op één enke

toe en vertoont

het verbruik vavolking. Ze tonen endien stijgt he

emeten over de an het leven aatste 14 dagen

e interpreteren bjd.

ciaal og

Vlaanderen

,6 28,6

,2 16,4 ,4 46,0

57

60,6

9,6

ele studie van het C

KCE Report

een grote variab

n antidepressivadat dit verbruik bt verbruik van

agressiviteit va(Kankerpatiëntenvan hun leven).

bij gebrek aan n

Wallonië Brus

46,4

47,7

27,7 31,2 42,8 47,1

52 48

85,8

57,1

11,9 11,7

Christelijk Ziekenfon

t 196

biliteit

a en boven deze

n de die Deze norm,

sel

nds.

I

BdIMI(IzZ(Oav6n

KCE Report 196

2.4.3 VeilighVeiligheid kan patiënt geen scZes indicatoreneerder matig. straling, maar aantal nosocStaphylococcusDe incidentie antidepressiva stabiel. Alleen d

Tabel 5 – Indicndicator

Blootstelling aan mde Belgische bevoncidentie van nosMRSA (1/1 000 opncidentie van pos(/100 000 ontslagencidentie van dooziekenhuizen (%)Ziekenhuismortalit(%) Ouderen die antidanticholinergischevoorgeschreven k65 jaar en ouder dnemen)

I OR Odds Ratio.

6

heid worden gedefinie

chade berokkent”. n evalueren de vEr is nog steedser lijkt een daling

comiale infectiess aureus) en de z

van postoperatmet anticholine

de incidentie van d

catoren ter beoor

medische straling olking (MSv/capitasocomiale infectiepnames) stoperatieve sepsien) orligwonden in

teit na een heupfr

epressiva met e nevenwerkingenregen (% patiënte

die antidepressiva

eerd als “de mate

veiligheid van de s een hoge blog te zijn in 2011s door MRSAziekenhuismortalitieve sepsis en ergische nevenwedoorligwonden in

rdeling van de veGlobaal

van a)

s door

is

ractuur

en van a

Belgian

e waarin het syst

zorg. De resultaootstelling aan m. Er is een dalinA (Meticilline-reteit na een heup

het voorschrijverkingen bij oudziekenhuizen nee

eiligheid van de België Mees

recegege

2,2 2011

1,5 2010

1224 2007

16,8 2007

6,3 2007

14 2010

n Health System

teem de

aten zijn medische

g in het esistente fractuur.

ven van deren is emt toe.

zorg st nte evens

Tendens tijd

1 kleine da2011

0 daling

7 stabiel

7 stijging

7 daling

0 stabiel

Performance

in de M V

aling in

1,84i

13 1

V Sociaal laag

Sochoo

4

ciaal og

Vlaandere

1,2

17

en Wallonië B

2,2 1

11 1

25

Brussel

1

10

26

2.4.4 ContinContinuïteit vanzoals de contincontacten met de contacten zorgverlenendelaat toe om coeen duidelijke vIn tegenstellingvan de bevolkinde resultaten vandere Europesgezondheidssysteammeeting -indicatoren wozoals de Usualanden die bescpatiëntgegevenEén resultaat, veronderstelt eMatige resultatde 7 dagen naresultaten hebbdossier en de het enige dat mspecifiek op gee

d De UPC,

die een padezelfde hdie een U4 met hun

nuïteit van zorg n zorg is een couïteit in informatiede verschillende tussen patiënt e

e instanties of orgnclusies te trekke

verbetering is verg tot de gevestigdeng of over doeltrevan de zorgcoördse landen. Sommsteem (globaal- “multidisciplinairden goed besch

al Provider of Cachikken over de ju

ns die nodig zijn ode UPC-index,

een goede relatieen worden gevon

a hospitalisatie enben betrekking oheropnames in p

momenteel wordt estelijke gezondh

de Usual Provider oatiënt heeft met zijnhuisarts bezoekt; dePC van minstens 0

n gebruikelijke huisa

ncept dat versche tussen de zorgv

zorgverleners, hen huisarts of deanisaties. De huiden over elk van dgeleken met het ve indicatoren overeffendheid van zoinatie in België te

mige indicatoren z medisch dor oncologisch c

hreven in de wetare index (UPC)d

uiste nationale dam dit te meten. kan als positief

e met de vertrounden voor contacn bespreking op op het gebruik vpsychiatrische zieverzameld door d

heidszorg.

of Care index, is de

n eigen huisarts; 1 we indicator geeft he,75 hadden, d.w.z.

arts hadden.

Belgian

illende dimensiesverleners, de plannet relationele aspe coördinatie tusdige set van 7 inddeze dimensies,

vorige HSPA-rappor de gezondheidstorg, is het erg moe vergelijken met zijn erg specifiek vossier, multidisconsult” (MOC)). tenschappelijke litd. Maar er zijn natabanken met ind

f worden beschouwde behandelenct met de huisarts

het MOC. De nevan het globaal ekenhuizen. Dit lade OESO en dit r

e proportie van de cwijst erop dat de patt percentage patiëndie minstens 3 cont

n Health System

s omvat, ning van pect van ssen de dicatoren hetgeen ort. toestand eilijk om die van

voor ons ciplinaire

Andere teratuur, niet veel dividuele

ouwd en nde arts. s binnen egatieve medisch aatste is richt zich

contacten tiënt altijd nten weer tacten op

Performance KCE Reportt 196

KCE Report 196

Tabel 6 – Indic

Indicator

Patiënten met dossier (%)

Patiënten metijdens deteammeeting (%

Ontmoeting meweek na ontslapatiënt van 65 j

Proportie van chuisarts (%), UP

Heropname binhetzelfde psyc(% ) - diagnose van

- diagnose van

Patiënten die chuisarts tijdenshun leven (%)i: Dit zijn de laatsii 72% van de perhet Christelijk Zieiii UPC, de Usual vertegenwoordigt

6

catoren ter beoor

een globaal me

et kanker bespe multidiscip%)

et huisarts binneag uit het ziekenhaar en ouder)

contacten met dePC index (%) iii

nnen de 30 dagchiatrische zieke

schizofrenie

bipolaire stoornis

contact hadden ms de laatste wee

ste nationale gegeversonen die thuis oveekenfonds).

Provider of Care int het percentage pa

rdeling van de co

Globaal

edisch

proken plinaire

en de uis (%

e vaste

gen in enhuis

s

et hun ek van

ens, terwijl de laatsterlijden hebben een

ndex, is het percentatiënten met een UP

Belgian

ontinuïteit en coö

België Meesrecengege

47 2010

68,8 2008

58,4 2009

71,4 2010

20,2

2009

15,6 2009

(72%) ii 2005

te OESO-gegevens n huisarts gezien tijd

tage contacten met PC van minstens 0,7

n Health System

ördinatie van de

st nte evens

Tendens de tijd

0 stijging

8 stijging

9 stabiel

0 stabiel

9i

stijging

9 i stabiel

5

voor België daterendens de laatste leve

de eigen huisarts v75; d.w.z. die minste

Performance

zorg

in M V

42 50

55,4 60,8

72,1 71,2

n uit 2007. ensweek (geen nati

van een patiënt; 1 wens 3 contacten op

Sociaal laag

Sociahoog

54 44

64,2 54,6

76,7 70,5

ionale gegevens, w

wijst erop dat de pat4 hadden met hun

aal

Vlaanderen

58

73,8

60,6

70,8

25,2

19,7

waarden gebaseerd o

tiënt altijd dezelfde heigen huisarts.

Wallonië Brus

32 29

62,7 55,7

57,8 42,5

74,4 65,9

17,2

10,2

13,4 7,1

op één enkele stud

huisarts zag; de ind

27

ssel

7

5

9

2

die van

dicator

28

2.4.5 PatiënPatiëntgerichtheen ontvankelijkindividuele patigeleid door de geen indicator onderzoek naaworden voorgegebrek aan geslechts versnipp

Tabel 7 – Indic

Indicator

Tevredenheid gezondheidsdiegoed)

Pijn altijd hospitalisatie (%

Patiënten diegebruikelijke woi Nationale gegevii Het niveau vantevredenheid ietsiii Resultaten van iv Gebaseerd op e

ntgerichtheid eid wordt gedefink is voor de vënt, en ervoor zowaarden van de die patiëntgeric

r indicatoren en elegd. Dit weerspegevens is, en perde informatie o

catoren ter beoor

ensten (% goed

gecontroleerd % patiënten)

e overlijden inoonplaats (%)

vens zijn nog niet ben tevredenheid ligt bs lager (87%). één enkele studie a

een studie van het C

nieerd als "zorgveoorkeuren, node

orgt dat alle klinispatiënt". Het vori

chtheid beoordeegegevens kunneniegelt het feit datde weinige meeover een complex

rdeling van de pa

Globaal

met of zeer

tijdens

n hun

eschikbaar. Resultaboven 90% voor co

alleen in RN4cast pChristelijk Ziekenfon

Belgian

erlening die respeen en waarden sche beslissingenge HSPA-rapport

elde. Na een dien slechts drie indt er momenteel e

etbare indicatorenx onderwerp.

atiëntgerichtheid

l België

>90% ii

(41,0) iii

(45,1)i

aten voor Vlaandereontacten met huisar

project. nds en andere publ

n Health System

ect toont van de worden t bevatte epgaand dicatoren een echt n geven

Uzghinvv

d van de zorg

Meest recente gegevens

Tein

2008

2009

2007 St

en en Brussel worderts, tandartsen, spe

licaties.

Performance

Uit de resultaten kzijn over de verscgegevens geven ohet relatief slecht ndicator over de van de tijd (mindeverschillen afhank

endens de tijd

M V

Geen verschil

tijging

en gezamenlijk geraecialisten en dienst

komt tot uiting datchillende gezondover het centrale o

in vergelijking mplaats van overli

er patiënten overlikelijk van de socio

Sociaal laag

Sochoo

Geen verschi

iv

apporteerd. ten voor thuiszorg.

t patiënten over hheidsdiensten. Sonderwerp van pi

met andere landenijden een positievijden in het zieke-economische sta

ciaalog

Vlaanderen

l Hoger

45,1i

Alleen voor zieken

KCE Report

het algemeen tevrlechts één studieijncontrole. Belgiën. Tenslotte toonve tendens in denhuis) maar met

atus.

Wallonië Brus

Lager Laag

45,1

huizen is het nivea

t 196

reden e kon ë doet t één

e loop grote

ssel

gste

1 i

au van

KCE Report 196

2.5 EfficiënEfficiëntie wordmiddelen (d.w.voor het systemiddelen wordemogelijk resultaDrie indicatoregezondheidssyser in België eenDe drie indicatovan voorschrichirurgische danormale bevalllanden dan de die in het eerstehet EU-15-gem

Tabel 8 – Indic

Indicator

Chirurgische da

Gemiddelde normale bevalli

Voorschrijven vgeneesmiddele

Andere indicasectie over aan

DDD = Standaard

6

ntie van het gezdt gedefinieerd alz. geld, tijd en peem (macroniveaen gebruikt om eeaat te behalen (ouen werden gessteem te evalueren tendens naar eeoren evolueren imften voor goedaghospitalisatie, eling (hetgeen eegemiddelde verble HSPA-rapport widdelde.

catoren ter beoor

aghospitalisatie (%

verblijfsduur vong (dagen)

van ambulante gen (% DDD op tota

atoren besprokengepastheid

d dagdosering (defi

zondheidssystels "de mate waapersoneel, input au) en ervoor gen zo groot mogeutput genoemd)”.4,

selecteerd om en. Net zoals in anen meer efficiënt g

mmers positief in ddkope geneesmen daling van d

en meer vergelijklijfsduur voor de twerd gebruikt), ma

rdeling van de ef

Globa

%) oor een

goedkope aal)

n in de

ined daily dose).

Belgian

eem rin de juiste hoevgenoemd) ingeze

gezorgd wordt dlijke winst of een , 7 de efficiëntie vndere Europese lagebruik van zorgde loop van de tijd

middelen, toename verblijfsduur v

kbare indicator istotale ziekenhuispaar nog steeds ho

fficiëntie van de

aal België

46,2

4,3

46,0

n Health System

veelheid et wordt at deze zo goed

van het anden is diensten. : stijging

me van oor een

s tussen populatie oger dan

Ainpvinbzinam

zorg

Meest recente gegevens

Tendin de

2008 Stijg

2008 Dalin

2010 Stijg

Performance

Andere indicatorenndicatie van de epatiënten met eenvermindering van ndicatoren is minborstkankerscreenzich vragen stellen gezondheidszoaangepaste zorg met efficiëntie. Dit

dens e tijd

M V

ing

ng

ing

n die in dit rappoefficiëntie van he

n globaal medischhet aantal dubbelnder positief. Bijvning gebeurt buiten over de efficiënorginterventies k(‘non appropriatwerd, bijvoorbee

Sociaal laag

Sociahoog

rt worden geanalyet systeem. De sh dossier kan bijvoe onderzoeken. Dvoorbeeld, aangeen het nationale ntie hiervan. Onvekan ook een pe’), hetgeen rechld, aangetoond v

aal g

Vlaanderen

46,2

yseerd geven ookstijging van het aoorbeeld leiden toDe tendens van anezien de helft va

programma kan erklaarbare variabproxy zijn voor htstreeks samenh

voor keizersnedes

Wallonië Brus

45,9 45,3

29

k een aantal ot een ndere an de

men biliteit

niet hangt

s.

ssel

3

30

2.6 DuurzaDuurzaamheid • een infrast

stellen en ten uitrustin

• innoverend• te reageren• duurzaam Voor de vier egeselecteerd. Dgenerische indi

Tabel 9 – IndicIndicator

% afgestudeerworden

Gemiddelde lee

Afgestudeerdeninwoners)ii

% huisartsen dagebruikt

Beddagen acut(aantal beddage

Totale gezondh

i Voor deze reeksii Deze indicator miii Deze indicator BBP Bruto Binne

aamheid wordt gedefinieertructuur, zoals eete behouden (bijv

ng); d te zijn; n op nieuw ontstagefinancierd te blelementen uit de

De laatste indicatocator voor financi

catoren ter beoor

rden in geneesk

eftijd huisarts

n verpleegkund

at een elektronisc

te zorg en per capita)iii

heidszorguitgaven

s indicatoren zijn gemoet worden geïntemoet worden geïnt

enlands Product.

rd als het vermogeen personeelsbesv. door opleiding e

ane noden; ijven door collectie definitie werdeor, totale gezondhële duurzaamheid

rdeling van de du

unde die huisart

de (per 1 00

ch medisch dossie

n (% BBP)

een gegevens bescherpreteerd samen mterpreteerd samen m

Belgian

en van het systeestand, ter beschien training, voorzi

eve ontvangsten.en specifieke indheidszorguitgavend.

uurzaamheid vanGlobaal B

ts 3

5

00 4

er 7

1

1

hikbaar per gewest,met de indicator vanmet de indicator van

n Health System

em om: kking te ieningen

dicatoren n, is een

DvbphgHgb2

n het gezondheidBelgië

30,1

51,4

41,7

74,0

1,2

10,5

, maar per taal (Fran de dichtheid van pr

n het percentage ch

Performance

De resultaten tonvan het systeem obijna op pensioenper inwoner; onvohuisartsen), en indgegevens over noHet percentagegespendeerd wordbedrag in absolute2010.

dssysteem Meest recente gegevens

Tendde ti

2009 dalin

2009 stijg

2010 stab

2010 stijg

2009 stab

2010 stijg

ns- of Nederlandstaraktiserende verple

hirurgische dagopna

en een mix van om de groep huisn gaat); matige reoldoende gebruik dicatoren die niet den (afgestudeerd

van het Brutodt aan gezondheide cijfers bedroeg €

dens in ijd

Neder

ng 29,2

ging 51

biel

ging 83,7

biel

ging

alig). egkundigen (in sect

ames (in sectie over

negatieve resultaartsen te vervang

esultaten (aantal lvan elektronisch kunnen worden g

den verpleegkundo Binnenlands dsuitgaven bedro€27,6 miljard in 20

landstalig Frans taligi

31,0

52

62,5

tie over toegankelijkr efficiëntie).

KCE Report

aten (slecht vermgen die ouder worligdagen in acutemedisch dossier

geïnterpreteerd zode).

Product (BBP)eg 10,5% in 2010003 en €37,3 milja

s

kheid).

t 196

mogen rdt en

e zorg r door onder

dat 0. Het ard in

KCE Report 196

2.7 GezondOm verschillenddit rapport een van gezondheid1. Gezondhei

uit te oefenruim begripvan Ottawbuiten hetgezondheidbinnen een

2. De meesgezondheidSommige waangepast

3. Er zijn wein4. De conven

kijk) gezondheidgezondheidindicatorenom de koe

e De vijf lijne - het uitw

van de zoplaatsen) - het creër- het ontw- het verst- het hero

De belanparticipatiemultisecto

6

dheidspromotiede redenen was hvolledig overzicht

dspromotie. idspromotie, het "nen over hun gezp. De strategische

wa) omvatten vert gezondheidszordssysteeme. Eenn specifiek concepste indicatoren dspromotie te eworden nog ontwaan de Belgische

nig gegevens besntionele, gemakkeuitkomstindicatored/gezondheidsgeddspromotie evena

n, met hun waarders te bepalen van

en van het Handves

werken van een gezorginstanties is om ren van ondersteun

wikkelen van individuterken van de actiesriënteren van de gegrijkste waarden ee, empowerment,

orialiteit.

e het niet mogelijk ot te geven van de

"proces dat menszondheid en die te lijnen (zoals gedrantwoordelijkhedrgsysteem bevind groot aantal ind

ptueel kader, zouddie nodig

evalueren zijn nwikkeld, terwijl ande/regionale contexschikbaar. elijk te meten (hen op drag zijn distale uals door andere faen en enige vorm het beleid.

st van Ottawa zijn: zond overheidsbele gezondheid op he

nende omgevingen (uele vaardigheden s van de gemeensc

ezondheidsdienstenen dimensies van , billijkheid, duu

Belgian

om binnen het bee performantie op

sen toelaat meer te verbeteren", is definieerd in het Hen die zich grotden en zelfs budicatoren, gestruden noodzakelijk zzouden zijn o

niet klaar voor dere nog moetenxt.

oewel met een bhet vlak

uitkomsten beïnvloactoren. Er zijn vevan benchmarkin

eid (de verantwoordet agenda van elk

(life settings)

chap

gezondheidspromurzaamheid, multi

n Health System

ereik van het vlak

controle een erg

Handvest tendeels iten het ctureerd zijn. om de gebruik. worden

beperkte van

oed door eel meer ng, nodig

delijkheid beleid te

motie zijn: strategie,

BpzVgpoinInWvtategvoliagsopBHlamvBggHozv

Performance

Bijgevolg wordt performantie van zoals getoond in TVoor veel van gezondheidsuitkompercentages middongelijkheden vasn de beter opgelenternationale benWe wijzen op hvoorkomt, nog steabaksconsumptiee hoog is, maar grote regionale onveel lager dan deopgemerkt. De wejkt dat de ve

alcoholconsumptiegeïnterpreteerd aasociaal wenselijk ongelijkheden vapercentage "problBrussel). Het percentage HIaatste jaren. Daamannelijke homosvergelijkingen geBelgische persongeïmporteerde ggezondheidspromoHet percentage ondersteuning ervzijn er grote sociaveel hoger bij oude

hier slechts eegezondheidsprom

Tabel 10. de klassieke

msten en gezodelmatig. Er wordstgesteld, met eenide klassen (met

nchmarking was shet probleem vaeds toeneemt en

e daalt, hoewel zeook hier treffen

ngelijkheden aan. e dagelijkse behoekelijkse alcoholcerslaving in ste moet echter mangezien het bijzo

antwoordgedragastgesteld voor ematisch drinken

IV-diagnoses bij Brenboven wordt eseksuele bevolkinetoond, aangezienen zou kunnengevallen die otiebeleid in Belg

van de bevolvaart ligt, gemiddale en regionale veren.

en partieel beemotie door midde

indicatoren vonde levensstijl

den echter belangn gunstiger levenuitzondering van lechts mogelijk vo

an obesitas/overgdat ernstige onge

e met 20% dagelijwe grote socialeDe consumptie v

oeften, maar er wconsumptie is nieijgende lijn gamet de nodige oonder gevoelig is g. Er worden g

deze indicatorn", d.w.z. een ten

Belgische burgerser een grote toenang. Er worden hien het diagnosen bestaan uit eniet zo relevaië. king dat een

deld genomen, niverschillen. Boven

eld gegeven vanel van 15 indicat

van de categozijn de nati

grijke regionale/sosstijl in Vlaanderealcoholconsumptioor enkele indicatgewicht dat erg elijkheden vertoonjkse rokers nog s

e ongelijkheden evan fruit en groenwordt een verbetet erg hoog, maaaat. Het percenomzichtigheid wovoor vertekening

geen regionale/sor (tenzij een hdens tot verslavin

s steeg langzaam ame vastgesteld er geen internatiepercentage bij en grote fractieant zijn voor

gebrek aan soet zo hoog. Noc

ndien is dit perce

31

n de toren,

orieën onale ociale en en ie). toren.

veel nt. De teeds

en vrij ten is tering ar het ntage orden

g door ociale hoger ng, in

in de bij de onale niet-

e van het

ociale htans ntage

Ind

Volw(%)ObeTanmet(gemPerbevDag

Alco-Pro-Ov-CoMinper MindagSlec

Tob

Scoop sGezgem% s

32

De Tobacco Cover het overhestaat hier op eeDe andere indilokale beleid imeten. Ze zij

Tabel 10 – Indi

icator

wassenen met ove ese volwassenen (%ndbederf, ontbrekent vullingen in de middelde score) rcentage HIV-diagvolking (/100 000 inwgelijkse rokers (% 1

oholconsumptie (% oblematischi verconsumptieii omazuipeniii stens 200g groentdag (%) stens 30 minuten l

g (%) chte sociale onders

bacco Control Scale

ore van aanbod vaschool zondheidspromotiebmeentenVII scholen met een gez

ontrol Scale Policeidsbeleid om de en middelmatige pcatoren zijn indexinzake gezondhen alleen beschi

icatoren van gez

ergewicht of obesi

%) nde tanden , tand

leeftijdsgroep 12

gnose in Belgiscw) 5+)

15+)

ten en 2 stukken f

ichaamsbeweging

steuning (%)

e

an lichaamsbeweg

beleid in

zondheidsteamVII

cies maakt een itabaksconsumpt

plaats. xen die tot doel heidspromotie in vkbaar in Vlaand

zondheidspromo

Globaal B

itas 4

1den -14 1

che 3

2

178

fruit 2

per 3

1

5

ging

de

Belgian

internationale verie te verminderen

hebben de krachtverschillende setderen (door de

otie

België Meest recentegegeve

46,9 2008

13,8 2008 1.3 iv 2010

3,9 2010

20,5 2008

10,2 2008

7,9 2008 8,1 2008 26,0 2008

38,1 2008

15,5 2008

50/100 2010

2009

2009

2009

n Health System

rgelijking n. België

van het ttings te

VIGeZ-

eTdislig

e ens

Tendens de tijd

stijging

stijging

stijging

daling

stijging stabiel stijging

stabiel

stijging

Stijging

Performance

enquêtes). Ze zijnTendensen gemetdat de cultuur vans (de cultuur ochaamsbeweging

gezondheidspromo

in M V

53,7 40,4

13,1 14,4

6,9 0,7

23,6 17,7

13,1

7,3

10,1 5,9 12,8 3,7 23,4 28,5

48,7 28,3

15,1 16

n moeilijk te interten door opeenvo

n gezondheidsproom deel te nemg verbetert. otiebeleid echter

Sociaal laag

Sh

57,8 40

19,1 9,

22,1 13

11,5 15,9 8,8,3 7,21,7 29

24,0 42

24,4 10

preteren zonder eolgende enquêtesmotie in de schol

men is vrij goeIn veel gemniet goed geïmple

ociaaloog

Vlaandere

0 47,1

,1 13,6

3,8

3,1 18,6

1 9,5

,4 7,9 ,6 8,9 9,4 30,0

2,8 45,1

0,1 12,4

5,5/10

37/36/50vi

42/64/54 v

KCE Report

een grondige anas lijken er op te wlen aan het verbe

ed), het aanbodeenten wordt ementeerd.

en Wallonië B

48,9 3

14,6 1

2,40 8

24 2

10,7

1

8,4 67 619,2 2

28,4 2

20,0 2

vi 40%v 4

t 196

alyse. wijzen eteren van

het

Brussel

39,8

11,9

8,9

22,3

14,4 6,7 6,2 25,3

24,7

22,9

40% v

KCE Report 196

i: Berekend op de ii15+ bij vrouweniii Risicovol drinkeiv Enkele gegevenv Voor Wallonië evi Indicatoren van

2.8 BillijkheBillijkheid is eengezondheidssysonderwerp, daliteratuur werdvoorgesteld. Wplaats van bigezondheidssysAangezien we ovan billijkheid oplaats hebbgezondheidsdegedocumenteerTen tweede hevan billijkheid markeren (resuBillijkheid in gesystematische tussen sociale hiërarchie". Omsocio-economisvan geslacht of

6

e populatie personen; 22+ bij mannen. en tijdens één gelegns maar te weinig laen Brussel samen. n VIGeZ; respectiev

eid en gelijkhein kernelement bij steem.1 Het is t verwijst naar o

d een ruim aaWij geven deze we

llijkheid bij de stemen" (beschikons bewust warenop twee complemben we deeterminanten en rd per socio-econbben we contextuin de gezondheltaten in Tabel 12zondheid wordt songelijkheden i

groepen die versm die reden concsche ongelijkhedef gewest) worden

en die alcohol drinke

genheid (≥6 drinks) anden.

velijk bij tabakspreve

id de evaluatie vanook een cont

oordeel en politianbod aan perseer in Supplemen

beoordeling vanbaar op de websin van dit kenmerk

mentaire manierene ongelijkhedegebruik van gez

nomische statusuele indicatoren veidszorg op een 2 en Afbeelding 2)soms gedefinieerdn gezondheid/ge

schillende positiescentreert dit hoofen. Andere ongelijn weergegeven in

Belgian

en (niet-geheelontho

minstens een keer

entie, gezonde voed

de performantie roversieel en nieke standpuntenspectieven en dnt S2 van dit rappn de performante).

k, hebben we de dn benaderd. In deen in gezozondheidszorg in(resultaten in Taoorgesteld die pro

globaal niveau). d als "de afwezighezondheidsdeterms innemen in eenfdstuk zich alleenjkheden (bijv. op

n de synoptische

n Health System

ouder) en gebaseer

per week.

ding en lichaamsbew

van een normatief n. In de definities port: "De ntie van

dimensie e eerste ondheid, n België abel 11). oblemen kunnen

heid van minanten n sociale n op de het vlak tabellen

vinoindon2Evoegtaolivvew

Performance

rd op CAGE, 2+ cut

weging (scores van

voor elke dimensndicator (zie Supook beperkt tot ndicatoren van dede administratieongelijkheid, zoalsniet onderzocht. 2.8.1 Socio-ecEr werden grote van algemenoverlijdensverwaceindpuntmetingen gezondheidsdeteralrijke indicatoreovergewicht/obesichaamsbeweging

vastgesteld voor dvoor de meeste economische gegworden gemeten.

t off.

VIGeZ).

sie, en worden plement S1). Weslechts één kene HIS) of de statuve databanken

s tewerkstellingss

conomische ongsocio-economischne gezondhhtingen, zelfra

die wijzen op minanten. Ongel

en op het vlaktas, te weinig

g doen en sociade dimensie van to

indicatoren vangevens beschikba

besproken in de hebben de socionmerk: het opleidus van preferentië. Andere dimetatus, inkomen of

gelijkheden he ongelijkheden heidsuitkomsten apportage gezobillijkheidsproblemlijkheden werdenk van gezondhg fruit en gale steun). Er woegankelijkheid. Jn de andere dimaar, en konden

de gedetailleerdeo-economische pdingsniveau (vooële terugbetaling ensies van sof etniciteit, werden

gemeten op het(levens-

ondheid); dit men in de ketenn ook vastgesteheidspromotie (rgroenten eten, werden ongelijkhJammer genoeg wmensies geen sde ongelijkheden

33

e per positie or de voor

ociale n hier

t vlak en

zijn n van ld bij oken,

aan heden waren socio-n niet

34

Tabel 11 – Ove

Algemene gezonLevensverwachtiLevensverwachtiLevensverwachti2001 i; ii Levensverwachti2001 i; ii % van de bevolkals goed of zeer gToegankelijkheiUitgestelde cofinanciële redeneBorstkankerscreeBorstkankerscreeAangepastheid% volwassen diaregelmatige ondeGezondheidspro% van de populahij/zij dagelijks ro% van de populsociale steun me% van de volwa(BMI ≥ 30) iii % van de volwzwaarlijvig of obe% van de populastukken fruit per d% van de populichaamsbewegin

erzichtstabel van

ndheidstoestand ng op 25 jaar bij mang op 25 jaar bij vrong in goede gezon

ng in goede gezon

ing (leeftijd 15 jaar goed beoordelen iii d van zorg ntacten met ge

en (% huishoudens)ening (% vrouwen inening (% vrouwen in

abetici die aangepaserzoeken van de retomotie atie (leeftijd 15 jaa

ookt iii atie (leeftijd 15 jaaldtiii

assen populatie dat

wassen populatie ees (BMI ≥ 25) iii tie dat meldt dat zedag eten iii ulatie dat meldt dng per dag heeft iii

n socio-economis

annen, 2001 i; ii ouwen, 2001 i; ii ndheid op 25 jaar b

ndheid op 25 jaar b

en ouder) die hun g

ezondheidszorgdien) iv n de leeftijd van 50-n de leeftijd van 25-

ste zorg krijgen, in ttina en bloedonderz

ar en ouder) dat ve

ar en ouder) dat e

t wordt beschouwd

dat wordt besch

e minstens 200g gro

dat ze minstens 3

Belgian

sche ongelijkhedTotalwaar

51,3857,09

bij mannen, 40,47

bij vrouwen, 40,42

gezondheid 76,8%

nsten om 14,0%

-69 jaar) v 60,1%-64 jaar) v 61,8%

termen van zoeken v

54,0%

ermeldt dat 20,5%

een slechte 15,5%

als obees 13,8%

houwd als 46,9%

oenten en 2 26,0%

30 minuten 38,1%

n Health System

den le rde (f)

Waarde laagste sociale groep (f

8 47,56 9 53,98 7 27,75

2 28,92

% 57,4%

% 27,0%

% 48,6% % 48,9%

% 48,0%

% 22,0%

% 24,4%

% 19,2%

% 57,8%

% 21,7%

% 24,0%

Performance

in

f)

Waarde inhogere sogroep (f)

55,03 59,9 46,33

47,1

85,7%

4,0%

62,9% 64,2% 58,0%

13,1%

10,1%

9,1%

40,0%

29,4%

42,8%

n ociale

Absoluut v(laagste vs

-7,47 -5,92 -18,58

-18,18

-28,3%

23,0%

-14,3% -15,3% -10,0%

8,9%

14,3%

10,1%

17,8%

-7,7%

-18,8%

verschil s hoogste)

Relatrisico(laaghoog

n.v.t.n.v.t.n.v.t.

n.v.t.

0,67

6,75

0,770,76 0,83

1,68

2,42

2,11

1,45

0,74

0,56

KCE Report

tief o

gste vs gste)

OverzimetingPAF)

3,73% 1,43% 15,30%

16,56%

11,6%

-71,4%

4,7% 3,9% 7,4%

-36,1%

-34,8%

-34,1%

-14,7%

13,1%

12,3%

t 196

icht g (CII of

%

%

%

%

%

%

%

KCE Report 196

i in jaren; ii 5 oplepercentages zijn goede gezondheBron: GezondheiPA lichaamsbewe

2.8.2 ConteWe hebben twindicator van prde verdeling varatio’s in Tabel(indirecte belasbelastingen regindirecte belasrijkere personengemiddelde pgedeeld door hvoorzichtig zijn twee jaren slecTen tweede, omhet niveau van de Gini-coëfficiëcoëfficiënt stijgtde ongelijkheidgewesten.

6

eidingsniveaus; iii 4 oniet aangepast aanid, PAF (Populationidsenquêtes (HIS) eeging.

extuele indicatorwee contextuele rogressiviteit van an het nationaal 12 dat het aandstingen) gestege

gressief omdat destingen betalen on een hoger deel ercentage indirehet inkomen) damet de interpretahts om gebudgettmdat de gezondhinkomensongelijkënt sinds 1988 in t met de inkomen

d toeneemt en ho

opleidingsniveaus; in leeftijd; samenvattn Attributable Fractioen EPS (WIV – ISP

ren van billijkheidbillijkheidsindica

overheidsfinancieinkomen. Ten eedeel van regressien is. Over het e rijken en de armop consumptiegovan hun inkomen

ecte belastingenalt met het inkom

atie van de tendenteerde bedragen gheidstoestand kankheid in een land, België. Aangeziesongelijkheid, ste

oger is in Brusse

Belgian

iv 5 inkomensniveautende metingen= Con) voor alle andereen KCE-berekening

d toren geselectee

ering en een indicerste tonen de beeve financieringsalgemeen zijn i

men hetzelfde peroederen en dienn sparen. Vandaan (indirecte belamen. We moeten

ns omdat het bij degaat. n worden beïnvlotonen we de evo

en de waarde van ellen we vast dat iel dan in de ande

n Health System

us; v 2 terugbetalingII (Concentration In

e indicatoren. gen).

erd: een cator van erekende bronnen indirecte rcentage sten en r dat het astingen n echter e laatste

oed door lutie van de Gini- n België

ere twee

Performance

gscategorieën. ndex of inequalities) van toepassing opp levensverwachtingg en levensverwach

35

ting in

36

Tabel 12 – Indi

Indicatoren va

Ratio proportioontvangsten

Ratio progressontvangsten

Ratio regressieontvangsten

Totaal

Bron: Vademecu

icator van billijkh

an progressiviteit

onele ontvangste

sieve ontvangste

eve ontvangsten

m van de sociale ze

heid: progressiv

t

en/totale

en/totale

n/totale

ekerheid, RIZIV – IN

Belgian

iteitsindicatoren

2005 (definitieve

rekeningen)(

re

71,1%

18,9%

10,0%

100,0%

NAMI, KCE-bereken

n Health System

n van de publieke

2006 (definitieve ekeningen)

(drek

71,0%

19,0%

10,0%

100,0%

ningen.

Performance

e financiering va

2007 efinitieve

keningen)(vre

72,0%

18,0%

10,0%

100,0%

n het gezondhei

2008 voorlopige ekeningen)

(r

70,6%

17,3%

12,1%

100,0%

dssysteem

2009 (voorlopige rekeningen)

(

69,4%

17,2%

13,4%

100,0%

KCE Report

2010 (budget) (bu

64,8% 6

19,4% 1

15,8% 2

100,0% 10

t 196

2011 dget)

61,4%

8,4%

20,2%

00,0%

KCE Report 196

Figuur 2 – Indoverdrachten,

Bron: ADSEI (BeNoot: de Gini-cobevolking. Wannde coëfficiënt 0. inkomen), is de verdeling van de

6

dicator van billijin België en gew

elgië) oëfficiënt is een coëeer er perfecte geliWanneer er perfecoëfficiënt 1. Eeninkomens.

jkheid: Gini-coëfwesten

ëfficiënt voor ongelijkheid is (iedereen ecte ongelijkheid isn lagere coëfficiënt

Belgian

fficiënt na belas

lijkheid van inkomeheeft hetzelfde ink

s (één persoon heet wijst op een mee

n Health System

sting en

en in een komen) is eft al het er gelijke

2GDvgglaHb

TMbzfibSuevvtomgte

Performance

2.9 ConclusieGezondheidstoesDe vier indicatorenvan de levensvergemiddelde, terwijgeleefde jaren vaange termijn) en Het percentage vbeschouwen, is ho

ToegankelijkheidMet betrekking tobezorgdheid (hogzekere mate uitginanciële redenebestaan van socSolidariteitsfonds)uiteenlopende resenkele regionale vaccinatiegraad vaccinatiegraad oegankelijkheid ismet betrekking togeleverd om gege weinig informati

es over zwakkestand n laten een positierwachting is ietsjl de gezonde lev

anaf een bepaaldde zuigelingenstevan mensen die oger dan het EU-1

d t de financiële toe mate van persgestelde contacten), ondanks eenciale vangnetten . De toegankelijkh

sultaten. De cijfersverschillen) zijntegen griep bbij kinderen iss een beschikbaot de behoeften. evens over de aaie over de behoeft

e en sterke pun

eve evolutie in des lager in vergelvensverwachting de leeftijd zonder erfte op een midd

hun gezondheid15 gemiddelde.

oegankelijkheid, issoonlijke uitgavenen met de gezn universele ziek

(maximumfactuheid van preventis voor kankerscre

n relatief laag, tbij ouderen ms goed. Een

aar aanbod aan Er werden aanz

anbodzijde te verkften.

nten

e tijd zien. Het resijking met het E(dit zijn de resteractiviteitbeperkin

delmatige plaats sd als (minstens)

s er sprake van n van de patiënt zondheidsdienstenkteverzekering enur, Omnio, Bijzoeve maatregelen eening (met sociaterwijl de cijfers iddelmatig zijn.

ander aspect gezondheidsperszienlijke inspannkrijgen, maar er is

37

ultaat EU-15 rende ng op staan. goed

enige en in

n om n het onder toont

ale en over

De van

oneel ingen s nog

38

Zorgkwaliteit De kwaliteit wdoeltreffendheidop het vlak vanop het vlak vatweede hoogstregionale verscopnames in pszijn nodig om dWat de aangteleurstellend tborstkankerscrerichtlijnen (ankeizersneden mveiligheid van wat betreft de MRSA en ziekevan postoperatanticholinergiscdoorligwonden de zorg zijn de bij dezelfde multidisciplinairvan het globaapsychiatrische beoordeeld. Egezondheidszosterven in de verzameld over

werd onderzochd liet een gemeng

n overlevingskansean de geestelijkete aantal zelfdodchillen), en een hosychiatrische zieke doeltreffendheidepastheid van

te noemen, met eening buiten dntibiotica, diabemet een grote varzorg zijn de resublootstelling aan

enhuismortaliteit ntieve sepsis en hche nevenwerkinneemt echter toeresultaten gemenarts, gemidde

re consultaties vol medisch dossieziekenhuizen. PaEr werd een rg vastgesteld, eigen woonplaa

r dit onderwerp.

t door middel gd beeld zien waaen bij kanker. Er i

e gezondheidszordingen in Europaoog en toenemendkenhuizen. Meer d in geestelijke gezorg betreft zijnhoge en nog sti

de doelgroepen, etespatiënten), riabiliteit tussen dultaten bemoedig

medische stralinna heupfractuur, ehet voorschrijvenngen aan oudere. Voor de continngd, met een goelde en stijgen

oor kankergevallenr en een hoog pe

atiëntgerichtheid khoge tevrede

evenals een toeats. Er moeten

Belgian

van 5 dimensarbij goed werd gis echter wel bezorg, aangezien Bea heeft (met zeed percentage gedindicatoren en ge

ezondheid te bescn de resultaten ijgende percentag

matige opvolgistijgende perc

de ziekenhuizen. end, met dalende

ng, de ziekenhuisen een stabiele in van antidepressren. De incidennuïteit en coördinede relationele connde percentagen, maar een lage ercentage heropnkon slechts deelsenheidsgraad ovenemende trendmeer gegevens

n Health System

ies. De gescoord orgdheid elgië het er grote dwongen egevens chrijven.

eerder ges van ing van centages Voor de e trends sbacterie ncidentie siva met ntie van atie van ntinuïteit s voor dekking

names in worden ver de om te worden

EDreginDreom

DDogdg

BDmgplebckoowefimoaggw

Performance

Efficiëntie De efficiëntie vanesultaten met

geneesmiddelen, ngrepen en een De positieve boodesultaten van so

ongeschiktheid, enmammogrammen

Duurzaamheid De duurzaamheid opmerkelijke resugroep van ouder dringend nood aagekoppeld aan ge

Billijkheid De dimensie vanmanieren. Ten gezondheidsdeterper socio-economevensstijl werden besproken. Ook chronische patiënkonden de meestonderzocht per sonvolledig wat betwerd ook benadeeen globaal niveainanciering van dminder billijkheid. ongelijkheid in daangetoond datgezondheidstoestagrote ongelijkheidworden geïnterpre

n het gezondheideen stijging inhet gebruik vandaling van de vedschap moet echmmige indicatoren dus verspilling vbuiten de doelgro

van het Belgischltaten met betrekwordende huisa

an gegevens ovegevens over de e

n billijkheid werdeerste werde

minanten en gebrmische status. Vo

sterke ongelijkhevoor kankerscr

ten werden ongee ziekenhuisgebasociale status, etreft ongelijkhedenrd via twee conteu onder de aanda

de gezondheidszoDe Gini- coëffici

de globale verdet de coëfficiënand. In België lig

d), maar hij stijgteteerd als een min

dssysteem toont gn het voorschrin het dagziekenherblijfsduur voor eter worden getem

en die wijzen op van middelen, zoaoep.

he gezondheidssykking tot de vervaartsen. Zoals hieer de behoefte avolutie van het aa

d benaderd open ongelijkhederuik van gezondheoor de indicatoreeden vastgesteld,reening en vooelijkheden waargeaseerde indicatoren de conclusien in zorgverleningextuele indicatoreacht brengen. Deorg daalt, hetgeenënt stemt overee

eling van inkoment samenhangt

gt de coëfficiënt rt in de loop van nder gelijke verdel

KCE Report

gemiddelde tot gijven van goedhuis voor chirurgeen normale bevamperd door de sleen zekere mate

als de bovengenoe

ysteem vertoont eanging van de huerboven vermeld aan verpleegkundanbod.

twee complemeen in gezondeidszorg geanalysn van gezondhe die hierboven we

or de opvolging enomen. In dit raen echter niet wo

e is nog groteng en kwaliteit. Billijen die dit probleee progressiviteit van een evolutie is

en met het niveauens in België.

met de glrelatief laag (dus

de tijd, hetgeenling van de inkom

t 196

goede dkope gische alling. echte e van emde

nkele uidige is er

digen,

ntaire dheid, seerd id en erden

van apport orden deels kheid

em op an de naar u van Er is obale geen

n kan msten.

KCE Report 196

GezondheidspTenslotte werdconventionele gaantal indicatoleefomgeving beschikbaarheiversnipperd gezondheids/lecijfer, maar evastgesteld. Wevrij hoge, en tabaksconsumpDe consumptiebehoeften, maaook belangrijkeouderen. Belginternationale indexen hebbegezondheidsproondernemingenzijn moeilijk te i

Meer gegevens

Voor elk van debeschikbaar opS1. Het vat dtechnische inforesultaten, waainterpretatie, en

6

promotie gezondheidsprogezondheids- en

oren met betrekken individuele vd van geschikte

beeld wovensstijlindicatoreer worden wel e wijzen op het p

stijgende trendptie daalt, maar me van fruit en gar gaat erop voore sociale en regiongië bevindt zich

Tobacco Controen tot doel de omotie in verscn) te meten, maarnterpreteren zond

s op onze website

e hierboven bescp de KCE-websitede rationale samormatie over de

aronder subgroepan alle bibliografisc

motie vooral benlevensstijlindicato

king tot het gezovaardigheden. Gindicatoren en g

orden getoonen wijzen op ee

grote regionarobleem van obes

d met grote vemet grote sociale roenten is veel

ruit. Het gebrek aanale verschillen, e

h op een middol Scale Policie

kracht van hchillende settingsr zijn alleen bescder een grondige

e!

hreven indicatoree in het documentmen voor het ke gegevensbronnanalyses en benc

che referenties.

Belgian

naderd aan de haoren, aangevuld ondheidsbeleid, g

Gezien de erg bgegevens kon allend. De en middelmatig nle/sociale ongelsitas/overgewicht

erschillen laat zen regionale verlager dan de daan sociale steunen baart vooral zodelmatig niveau es. Sommige coet lokale beleids (scholen, gemhikbaar in Vlaandanalyse.

en is een technisct met als titel Supiezen van de in

nen en berekenichmarking, beperk

n Health System

and van met een gezonde beperkte een een meeste

nationaal ijkheden dat een

ien. De rschillen. agelijkse vertoont orgen bij

op de omplexe inzake

meenten, deren en

che fiche pplement ndicator, ng, alle

kingen in

3

3HhvbdvnneDmApfugdabobieinpv

Performance

3 HET 201TOEGEVBEPERK

3.1 Wat is heHet uiteindelijke dhoog performant verbeteren van debetekent dat de dienen om, indienverbeteren. Het mnieuwe gezondheniveau. De formueen belangrijke stDit zou immers tomaken tussen de vAan de hand van performantie van ungeren als agezondheidssysteduurzaamheid en al bewust van dbijkomende analyondernomen. In beleidsmakers, eneder geval moet ndicatoren wordeprioriteiten gesteldverdere studies.

12 HSPA-RVOEGDE WKINGEN et nut van dit HSdoel van het gezsysteem aan te e gezondheid vaninformatie die in

n nodig, de performoet de beleidsmaeidsgerelateerde dulering van gezontap in het proces

oelaten om in de vooropgestelde e74 indicatoren gehet Belgische

alarmsignalen wem in termen vabillijkheid. In som

e problemen en yses om te wandere gevallen

n zal dus een verde uitgebreide e

en voorgesteld d kunnen worde

RAPPORT: WAARDE E

SPA-rapport?zondheidssysteem

bieden dat een n de inwoners op dit rapport wordmantie van het gakers ook helpen doelstellingen op ndheids(gerelatee

s van de beoordevolgende evaluat

en de bereikte reseeft dit rapport eegezondheidssyst

wat betreft de n toegankelijkhei

mmige gevallen zhebben ze al

weten welke acn zijn deze signrdere diepgaandeen gestructureerdervoor zorgen

en betreffende de

NUT, EN

m is om in Belgïebijdrage levert to

p zijn grondgebieddt weergegeven ezondheidssysteebij het formulerenfederaal of regi

erde) doelstellingeling van performties een vergelijkisultaten. en breed beeld vateem. De indica

toestand van d, kwaliteit, effici

zijn beleidsmakersopdracht gegeveties moeten wonalen nieuw vooe analyse nodig zde manier waarodat er gemakkee nodige acties

39

e een ot het d. Dit moet

em te n van onaal en is antie. ing te

an de atoren

het ëntie, s zich en tot orden or de ijn. In op de elijker en/of

40

3.2 Wat is vergele

Het eerste rappde performanticonclusie ervanuit te voeren, nadministraties. de performantiepunten kunnen

Verbeterde bes

Er was een agegevens: gegbij kanker, voobeschikbaarheiweggewerkt.

Een uitgebreidsysteem Zoals uiteengezuitgebreid voorwerden behandop het vlak zorgcontinuïteittermijn, patiënindicatoren vansystematisch gde gegevens be

de toegevoegdeken met het voport, met als ondeie" was voornamn was dat het in Bniet in het minst dDit tweede rappo

e van het Belgiscworden geïdentif

schikbaarheid va

aanzienlijke verbevens zijn nu beor kindersterfte, d van nationale

dere set indicat

zet in de operatior die domeinen odeld in het vorigevan geestelijke

t, en in minderetgerichtheid en

n billijkheid werdegeanalyseerd volgeschikbaar waren

de waarde vanorige? ertitel "eerste stapmelijk een pilootselgië haalbaar wa

dankzij de goede ort biedt de eerstche gezondheidssficeerd.

an gegevens

betering in de bschikbaar voor hen de vertraging

e overlijdensgege

toren voor een

onele doelstellingeof dimensies die e rapport. Indicato

gezondheidszore mate, palliatievgezondheidsprom

en toegevoegd, egens socio-econon).

Belgian

dit rapport

ppen naar het mestudie. De voornas om dergelijke esamenwerking tue volledige evalu

systeem. Volgend

beschikbaarheid et overlevingsperg met betrekkingevens werd grot

globaler beeld v

en werd de indicaminder of helem

oren werden toegrg, zorg voor ove zorg, zorg omotie. Twee conen de indicatoren omische status (w

n Health System

eten van naamste evaluatie ussen de uatie van e sterke

van de rcentage g tot de tendeels

van het

atorenset maal niet gevoegd ouderen, p lange

ntextuele werden

wanneer

VmDvsb"vwginin

SDwloe

GEggZdnHkd

VTed

Performance

Vereenvoudigingmakkelijker begriDe structuur vanverduidelijkt. Alleeset. Indicatoren wbesproken in deindicatoren in o

vergemakkelijkt hewijzigingen in de gegevens. Het endicatoren werd vnterpretatie ervan

Systematisatie inDe analyse van werden altijd voorgoop van de tieconomische kenm

Gebruik van al beEr werd maximagegevens (bijv. in gezondheidsenquêZiekenhuisgegevedatabanken van nosocomiale infecHet gebruik van kosten met zich mde analyse van ten

Verbetering van dTenslotte werden en gemakkelijk eede interpretatie erv

g van de structuip n de indicatorenen gemeten indicawaarvoor we geee sectie "gegevontwikkeling" (bet begrip van de beschikbaarheid

eerdere onderscverwijderd aange

n.

n gegevensanalygegevens werd

gesteld door middijd, per gewestmerken en interna

eschikbare informaal gebruik gemadministratieve dêtes (Health Int

ens (MZG), de het RIZIV (do

cties, vaccinatie-eroutineus beschi

meebrengen voor ndensen in de tijd

de communicatiesynoptische tabe

en overzicht te kuvan; dit laat ook v

uur van de indi

nset werd op veatoren werden been gegevens koens zijn binneneschreven in Sindicatorenset, vvan gegevens e

heid tussen primzien dit geen rol

yse gesystematiseer

del van dezelfde st, subgroepanalyationale benchma

matie maakt van routatabanken of in n

terview Survey –EPS (permane

oc N, Pharmaneenquêtes, het Bekbare gegevens gegevensverzam

d.

e van resultatenllen met kleurcod

unnen krijgen vanvergelijking van ind

KCE Report

catorenset voor

erschillende manehouden in de hu

onden vinden, wenkort beschikbaaSupplement S1)vestigt de aandacen wijst op lacunmaire en secunbleek te spelen b

rd, en de indicastructuur: evolutie yses volgens srking.

tinematig verzamnationale registers– HIS), de Minente steekproef)et), het registerelgisch Kankerreg

die geen bijkommeling, vergemak

des ontwikkeld omn de resultaten endicatoren toe.

t 196

r een

nieren uidige erden

ar" of . Dit

cht op nes in ndaire bij de

atoren in de

socio-

melde s): de imale

), de r van gister.

mende kelijkt

m snel n van

KCE Report 196

3.3 Wat zij3.3.1 Perfor

anderJammer genoeggedefinieerd inwaarde van dede doelstelling.WGO-gedefinievan andere lanhet gemiddeldgepositioneerd geen antwoordSommige resuvergeleken metgeconfronteerdinterpreteren vperformantie nmethodologischzinvolle vergelij

Verschillende inEuropese landgezondheidszotweejaarlijks rasamenwerking ECHI-indicatoreHealth ConsumConsumer Pow

6

n de beperkingrmantie tegenovre Europese landg werden zeer we

n België. Waar d indicator beoord. Anderzijds was eerde) streefdoelenden. Waar mogee van de EU-1in vergelijking to

d op de vraag "Zultaten kunnen int andere landen, met de lanvan de resultatnog ter discusshe en contextuelkingen te maken.

nternationale orgaden voor indicatrg: de WGO mepport “Health at avan de OESO e

en, ondersteund mer Index13 van

werhouse.

gen van dit rapver welk streefdoden lost het probeinig specifieke endergelijke streefddeeld door vergeli

het oordeel geben, of door vergeelijk werden de ind15-landen. Hierdoot de naaste buZijn onze resultatnderdaad goed zterwijl ze dat niet

nddoelstellingen. ten van internatsie8, en zijn ere variaties, waar

anisaties vergelijktoren van gezonet het “World Hea glance Europe”1

en de Europese Udoor de Europede private Zwe

Belgian

port? oel? Benchmarkbleem niet op n meetbare doelstoelen bestaan, wijking met de waabaseerd op exterelijking met de redicatoren vergeleoor kan België urlanden, maar dten nu goed of szijn wanneer ze t zijn wanneer ze

Bovendien stationale vergelijkir veel valkuilenrdoor het moeilij

ken België al metndheidstoestand ealth Report 2000,11 dat voortvloeiUnie, de websiteese Unie12 en d

eedse organisatie

n Health System

king met

tellingen werd de arde van ne (bijv.

esultaten eken met

worden dit biedt slecht?". worden

e worden aat het ing van n, zoals k is om

t andere en van

00”9, het t uit een van de de Euro e Health

3Sdamzbgvin

3

Dinn1

2

Performance

3.3.2 BeslissinSommige gegevedateren al van 2administratieve gemoesten we vaak zou het voor belebasis van dergeligeleverd door hevolgende HSPA-ran 2013.

3.3.3 Een uitginstrume

De meeste problendicatoren, het genaar een betere in

. Globale gezohoog actieveHet vorige rapgezondheidsto(PYLL – Potestudie van vroook de vermgezondheidsz

2. Financiële toEen noodzakedomein van fiin ambulahospitalisatievhospitalisatievprivate verzek

ngen nemen op ns zijn duidelijk 2 jaar geleden. egevens of registsteunen op gege

eidsmakers moeiijke verouderde t HIS worden zeapport aangezien

gebreider beeld, ent emen hebben te ebrek aan (recen

ndicator of naar mondheidstoestanermogen: vermijdpport omvatte vrooestand, uitgedruential years of lifeoegtijdige sterfte mijdbare sterfte,zorgdiensten kunnoegankelijkheid: elijke voorwaardenanciële toegankeante supplemverzekeringen (heverzekering, en wkeringen, en aan w

basis van verouverouderd, en zeDit is inherent

ters. Voor de inteevens uit 2005! In lijk zijn om besliinformatie. Wat

eer recente gegeeen nieuwe HIS

maar nog steed

maken met een te) gegevens, deeer details.

nd: een indicatordbare mortaliteit egtijdig overlijdenukt als mogelijk e lost) vóór de leper categorie va zou een inter

nen toevoegen. nood aan een ui

e om het beleid aaelijkheid is een vementen evenet percentage perwat specifiek wowelke kost).

uderde gegevenselfs de meest reaan het gebruik

ernationale vergelverschillende gevssingen te nemebetreft de indica

evens verwacht izal worden uitgev

ds hiaten in het

gebrek aan gesce nood om uit te k

r toevoegen met

n als een indicatorverloren levens

eeftijd van 70 jaan oorzaak en moressante kijk op

tgebreider beeldan te sturen binneerbeterde transparals in p

rsonen met een pordt gedekt door

41

s? cente

k van lijking vallen en op atoren n het voerd

chikte kijken

t een

r voor sjaren ar. De ogelijk p de

d en het rantie rivate rivate deze

42

3. FinanciëleEen meer vis rekening(officiële reverzekeringde socio-einkomen eberekenen

4. PersoneelEr zijn nu gegevens oplanning vworden ovhet aanbodaanbod zijwerden nogedefinieerafhankelijk waarop heerstelijns-

5. GeestelijkDe huidigesector nieevenwichtigontwikkelinproject”'). Hmoeten womoeten zijnop de nodvoorgesteldpatiënten ambulante uitgaven voworden ge

e toegankelijkheivolledige manier og te houden metemgelden, supplegen en tussenkomeconomische staen alle uitgaven z. stellingen betere gegevens

over de behoeftenvan de personeerwogen binnen d en met de behojn de laatste jarog geen indicatord. Anderzijds is

van de mediscet gezondheidss- versus ziekenhue gezondheidszo

e indicatoren weert. De meest recg geïntegreerd zo

ng van "zorgneHet hoofddoel is dorden aangeboden wanneer ambulden van de patd om deze evolmet case manazorg en zorg in d

oor geestelijke gemeten omwille va

d en billijkheid om de billijkheid vt de verdeling v

ementen, netto temst van de maximatus. Individuele zijn nodig om ee

s beschikbaar ovn ontbreken nog seelsbezetting in een globaal beleoeften van de paren ongetwijfeld oren voor de bs het benodigdehe behoeften, msysteem georganiszorg. org rspiegelen de reccente hervormingorgmodel te beko

etwerken" (het dat, waar mogelijkn, waarbij ziekenante zorg geen gtiënt. Enkele nieuties te monitore

agement; het pede thuisomgevingezondheidszorg). an de beperkingen

Belgian

van het systeem tan persoonlijke u

erugbetalingen domumfactuur) in fun

patiëntengegeveen dergelijke verd

ver het aanbod, msteeds. Een doelt

gezondheidszorid rekening houd

atiënt. Gegevens veel verbeterd.

behoeften in dit e personeel nie

maar ook van deniseerd is, bijvo

cente veranderinggsinspanningen oomen, richten ziczogenoemde “A

k, gemeenschapsdhuisdiensten bescoed antwoord kanuwe indicatoren en (bijv. het perercentage uitgave

vergeleken met dMaar ze konden

n in de huidige geg

n Health System

te meten uitgaven oor privé nctie van ns over

deling te

maar de treffende rg moet end met over het Maar er

rapport t alleen

e manier oorbeeld

en in de om een

ch op de Art. 107 diensten chikbaar n bieden

werden rcentage en voor de totale nog niet gevens.

6

7

8

Performance

6. ZorgcontinuiMet de nieuwbinnenkort beresultaten vanvoor type momenteel gede volgende andere relevazorgcoördinatgezondheid va

7. PatiëntgerichPatiëntgerichtgegevens, ogezondheidssbijzondere nopatiënt te stimde volgende bevatten over(huisartsen ointernationalepatiënten mevolgende upd

8. Zorg op langom de kwalibeoordelen, zoudere patiënvallen, de inpolymedicatiemarkeert het zal echter spindicatoren. Dnoden te beooeen beroep do

iïteit en -coördinwe trajecten in ameschikbaar zijn, mn de nieuwe traje2-diabetes of eëvalueerd. Die e

editie van dit rante indicatoren, tie, of de bean patiënten op ehtheid: veel intheid is intrinsiekmdat het same

systeem om een oden van de patmuleren. Om ons

golf van de Her de ervaring van f specialisten), g vergelijking te

et ambulante zorate van dit rappor

ge termijn: er weiteit van de zorzoals de prevalennten die fysiek gncidentie van d

e. Die indicatoren huidige gebrek aoedig gegevens

De BelRAI is een ordelen van oudeoen op thuiszorg.

atie mbulante zorg zuaar er blijven tochecten in ambulanchronische nier

elementen zullen rapport. Er ontb

zoals de ervarineschikbaarheid veender welk ogenbnitiatieven maark moeilijk te menhangt met hetsuccesvol antwo

tiënt of om de bbegrip in dat domalth Interview Sude patiënt met am

gebaseerd op de vergemakkelijken

rg zal dus wordert.

erden verschillendg op lange termntie van ondervogefixeerd worden

doorligwonden enkonden nog niet w

aan gegevens in dverstrekken over instrument dat w

eren in residentiël

KCE Report

ullen nieuwe gegeh nog veel lacunete zorg (zorgtrajerinsufficiëntie woworden opgenomreken gegevens ng van patiëntenvan informatie blik. r weinig gegeten met kwantitat vermogen vanoord te bieden obetrokkenheid vamein te verbetereurvey een set vrmbulante zorgdieOESO-vragenlijs

n.14 De ervaringen opgenomen

de indicatoren gekmijn voor oudereeding, het percen, de prevalentien het probleem worden gemeten dit domein. De Benkele geselecte

werd ontwikkeld ole voorzieningen o

t 196

evens es. De ecten) orden

men in over

n met over

evens. atieve n het op de an de n, zal ragen nsten st om g van in de

kozen en te ntage e van

van en dit elRAI eerde

om de of die

KCE Report 196

9. Palliatievenationale gebaseerd populatie pniet de hepalliatieve beschikbaagegevens noch over andere zovertegenwo

10. Gezondhe(health literEuropese begrip datgezondheidindividuele interagerenbeheersente maken. 2013 strateresultaten

11. Efficiëntierapport. Hvoldoende rapport wevaak metinoutputs onderzoeks

12. Ongelijkheomdat in economiscziekteverzeeerder onn

6

e zorg: veel lokagegevens. De op de populatiepatiënten die thule populatie van zorg omvat, hetg

arheid van gegevop nationaal nivde kwaliteit van

orgdomeinen is poordigd in databa

eidspromotie: gracy) ontbreken, tlanden. Gezond

t als een essedsmanagement.

vaardigheden n met de gezond. Dit geeft individuHet werd gedefin

egie van de Europuit de EU Health L

e moet meer aHet is duidelijk kan worden beoo

erden geselecteengen voor efficiënidentificeren.7,15 sgebied vormen. eden konden nietsommige gegeve

che gegevens besekering is de infonauwkeurig en ben

ale onderzoeken enkele indicator van terminale kis palliatieve zorgpatiënten die in

geen wijst op eevens. Bovendien veau gepubliceerde palliatieve zorpalliatieve zorg wnken van internat

gegevens over terwijl ze wel al bdheidsalfabetismeentieel hulpmidde

Het kan wordedie noodzakelijk

dheid van het induen de gelegenhenieerd als een actpese Unie, en vooLiteracy Survey naandacht krijge

dat efficiëntie iordeeld met de enrd. In de interna

ntie voorgesteld dDit kan ze

t worden onderzoensbronnen (RHschikbaar waren.

ormatie over de snaderend.

Belgian

in België, maarren in dit rappankerpatiënten, og krijgen. Hierdooaanmerking kom

n duidelijke lacunwerden tot dusv

rd over toegankerg. In vergelijkingweinig of helemtionale organisatie

gezondheidsalfabeschikbaar zijn ine is een relatieel wordt beschoen gedefinieerd k zijn om factodividu te begrijpeeid om gezonderetieprioriteit voor d

or sommige landeu beschikbaar. n in het toekon gezondheidszo

nkele indicatoren dationale literatuur die uitdrukkelijk ineker een inte

ocht voor alle indiM – MZG) geen In de gegevens

socio-economisch

n Health System

r weinig port zijn of op de or wordt

men voor ne in de ver geen elijkheid, g met de

maal niet es. abetisme n andere f nieuw

ouwd in als de

oren die en en te e keuzes de 2008-n zijn de

omstige org niet die in dit worden

nputs en eressant

icatoren, n socio-

s van de e status

4DdeinggwDragelaoBogoedvte(olaavoSred

f

Performance

4 ALGEMDit rapport geeft dde performantie veen eerdere haandicatoren met ngeven van de pegewezen op enkworden gegenereeDit rapport is eeapport, doordat

geactualiseerd menkele gevallen acunes in basisgeoorzaakspecifiekeBelgië is niet heondertekenen ingezondheidssysteom de performanevalueren. Verschde performantie vvoor dit rapport, vekortkomingen diook vastgesteld iage beschikbaaractualiseren van avan resultaten oponderzocht. Samen met de Eechten van de p

deze verbintenis e

Richtlijn 2011

maart 2011 grensoversch2011

ENE CONCde resultaten weean het Belgisch galbaarheidsstudieumerieke waarderformantie van h

kele richtingen verd voor verdere oen aanzienlijke v

het uitgebreideret meer relevanhet meten van egevens ingevuld mortaliteitsperce

et eerste land dn 2008 van men hebben de l

ntie van het gezhillende buurlandevan het gezondhevooral het Nederlae het succesvol mn de eerdere Ne

rheid van geactuadministratieve g

p een website is

Europese Richtlijatiënt bij grensov

een gemeenschap

1/24/EU van het Ebetreffende de toe

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CLUSIE er van een eerstegezondheidssystee. Aan de handen tracht dit rapphet gezondheidssyvoor beleidsactieopvolging of ondeerbetering verger is en doordat te indicatoren. Bevolutie toe. Oo

d sinds de vorige ntages of kankero

dat deze uitdaginhet Verdraglidstaten zich er fzondheidssysteemen met jaren ervaeidssysteem, fungandse Performantmeten van performderlandse performualiseerde gegev

gegevens en het één van de pis

jn betreffende dverschrijdende geppelijke bezorgdhe

uropese Parlementepassing van de reeidszorg, Official J

e globale evaluatieeem, voortbouwend van vierenzevport een totaalbeeysteem, waarbij ws en waarbij vr

erzoek. leken met het vde vorige set

Bovendien laat hok werden belaneditie, bijvoorbee

overleving. ng aangaat. Mevan Tallinn informeel toe verbo

m te monitoren earing in het metengeerden als voortierapport. Een vamantie in de weg mantierapporten) vens. Het regeldynamisch public

stes die moet wo

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t en van de Raad echten van patiëntJournal L 88/45, 4

43

e van nd op ventig eld te wordt ragen

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eld de

et het nzake onden en te n van beeld an de staat is de matig ceren orden

an de wordt tatenf.

van 9 ten bij 4 april

44

Zodra de Richoktober 2013, zeen andere lveiligheids- en grensoverschrijrapport niet abeoordeling vaneen eerste stakwaliteitsvolle, Belgische als b

htlijn wordt geïmzullen de lidstatelidstaat relevant

kwaliteitsnormendende gezondhealleen de basisn de performantieap naar de veratoegankelijke en

uitenlandse patië

mplementeerd alsen ervoor moetene informatie kun om een welovidszorg te makens van een toee, maar kan het ooantwoordelijkheid n efficiënte gezonten te garandere

Belgian

nationale wetge zorgen dat patië

unnen krijgen overwogen beslissin. In deze contexekomstige systemok worden bescho

van België om ondheidszorg vooen.

n Health System

eving in ënten uit over de ing voor t legt dit

matische ouwd als

veilige, or zowel

Performance

KCE Reportt 196

KCE Report 196

SCIE

6

NTIFIC RREPORT

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n Health System

111TInthTopspbrefuhadtoecsfosaTthfi

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1 BACKG1.1 Context 1.1.1 InternatiThe Tallinn Chartn June 2008, thehe European regiTallinn Charter onobjective of the Tpeople’s health byseven commitmeperformance: “(thebe accountable foesults”. The ratiounctioning health health systems neacknowledged thadisease preventiono address health extensively develocommitments in tsolidarity, equity ostering investmesystems more resand ensure that heThe last commitmhe Tallinn Confeinancial crisis.

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distributing the and aim at efficinterim report omember statesparallel, the Wpolicy, Health 2policy framewopast decadesdecreasing fertaccelerating tincreasing accefour policy prior(1) Investing inpeople, demonbenefits of heal(2) Tackling Euthe burden of activity, HIV/AID(3) Strengtheniand preparedne(4) Creating a h1.1.2 Nation2010, publicatiAssessment Two years afteron Health SysJune 2010.1 Thperformance oprudence of thesystem (a muchof this prudenc

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ian performancormance report mnspired by the Dgian health systemframework is comresent a hierarchyrminants of healthalth promotion, prife care. Each ons: their quality, aefined as an over

nistrations of theakeholders were d two main sectiod based upon inteecond, a core sete measured. Baseolution over time

port, the commisbe continued, aith System. The ators with indicatoerm care and endfirst report. In addtors to assess thefrom the evaluathealth system. Lateredness and eqd new indicators

ce framework amakes use of a Dutch and Canadm. mposed of threey. The three tiersh and the health sreventive care, cuf these domains accessibility, efficrarching dimensio

KCE Report

e federal and regconsulted extens

ons. First, the Beernational experiet of 55 indicators

ed on these indicaand proposed ac

sioners of the Beming at a syste

commissioners ors in specific domd-of-life care, as tdition, the regions performance of hion of the healt

astly, three dimenquity) were considhad to be propos

and definitions conceptual framedian frameworks

e interconnected s include health system itself, consurative care, long

can be evaluateciency or sustainaon.

t 196

gional sively. elgian ences s was ators, ctions

elgian matic

also mains those s and health hcare

nsions dered sed to

ework ,20, 21

tiers, tatus,

sisting g-term ed on ability.

KCE Report 196

Figure 3 – The

6

e conceptual frammework to evalua

Belgian

ate the performa

n Health System

nce of the Belgia

Performance

an health systemm

47

48

Definitions useThese definition(2006)4, VlayeCommittee (200

Health statusThis tier addresBelgium?”, covdisease, disordfunctions (altera[activity limitatibeing (physical

Non-medical dThis tier encomon if, when anbehaviour/lifestand working c(e.g. air, water,waste disposal)

Health systemWithin the politsystem is the eand resources system encompactivities to inflthe social, envir

Domains of theThe health syscurative care, lgoes far beyond• Preventive

disease (pi.e. taking episode) o

ed in the concepns are based on en (2006)6, Au01)22 and the Otta

sses the questionvering several dimder, injury, traumations to body, stion] and particip, mental, and soc

determinants of hmpasses the deternd how we use tyle (e.g. smokingonditions, person, food and soil qu).

tical and institutio

ensemble of all pumandated to im

passes both persuence the policieronmental and ec

e health system stem has been glong-term care ad the boundaries

care: healthcareprimary prevention

medication to por to detect hea

ptual framework the following sou

ustralian Nationaawa Charter23.

“How healthy is mensions, such a

ma or other healttructure or functioation [restrictionsial well-being), an

health rminants that havcare. These dete

g, physical activitnal resources, anuality resulting fro

onal framework oublic and private prove, maintain osonal and populaes and actions of conomic determina

and health promgrouped into 4 dond end-of-life carof the health syste aiming to prevn, i.e. vaccinationprevent myocardialth problems bef

Belgian

rces: WHO (2008al Health Perfo

the population reas health (prevah-related states),on [impairment], as in participationnd death.

e an effect on heerminants includety), genetic factornd environmental

om chemical pollu

of each country, aorganizations, insor restore healthation services as other sectors to

ants of health.

motion omains: preventivre. The health prem.

vent the occurrenn; secondary preal infarction aftefore they occur

n Health System

8)3, Arah ormance

siding in lence of , human activities

n]), well-

ealth and e health rs, living l factors tion and

a health stitutions . Health well as

address

ve care, romotion

nce of a evention, r a first (regular

•

•

•

•

g

Performance

testing, screeproblems earl

Curative carepromote recov

Long-term caorganisation aare limited inover an extecomponents operiod, and sprogram acromain populatilong-term careLong-term carhome nursing

End-of-life caclear that thecare includes elements of ca

Health promoenabling peodeterminants,

Home nursin

daily living (Aprovided by example woucare (mainly In the residepersonnes âgvoor bejaardefacilities to opersons whopermanent hrepos et de costs and cohealth insura

ening for diseasesy before they mane: healthcare thvery. are: The term “loand delivery of s their ability to fu

ended period of of this definition: fsecond, the careoss service compons: first, long-tee for persons withre for older perso care, homes for tre: the care of a p

e person is in a ppalliative care bu

are relevant to theotion has been deople to increase and thereby imp

ng care is availableADL) and/or cognitiv

home nurses incund dressing and ahygienic care in pat

ential sector, homgées”, MRPA /”wooen” ROB) provide nolder persons with o are strongly deospital treatment arsoins” MRS/”rust-

osts of care in residnce, board and lodg

s, and other servnifest symptoms).at tends to ove

ong-term care seservices and assiunction independ

time. There arefirst, the care conte is usually proviponents.24 This rrm care for older

h mental disorder.ons include the folthe elderly and nuperson from the mprogressive state ut also broader soe end of the life. efined by the WHe control over rove their health"

e for persons with lve limitations, irrespcludes technical nuadministering medictients with ADL dysf

mes for the elderlyonzorgcentra”, prevnursing and personmainly low to mo

ependent on care re admitted to nursen verzorgingstehudential care facilitieging costs are to be

KCE Report

ices that detect h. ercome disease,

ervices” refers tostance to peopleently on a daily e two complemetinues over a longided as an integreport focuses on

persons, and se llowing major servursing homes.g moment it has be

of decline. End-ocial, legal and sp

HO as “the procetheir health an. The health prom

ow to severe activitpective of their ageursing interventioncation) and basic nfunction).

y (“maison de reposviously called “rustonal care as well asoderate limitations.

but who do not sing homes (“maisuis” RVT). While mes are covered by e paid by the residen

t 196

health

and

o the e who basis

entary g time grated n two cond,

vices:

come of-life

piritual

ess of d its

motion

ties of . Care s (for ursing

s pour oorden living Older need

son de medical

public nt.

KCE Report 196

goes far bemeans of policy thathousing, foThe other settings, inindividuals

Health systemThis is a muchthan healthcardeterminants, picture of popul

Dimensions ofHealth system health system dquality, efficienequity. Accessibility reached”. It recfinancial, culturthat health servQuality is definand populationsconsistent withinto five sub-dipatient-centered• Effectivene

outcomes, services to

• It is therefoas “the degneeds, giveThe link bebetween ou

6

eyond the boundahealth promotiont addresses the ood security, emp

axes defined inncrease the role o, reorientation of t

performance h broader concepre system perfohealthcare and lation health.

f Health System performance, wh

domain, is groupency and sustaina

is defined as “thcovers physical (ral, psychologicavices are a priori aned as “the degres increase the like

h current professimensions, includidness and continu

ess is defined given the correc

o all who could benore closely relatedgree to which proen the current besetween effectivenutcomes and proc

aries of the health n occur through d

prerequisites of ployment, and qu the Ottawa Cha

of the community,the health service

ptual approach tormance by explcontextual inform

Performance hich is presenteded into four main ability, and the o

he ease with wh(geographical disl dimensions of

available. ee to which healtelihood of desiredional knowledge”ing effectiveness,uity. as “the degree ct provision of evnefit but not thosed to appropriateneovided healthcarest evidence and thness and approprcesses.

Belgian

sector: indeed ondeveloping healthhealth such as

uality working coarter are: create increase the skil

es.23

o measuring perfoicitly using non-

mation to give a

d and analysed fdimensions: acce

overarching dimen

hich health servistribution), organizaccess. Access

th services for indhealth outcomes. It is further su, appropriateness

of achieving dvidence-based hee who would not bess, which can be

is relevant to thehe provider’s experiateness reflects

n Health System

ne of the hy public

income, nditions. healthy

ls of the

ormance -medical clearer

for each essibility, nsion of

ices are zational, requires

dividuals and are bdivided

s, safety,

desirable ealthcare benefit”. e defined e clinical erience”.

the link

•

•

•

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Safety can bestructures, reharm to the usenvironment i

Patient-centerand responsivand ensuring

Finally, contispecified useproviders, instrajectory is corganisation ato be part of c

Efficiency is defini.e. money, time a

ensuring that theesults (i.e. allocat

Sustainability isnfrastructure sucacilities and equineeds. Important fhe health personnEquity is a transvall three tiers of thdistribution of hepayment for healtmedical determinaoverlaps with the d

Assessment of thOnly a partial assmade into the scPerformance of he Outcomes of

Nutbeam’s fra

e defined as “the dnders services, aser, provider, or en this definition exredness is definedve to individual pthat patient valuenuity addresses rs, over time, is

stitutions and regcovered. This alsoacross providers, continuity. ned as “the degreand personnel) is se resources aretive efficiency)”. s the system’s h as workforce ipment, and be ifactors for the manel’s satisfaction aversal dimension, e framework. Equ

ealthcare across thcare. Above thants of health andimension of acce

he Health promosessment of the hcope of this workealth promotion.

the health promamework in Chap

degree to which thand attains resultsenvironment”. Inclxtends the dimensd as “providing ca

patient preferencees guide all clinica

“the extent to smoothly organisions”, and to wh

o means that ‘cooinstitutions and

ee to which the rfound for the sys

e used to yield

capacity to p(e.g. through ednnovative and re

aintenance of the and working condbeing considereduity is concerned wpopulations andis, “equity” can bnd for health staessibility.

tion health promotion k. More details ar

motion can be catpter 7 Performanc

he system has thes in ways that pruding the providesion beyond qualiare that is respectes, needs, and val decisions”. which healthcar

sed within and aich the entire dis

ordination’ (i.e. smregions) is consid

right level of resostem (macro-levelmaximum benef

rovide and maducation and trainesponsive to emeworkforce also initions. and presented awith the fairness o with the fairnebe estimated for atus. There are

performance coure given in Chap

tegorized (see fuce of health promo

49

e right event

er and ity. tful of alues,

re for cross

sease mooth dered

urces l) and fits or

intain ning), erging clude

cross of the ss of non-

many

uld be pter 7

urther, otion)

50

into outcomhealth outoutcomes,

• The main participatiointervention

Health systemThis includes thspecific to theinterpreting thein a broad wainfluence the framework, finaThis also mea(federal, regionsystem influenperformance itwhich has an im

Health in all poThis is a dimehealth system. related strate(http://www.eurpolicies” is to improve healthother than healt

1.3 ObjectiSystematic evaprocess, with Strategic objectto be differentiaoperational sub1.3.1 StrateThe HSPA proc

mes very distal to tcomes (like adocalled “health pro

values and pon, empowermens, sustainability.

design and conhe important desige Belgian health health system peay, encompassinhealth system (

ancing) and the inans that the articnal, local) is consncing its perforself. An addition

mportant influence

olicies ension linking no

It can be defineegy contributingro.who.int/docume

examine determ, but which are mth.

ives of the perfaluation of healpublication of H

tives, defined as tated from the specb-objectives. egic objectives ocess pursues thre

action (like healthopting healthy lifeomotion outcomesrinciples of the

ent, equity, m

ntext gn and contextua system, and werformance. Cont

ng both the loca(e.g. federal vs. nternational conteculation between idered to be a chrmance, rather

nal contextual face on ethical questi

on-medical determed as a horizontag to improve

ent/E89260.pdf). Tminants of healthmainly controlled

formance projeth system perfoHSPA reports athe objective of thcific objective of t

of the HSPA proce strategic object

Belgian

h outcomes), interestyle), and mors” (like health litera

health promotimultistrategic/multi

al information thatwhich are necesstext should be intal (national) fact

regional contexext factors (e.g. E

the different auharacteristic of th

than a dimenctor is the local ions.

minants of healthal, complementaryed population The core of “hea that can be altby the policies of

ect ormance is an oas important milee on-going procesthe present report

cess ives:

n Health System

rmediate re direct acy). on are: sectorial

t may be sary for erpreted ors that xt, legal Europe). uthorities e health sion of culture,

h to the y policy-

health lth in all tered to f sectors

on-going estones. ss, have t, and its

1

2

31OTcndpaF1

2

3

4

1OsTbF

Performance

. To inform thesystem and to

2. To provide a system perforTallinn Charte

3. On the long-te1.3.2 Overall aOverall objective: To propose and chosen dimensionnumber of indicadomains would beprofusion of resultaimed at a set of aFour operational o

. To review thespecial focus 2010;

2. To enrich thehealth promoend-of-life cacontinuity of propose indica

3. To measure tin the availabi

4. To interpret thperformance oincluding an in

1.4 Methods Operational objecspecial focus on thThe update of thebetween the reseFederal Public Ser

e health authorito be a support for transparent and

rmance, in accorder; erm, to monitor thand operational

measure a set ons of our healthators. With a tooe missed. But a toots would dilute mabout 80 indicatorobjectives have bee core set of 55 i

on the 11 indic

e core set with iotion, general meare; to add indi

care (two sub-dators on equity in he selected indicaility of data; he results in ordeof the Belgian henternational bench

to reach operactive 1: To reviewhe 11 indicators fo former 55 indica

earch team and arvice (FPS) Public

ties of the perfopolicy planning;accountable view

dance with the co

e health system pobjectives of the

of indicators cove system, while ko small set, impo large set is difficain messages. Fo

rs. een defined: ndicators of the pators for which t

indicators from thedicine, mental hicators on patiedimensions of qthe health system

ators, when possi

er to provide a glalth system by mhmarking when ap

ational objectivew the core set ofor which there wetors was made ina specialist in hec Health.

KCE Report

rmance of the h

w of the Belgian hmmitment made

performance over e 2012 report

ering all domainskeeping a reasoportant dimensioncult to manage anor the 2012 repor

previous report, wthere were no da

he following domhealth, long-term nt centerednessuality); and fina

m; ible, or to identify

lobal evaluation oean of several crppropriate.

es f 55 indicators, wre no data in 2010

n a consensus meealth indicators o

t 196

health

health in the

time.

s and nable ns or nd the rt, we

with a ata in

mains: care, and lly to

gaps

of the riteria,

with a 0. eeting of the

KCE Report 196

Operational objthe following dolong-term care,and continuity introduce indicaThe strategy fodimensions conThe indexed litsearch for Heathe grey literatreport) or inteHealth for All Ddimension studprocess occurrand panels of escoring allowedmany criteria (potential for acconsensus amoIndicators on threcent RIZIV –Indicators on tliterature. A spethe performancreport. The whole set avoid redundanOperational objobjective 2, andAfter the settingathered the dawere classified within the next whom these inlack of relevan

6

jective 2: To enriomains: health pr end-of-life care; of care (two sub

ators on equity-iner the selection of

nsisted of the folloterature was sea

alth Services Studture, mainly repo

ernational organizDatabase, Eurostdied). This resultered on an iterativexpert specific fod to select the mo(relevance, contection). In the othong experts. he performance oINAMI project usithe equity of theecific working papce of health system

of indicators wasncies in indicators jective 3: To mead to identify gaps ing up of an updaata to measure thinto two categortwo years, and tdicators should b

nt data, these ind

rich the core set wromotion, general to add indicators

b-dimensions of thequality in health/new indicators in

owing: arched using usudies.25 Many indicorts of national (zations (e.g. OEtat, and reports sed in long lists of ve way, involving or each topics. In ore appropriate inent validity, reliaer cases, the se

of general medicing the same meth

e system were dper “The place of ms can be found

s then reviewed and enhance the

asure the indicatoin the available daated set of indicahem. Indicators wries: those for whthose for which itbe collected. Nevdicators were sel

Belgian

with indicators illul medicine, mentas on patient centehe quality); and f/health system. a variety of doma

al standards of lcators were also (e.g. Dutch perfo

ECD Health Dataspecific to the doindicators. The sboth the researcsome cases, a t

ndicators, with rebility, interpretab

election was base

ine were selectedhodology.26 erived from interequity in assessmin Supplement S

by the research e consistency of thrs selected in opeata. ators, the researcithout (yet) availaich data will be at is not clear howvertheless, in spitlected by the exp

n Health System

ustrating al health, eredness finally to

ains and

iterature found in ormance a, WHO omain or selection ch team two step gards to ility and ed on a

d from a

rnational ments of

S2 of this

team to he set. erational

ch team able data available

w and by te of the perts as

bdFwOeWadrereaTgfo

Performance

being relevant, development”. For each measurwritten with detaileOperational objectevaluation of the pWhen the data wanalysis at nationademographic and ecent results coesults were discu

and identify shortcThe documentatiogathered in Supplor all indicators us

and were kept

rable indicator, aed results, includintive 4: To interpreperformance of thewere available, thal and regional lesocioeconomic fampared to Europussed with the ecoming and areas on sheets and thlement 1. A synosing colour-coded

under a secti

a complete docung international coet the results in ore Belgian health she following analyevel (with trends oactors, and finally pean Union (EU

expert groups to for further develo

e detailed resultsoptic table summad cells.

on “indicators u

umentation sheetomparisons. rder to provide a gsystem. yses were perforover time), analysbenchmarking of )-15 countries. Tfacilitate interpret

opment. s of the indicatorarises the main re

51

under

t was

global

rmed: sis by f most These tation

rs are esults

52

1.5 The 20this rep

The selected 7domain and byresults (valuesfollowing chapteChapters 2 to indicators illusconsists of thre1. First, we e

to a motiva2. The “facts

indicator wfor the thperspectivealso availa(available o

3. At the endanalysis in

The following cdiscussed in Cinequalities andat the beginningIndicators for widentify gaps recommendatioThe result of recan be found i2010, 5 indicatoeither removed soon. Another because they wdata were outdaIn addition to thwithin a two-ye

012 set of perfoport 74 indicators whiy performance dim) of the indicatorers of this report. 6 have the sam

strating one dime parts:

explain how the dation of the selecti

and figures” sectwe present the ma

ree regions ‘(whe with internationable in each docon the website). d of each sectionkey findings – mo

chapters illustrate Chapter 7 and Chd equity. The concg of this documenwhich there are c

in availability ons to policy makeeviewing the 2010n Appendix 2. Frors could be meafrom the set, eith12 indicators h

were deemed as ated.

hese 74 indicatorsear timeframe ha

ormance indica

ich could be memension in Appenrs are summarize

me structure. Eacension (e.g. qu

imension was evaon of the indicatotion is the core o

ain results of the dhere possible) aal results and tre

cumentation shee

n, we summarizeostly one key findsome specific iss

hapter 8 discusseclusion and discunt. currently no data of data in Be

ers in Chapter 9.0 set of indicatorsrom the 11 indicaasured in this repoher moved to the ihave been remov

not being releva

s, 11 indicators forave been selected

Belgian

ators and struct

easured are classndix A of this reped and discussed

ch chapter discusality, sustainabili

aluated which boors. of each chapter. Fdata analysis for Bnd put these re

ends. Detailed reset in the Supplem

e the results of ting per indicator. sues: health promes the aspects ossion are in the s

have been discuelgium, and to

s (operational objeators with data mort. The others handicators to be mved from the 20ant anymore, or b

r which data are ed. Probably, they

n Health System

ture of

sified by port. The d in the

sses the ity) and

ils down

For each Belgium, esults in sults are ment S1

the data

motion is of health ynthesis

ussed to provide

ective 1) issing in

ave been measured 010 set, because

expected y will be

inliM•

•

•

Performance

ncluded in the nexsted in Appendix

More documents a In Supplemen

presented, stechnical infointerpretation,A list of indicbut for which presented in discussed to provide recomdetails in Cha

In Supplemeperformance opaper on equperformed in B

In Supplemenselection of indicators inidomains: HeaPatient centeof-life care.

xt edition of the p3.

are available on thnt S1: one documummarising the rmation on data s, and the bibliograators that were dno initiatives are

this Supplemeidentify gaps in

mmendations to apter 9. nt S2: “The plaof health systemsuity, indicators foBelgium. nt S3: All techniindicators (MESHtially selected, salth promotion / redness / Long-te

erformance repor

he KCE website: mentation sheet p

rationale for chsources and com

aphical referencesdeemed pertinent e currently taken nt S1. These iavailability of dapolicy makers w

ace of equity in s” (author: Christiaor equity and rev

ical details of litH terms, databascoring of expe

Mental health /erm care and car

KCE Report

rt. These indicator

per indicator has hoosing the indic

mputation, limitatios.

by the expert grto collect data, isndicators have

ata in Belgium, ahich are discuss

assessments oan Léonard): a spview of available

erature searchesases searched, lrts) for the follo/ Continuity of cre of the elderly /

t 196

rs are

been cator,

ons in

roups, s also been nd to ed in

of the pecific

work

s and ist of owing care /

End-

KCE Report 196

2 OVERAPOPU

2.1 How dipopula

The objective assessment of anyway 4 globageneral outcomwell as a reflecindicators are:1. Life expect2. Health exp3. Percentage4. Infant mortFour other heamatter of fact, individuals andspecific domain• Suicide rat

care) • Overweigh

social outc• Rate of ne

social outc• Mean num

in the secti

6

ALL HEALLATION d we describe tion?

of this performthe health status

al health status inmes of the health ction of the global

tancy pectancy e of population petality rate lth status indicatowhile those four societal actors,

n or dimensions. Tte (described in se

t and obesity rateomes) ew HIV diagnosisomes) ber of decayed, mon 7.2.1, health a

LTH STATU

the overall hea

mance report ws of the Belgian dicators. Those csystem/health prdevelopmental le

erceiving their hea

ors were describeparticular indicatothey make part o

Those four indicatection 4.1.1, effec

es (described in

s (described in s

missing, filled teethand social outcom

Belgian

US OF THE

alth status of th

was not to perfpopulation. We d

can be seen as veomotion interventevel of a society.

alth as good or ve

ed in other sectionors can be influe

of the evaluation ors are:

ctiveness of menta

section 7.2.1, he

section 7.2.1, hea

hes in children (demes)

n Health System

E

he

form an describe ery distal tions, as Those 4

ry good

ns. As a enced by of some

al health

alth and

alth and

escribed

2

Tfow

LLereaimsL2msHaineycbHliliinfo

h

Performance

2.2 Facts and

This section is a sor each indicatorwebsite).

Life expectancy aLife expectancy (Lexpectancy has reductions in mort

attributed to a nmproved lifestyleservices.5 LE was 5.3 years 2010 and is highemen and 1.8 yearslightly lower than Health expectancyage without long-ndicator named ‘Hexpectancy to moyears lived. HLY consistent with prebut data for many HLY at 25 in Belgve thus about 5 ved in activity limn women. The HLor both sexes (Ta

SPMA: https:

isp.be/SASSt%2FHealth+E

d figures

hort summary of tr in the Supplem

and Health expecLE) at birth in Beremarkably incretality rates at all number of facto, better education

higher in women er in Flanders thars in women) (Tathe average of th

y represents the -term activity limiHealthy Life Yearsorbidity and disab

can be computevious published other reference a

gium was 41 yearyears longer tha

mitation. HLY increLY at 25 is highe

able 13).

://stats.wiv-toredProcess/guestExpectancy+Statisti

the detailed resultent S1 of this re

ctancy elgium was 80 yeeased since deca

ages. These gainors, including risn and greater ac

(82.6 years) thanan in Wallonia (dable 13). Life exphe EU-15, 80.7 yeremaining years tation. This is ths’ (HLY).28 It extebility in order to ted for several work, we presen

ages can be founds in men and wo

an men, but thoseases slowly in m

er in Flanders tha

t?_program=%2FEhics&_action=proper

ts which are preseeport (available o

ears as of 2010.2ades, reflecting sns in longevity casing living standccess to quality h

in men (77.4 yeaifference of 3 yea

pectancy in Belgiuars in 2010 (Figulived from a parte structural Euro

ends the concept assess the qual

ages. In order tt the HLY at 25 y

d. men in 2008h. Woe additional year

men but remains sn in the other reg

hleis%2FStored+Prorties

53

ented n the

7 Life sharp an be dards, health

ars) in ars in um is re 4). ticular opean of life lity of to be years,

omen rs are stable gions,

ocess

54

For internationBelgium is situ62.6 years versEU-15.

Table 13 – Lifeage 25 (2008),

Male Life ExpectancyHealthy life yeaFemale Life ExpectancyHealthy life yeaSource: * DGSIE

i https://sta

isp.be/SA%2FHealt

nal comparisons, ated close to thesus 63.0 years in

e expectancy atby sex and regio

Belgiu

y at birth* 77.4

ars at 25** 41.3

y at birth* 82.6 ars at 25** 41.2 E, data 2010; ** SPM

ts.wiv-SStoredProcess/guth+Expectancy+Sta

Eurostat compue average of EU-n EU-15, and for

t birth (2010), anon

um Brussels F

76.9 738.5 4 82.8 840.6 4

MA i, data 2008

uest?_program=%2Ftistics&_action=pro

Belgian

utes the HLY at-15 countries: formen 64.0 versus

nd Healthy Life Y

Flanders Wallon

78.5 75.5 43.7 37.4

83.3 81.5 42.3 39.1

FEhleis%2FStored+perties

n Health System

t birth.29 r women s 63.1 in

Years at

nia

+Process


KCE Report 196

Figure 4 – Life

Source: OECD H

74

75

76

77

78

79

80

81

82

2000

Life

exp

ecta

ncy

at b

irth

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Net

EU-

6

e expectancy at b

Health Data 2012

0 2001 2002 2003

gium

therlands

-15

birth: internation

2004 2005 2006 20

France

United Kingdom

Belgian

al comparison (2

007 2008 2009 201

Germany

United States

n Health System

2000-2010)

0

DenPorFi

BeGer

GrUnited King

EA

LuxembNether

IrFr

SwS

Performance

77 78

nmarkrtugalnlandlgiummanyreecegdom

EU-15ustriabourgrlandselandrance

wedenSpain

Life

79.379.8

80.280.3

8088888

79 80 8

e expectancy at birt

30.580.680.680.780.780.780.8

81.081.3

81.582.2

81 82 83

th (2010)

55

56

Self-perceivedSelf-perceived and as highly pIn 2008, 77% ogood or very subjective appreven after adjuregions. Two databasesOECD Health Dthe European Usurvey. The for

Figure 5 – Infa

Source: OECD H

2

3

4

5

6

7

8

20

Dea

ths

per 1

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live

birt

hs(in

fant

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d health health has been predictive of mortaof the people agegood. This rate

raisal of health stausting for age. It

s provide informaData (in which daUnion Statistics onrmer database wa

ant mortality rate

Health Data 2012

000 2001 2002 200

lgium

therlands

-15

proven as a reliabality. ed 15 years or o

e has slightly incatus was slightly lewas higher in Fl

ation for the interata from Belgium n Income and Livas chosen for its

: international co

03 2004 2005 2006

France

United Kingdom

Belgian

ble reflection of m

lder rated their hcreased over timess favourable in landers than in th

rnational compariscome from the Hing Conditions (Ecomparability with

omparison

6 2007 2008 2009

Germany

United States

n Health System

morbidity,

ealth as me. The women,

he other

son: the HIS) and EU-SILC) h results

a7

InTqoEto3rath

2010

s

PS

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above. Belgium co71.7%).

nfant mortality raThe infant mortalitquality of health cof development. TEU countries, sucho 3.5/1000 live b3.4/1000 live birthates in the three rhan for female inf

0.0

FinlandPortugalSweden

SpainEU-15

enmarkermany

ItalymbourgBelgiumFranceGreeceIrelanderlandsAustriaingdom

Num

ompares very wel

ate ty rate (IMR) is a bare services, and

The IMR has regulh as in Belgium (abirths in 2010, w

hs (Figure 5). Datregions. Rates arefants (3.4/1000).

1.0 2.0

mber of deaths per

l with other EU-15

basic indicator ford is highly correlatlarly decreased ovaround 5 deaths/1which is within tta per region (froe also higher for m

2.32.52.5

3.23.43.43.43.43.43.53.6

333

3.0 4.

r 1 000 live births

KCE Report

5 countries (avera

r population healthted to a country'sver the last decad1000 live births in he EU-15 averag

om 2008) show smale infants (4.2/1

3.83.83.83.9

4.2

.0 5.0

(2010)

t 196

age of

h and s level des in 2000

ge of similar 1000)

KCE Report 196

2.3 Key fin• Life expec

increasingFlanders. average of

• Although wlonger in greported) aranking w

• 77% of thegood in 20women, another EU-1

• Infant morThe figure1000 live bclose to thneighbour

6

dings ctancy at birth in g over time, and Life expectancy f the EU-15 (80.7women live longgood health sincactivity limitationithin the averagee population repo008. This proportnd drops with ag15 countries (avertality has decreaes are similar in tbirths in 2010. Inhe average EU-15ring countries.

Belgium was 80is higher for womin Belgium is sli

7 years in 2010).ger than men, thece the number ofn is higher in woe as compared worted their healthtion is higher for

ge. Belgium comerage of 71.7%).ased regularly ovthe three regionsfant mortality rat5 rates, and bette

Belgian

0 years as of 201men. It is higher ightly lower than

ey do not live muf years with (self-omen. Belgium iswith the EU-15. h to be good to vr men as comparpares very good

ver the last decas and are close totes in Belgium aer than in the

n Health System

0. It is in

n the

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33AinapInawupreposW12F345

C6789Ac1

Performance

3 ACCESS3.1 How did wAccessibility is defn terms of physicavailability of quaprerequisite of a qn this report, waccessibility of theworkforce, addresused to determinepocket payments easons. Another

preventive policiesone indicator relaservices. Workforce

. Number of pra2. Number of praFinancial accessib3. Coverage of t4. Amount of co-5. Percentage o

because of finCoverage of preve6. Breast cancer7. Cervix cancer8. Coverage of v9. Coverage of iAccessibility of locarers)

0. Number of beand older

SIBILITY Owe evaluate thefined as the easecal access (geog

alified personnel.4ualitative and effic

we have definede healthcare systssing the availabie financial accessand delaying cogroup of indicat

s such as canceates to the timing

actising physicianactising nurses pebility the population in t-payments and ouof consumers whnancial reasons entive measures r screening (womer screening (womevaccination for younfluenza vaccinat

ong-term care (re

eds in residential

OF CARE e accessibility with which health

graphical distribut4 Accessibility of cient health systed twelve indicatem. Some indicality of healthcare s, focusing on insntacts with healttors measures thr screenings and

g (or timeliness) o

ns per 100 000 poer 100 000 popula

terms of health insut-of-pocket paymho delay contact

en aged 50-69 yeen aged 25-64 yeung children tion for the elderlyesidential care fo

care facilities pe

of healthcare?h services are reation), costs, timea health systemm. tors to evaluate

ators are related tpersonnel, other

surance status, ohcare due to finahe coverage rated vaccinations. Fiof access to pall

pulation ation

surance ments t with health ser

ears) ars)

y (65 years and olr elderly and info

er population 65

57

? ached , and

m is a

e the to the rs are out-of-ancial es for inally, liative

rvices

der) ormal

years

58

11. Percentagecarer

Accessibility of 12. Start of pal

3.2 Facts a

This section is afor each indicawebsite).

Workforce The number of currently activeaccessibility of The number of31 815 in 2010these, 38.4% wpsychiatrist spethe RIZIV – population (TabFew EU-15 Eurto the OECD. Ball registered pway of countinwhich was oneon data older thphysicians, givBelgium. Compof practising phbut is slightly hi

j For intern

RIZIV – Iservice du

e of population ov

end-of life-care: tlliative care very c

and figures

a short summary ator in the Supple

care providers ge in the healthcthe healthcare syf practising physi0, corresponding were GPs and 6ecialists. ExpresseINAMI since 20ble 14). ropean countries Before 2009, Belghysicians at the R

ng resulted in a p of the highest inhan 2009) the deving a better picpared to other OEhysicians, the dengher than in the U

national comparisoNAMI as those whuring a year.

ver 50 years old re

timeliness of start close to death

of the detailed resement S1 of this

gives information ocare sector, andystem. iciansj increased to a density of 2

6.07% psychiatrised in full-time equ09), this density

report the numbegian data on practRIZIV – INAMI (pophysician density

n Europe.1 Since 2nsity is based oncture of the ‘usCD countries whi

nsity in Belgium isUK (in 2009) (Figu

ns, the practising

ho provided more th

Belgian

eporting to be an

of palliative care

sults which are pr report (available

on the medical wd thus indirectly

from 28 999 in 2.91/1000 popula

sts and 56% wheuivalents (as calcuy reduces to 1.

er of practising phtising physicians otentially practisiny of 4.03/1000 po2009 (and retrosp the number of peful’ medical dech also report thes lower than in Gure 6).

physicians are dehan one reimburse

n Health System

informal

resented e on the

workforce on the

2000 to ation. Of ere non-ulated by 99/1000

hysicians included ng). This opulation pectively ractising

ensity in e density

Germany,

efined by ed clinical

TE

P

M

SNre

Performance

Table 14 – NumbEquivalent, and d

Profession

Medical doctorsGPs Psychiatr

Source: RIZIV – INANote: Practising phyeimbursed clinical s

ber of practisingdensity (/1000 po

Totpractisin

31 8112 22

rists 1 93AMI ysicians are defined service during a yea

g physicians, estopulation) (2010)

tal ng

Density

15 2.9228 1.1232 0.18

as those who proviar.

KCE Report

timation of Full

Total FTE

De

21 6918 6461 260

ided more than one

t 196

Time

ensity

1.99 0.79 0.12

e

KCE Report 196

Figure 6 – Num

Source: OECD H

Nurses are geoutnumbering pnumber of pracnumber of prapayroll of hospiof them. Only INAMI databaslarge survey to showed that onin the healthcafor older person

0

0.5

1

1.5

2

2.5

3

3.5

4

2

Num

ber o

f pra

ctis

ing

phys

icia

ns p

er 1

000

popu

latio

n

Belg

Uni

6

mber of practisin

Health Data 2012

enerally the mostphysicians in almctising nurses is ectising medical ditals or nursing honurses outside th

ses. For that reameasure the num

n the 152 376 nursre sector (39% inns or in nursing h

2000 2001 2002 200

gium F

ted Kingdom U

ng physicians (pe

t numerous healmost all OECD ceven more challendoctors; indeed, momes, and there ihe hospitals are son, the FPS Pumber of practisingses included in th

n hospitals, and thhome care). This

3 2004 2005 2006 20

France

United States

Belgian

er 1000 populatio

lth professionals,countries.5 Estimanging than evaluamany nurses areis no centralized cregistered in the ublic Health orgag nurses in 2009.he study, 70% werhe rest in residencorresponds to a

007 2008 2009 2010

Germany

EU-15

n Health System

on): internationa

, greatly ating the ating the e on the counting RIZIV –

anized a Results re active

ntial care a density

okInmd

United King

Luxemb

Belg

EU

Germ

S

Au

Performance

al comparison

of practising nursknow the number nternational commeaningless, as Bdiploma, and not o

0 1

dom

ourg

gium

U-15

many

Spain

ustria

Number practis

ses of 9.9/1000 pof corresponding

mparison based Belgian data still reon their working st

2.7

2.8

2.9

3.4

3.

3

2 3 4

sing physicians per (2010)

population.30 HowFTE. on OECD Hea

epresent all nursetatus in healthcare

.7

3.8

4.8

5 6

1 000 population

wever, we still do

lth Data is cures (on the basis ofe).

59

o not

rently f their

60

Financial acceA prerequisite fA compulsory hcitizens living iasylum seekersand hence are they have no expenses are c CPAS), and nHealth Data re99.5% in 2009(with many coucoverage, both level of accesscovered and thacross countrieof complementcurrently availaLow out-of-pocaccessibility toexpenditures bocover the (fullpayments (tickmedications anBetween 2003€7.25 billion, bremained const2010). Co-paymin 2010. Expretotal of €665 in

essibility for financial acceshealth insurance, in Belgium. In prs) may not fulfil ad

not affiliated to aright to necess

covered by the pot by the sicknesport a constant p. Other Europeanntries reporting 1public and privat

sibility across thee degree of cost-

es. Another indicattary health insurble in Belgium. cket (OOP) payo the healthcareorne directly by a) cost of the heket modérateur nd other expendit and 2010, the ut compared to ttant during the saments representeessed per inhabit2010.

ssibility is coverain principle, coverractice, some cadministrative and/a sickness fund. sary medical caublic municipal wss funds. The da

percentage of 99%n countries repor00%). Neverthelete, is an imperfecte countries, sincsharing applied totor of financial accrance (usually pr

yments are anote system. Out-oa patient where health good or se

/ remgeld), cotures paid directly

OOP expendituthe total health eame time period (ed 26.7% of all outant, out-of-pocke

Belgian

ge with health insrs the whole poputegories of citize

/or financial requirThis does not mere, but their he

welfare centres (Oata for Belgium in% insured personrt similarly high cess, total health int indicator to com

ce the range of o those services ccessibility is the crivate), but no d

ther condition foof-pocket paymehealth insurance dervice. They inclosts of over-they by private hous

ures rose from €expenditures, the(20.0% in 2003, 1ut-of-pocket expeet payments repr

n Health System

surance. ulation of ens (e.g. rements, ean that

ealthcare OCMW –n OECD ns, up to coverage nsurance pare the services can vary

coverage data are

or good ents are does not ude co--counter seholds. €5.33 to eir share 19.4% in enditures resent a

CoEeeaUdc

Performance

Comparison of heon the System of Eurostat, WHO anexpenditures at expenditures in Bare at the higher eUK lying below 10detailed scrutiny calculation of their

ealth expendituresHealth Accounts

nd OECD, is a coa national levelelgium (expresseend, with countrie0% (Figure 7). Aga

of all expenses r System of Health

s across Europea (SHA). The SHAmmon way to rep. The comparis

ed as a % of totaes such as Franceain, this statemen

included or noth Accounts.

KCE Report

an countries are bA, developed joinport and classify hon shows that

al health expendite, the Netherlandsnt should require at by countries in

t 196

based tly by

health OOP

tures) s and a very n the

KCE Report 196

Table 15 – Out

Year

All out-of-pockeBillion € % expenditure o€/capita Co-payments oBillion € % of all out-of-pSource: - Out-of-pocket e- Co-payments (t

Figure 7 – Out

Source: OECD H

6

t-of-pocket expen

et expenditures

on health

only

pocket expenditur

expenditures: Systemtickets modérateurs/

-of-pocket expen

Health Data 2012

nditures (2003-2

2003

5.5337420.0 533.31

res

m of Health Accoun/remgeld):RIZIV – I

nditures (as a pe

Belgian

010)

2004 20

4 5.53049 5.

18.8 18530.70 54

nts (SHA), OECD HeNAMI

ercentage of tota

n Health System

005 2006

68334 6.270448.6 20.5 42.37 594.47

ealth Data 2012

l health expendit

Performance

2007 20

4 6.73778 7.0

20.9 20634.10 65 1.8 26

tures): internatio

008 2009

02868 6.859820.3 18.9 56.27 635.38

85261 1.966206.4 28.7

onal comparison

2010

2 7.25518

19.4 665.88

0 1.93881 26.7

n

61

62

To guarantee fhave introducehouseholds wiexpenses agaithese social capostpone healtmental healthcreaches 26% o1997, this perceIt is difficult to bneeds are availdue to waiting tThe five followmeasures are e

Coverage of scThese two inmodalities: orgopportunistic scthe colorectal c

k Only to ci

co-paymeimplemen

l For coloreregional aBrussels),years, peroccult blohigh risk.3program, Flanders,

financial accessibed several “sociith low financialnst catastrophic

are nets, 14% of thcare (medical care) for financiaf the households entage was belowbenchmark these lable in OECD Hetimes or distanceswing indicators meffectively accessi

creening for breanterventions currganized nationalcreening for the cancer screening p

ite some of them: t

ents (introduced in ted in 2002) and theectal cancer, there approaches co-exis, a screening progrrsons aged 50-74 y

ood test), or directly31 There has beenbut it is still too pilot projects were

bility of healthcaral care nets”, wl means or withealthcare expethe households dcare, surgery, dr

al reasons. In B(14% in Wallonia

w 10%. data: indeed, dat

ealth Data, but thos.

measure in which ible and used by t

ast and cervical rently run with program for t

cervix cancer. It isprogram.l

the entitlement to i

1963), the Maxime OMNIO status (inis no national pro

st: in the French ramme was startedyears old are invitey a colonoscopy fon a preliminary ev

early to evaluatealso started.33

Belgian

re in Belgium, legwhich aim is to h very high hensesk. However, declared that theyrugs, glasses or russels, this per and 11% in Flan

a on global unmeose also include p

way specific prthe population.

cancer different organ

the breast cancs still too early to e

increased reimbursmum Billing Systemtroduced in 2007).gram in place, butCommunity (Wallo

d in March 2009. Eed to perform a FOr individuals at higaluation of the sta

e the global cover

n Health System

gislators protect

ealthcare despite

y had to lenses,

rcentage ders). In

et clinical problems

eventive

izational cer and evaluate

sement of m (MAB,

t different onia and

Every two BT (fecal h or very

art of the rage.32 In

•

•

m

Performance

For breast caFlanders and years. The latperformed ouare called hemammogramsResult: In 2060%, far belo75% target scoverage occthe “mammotwith regard toonly 11% in Bpartially due opportunistic the program.3

Cervical cancprognosis, catest (or Pap twomen aged essentially opResult: The caround 62% b2000, the coEuropean cou61% in 2008, Finland (70%)

m It is not poss

done for oppo

ncer, a national s2002 in Wallonia

tter co-exists with tside of the progrreafter “mammotes (opportunistic sc10, the total cov

ow the EU-15 aveset by the EU.5 curred within the ptests” in 2010). Do the coverage witBrussels and 7%

to the persistescreening in Wa

34 cer, a cancer with an be largely detetest).35 This test 25-64 years. Curr

pportunistic. cervical cancer scbetween 2007 anoverage rate wasuntries, Belgium but is still far from

) (Figure 9).

sible to distinguish iortunistic screening

screening programa and Brussels) fopportunistic scr

ram). Mammogramests”, to be distincreening or diagn

verage of breast erage of 68%, an(Figure 9) Moreoprogram (30% sc

Differences betweethin the program: 4in Wallonia. (Figu

ence of pre-exisallonia and Brusse

a low incidence ected in a curablis recommended rently, the screen

creening coveraged 2010. In a prevs already 59%.3caught up with tm some countries

n the nomenclature from mammogram

KCE Report

m exists (since 20for women aged 5reening (mammogms within this pro

nguished from all ostic test)m. cancer screeningnd even further oover, only half ocreening coverageen regions are st46% in Flanders, ure 8) This is prosting higher leveels before the st

and a medium toe stage by the severy three yea

ing for cervix can

e has remained svious study from 16 Compared to the EU-15 averas such as UK (80

e between mammogs done for a diagno

t 196

001 in 50-69 grams ogram other

g was of the of this e with triking while

obably els of art of

o poor smear rs for cer is

stable 1998-other ge of %) or

grams ostic.

KCE Report 196

Figure 8 – Per2010)

Note: mammotes

6

rcentage of wom

st = organised scree

en (aged 50-69)

ening program, mam

Belgian

who had a mam

mmogram = organiz

n Health System

mogram (within

zed + opportunistic s

Performance

program (a) or o

screening + diagnos

overall (b)) within

stic test; Source: IM

n the last two ye

MA-EPS, KCE calcul

ears, by region (2

lation

63

2006-

64

Figure 9 – Brea

Source: OECD H

Coverage of vaImmunisation iprimary prevenbased on the Indicators Moniregional healthregional level, athe three regionThe WHO-recofor Diphteria-Te

0

10

20

30

40

50

60

70

80

90

2000

%fe

mal

es 5

0-69

year

s sc

reen

ed fo

r bre

ast c

ance

r

Be

Ne

ast cancer and c

Health Data 2012, ex

accination s one of the m

ntion. The choice international indicitoring (ECHIM) ah competence, tand a national ranal rates. ommended target etanos-Pertussis

0 2001 2002 2003

lgium

therlands

cervical cancer s

xcept IMA-EPS for B

ost powerful andof the vaccinatio

cators from Euroand OECD. In Belthe vaccination

ate is computed a

rate for a collect(DTP) and 95 %

2004 2005 2006

France

United Kingdom

Belgian

screening: intern

Belgium 2008-2010

d cost-effective fons included in ouopean Communitylgium, as vaccinarates are meas

as a weighted ave

tive immunisation for measles. In

2007 2008 2009 2

Germany

EU-15

n Health System

ational comparis

0 (KCE calculation)

forms of ur set is y Health ation is a sured at erage of

n is 90% general,

thcBesolaCDcre

20100

10

20

30

40

50

60

70

80

90

%fe

mal

es 2

0-69

year

s sc

reen

ed fo

r cer

vica

l can

cer

Performance

son (2000-2010)

he recommendedcoverage of DiphtB (Hib), poliomyeexceeds 95%. Onstill just below 95%outbreaks of measarge outbreak of mCompared with oDTP3 coverage, pcoverage ranks ecommended lev

2000 2001 2002

Belgium

United Kingdom

d coverage rates teria-Tetanos-Pertelitis (Polio3), hely for Measles-Mu% in 2009. It mussles have occurremeasles occurredther European c

particularly since 2good, has muchel.

2003 2004 2005 2

Germany

EU-15

are reached in Btussis (DTP3), Haepatitis B (Hep3umps-Rubella (MMst be noticed thated in recent year

d in 2011.37 ountries, Belgium

2003. For measlesh improved and

2006 2007 2008 20

Netherla

KCE Report

elgium. The 3rd daemophilus Influe

3) has increasedMR) the coveraget some small epidrs, in all regions a

m ranks very goos (1st dose), the g reaches almos

009 2010

ands

t 196

dose-enzae d and e was demic and a

od for global st the

KCE Report 196

Figure 10 – Pe

Source: OECD H

In Belgium, seagroups of perpersons aged >professionals; risks like obestarget vaccinatAgency (IMA) rthe vaccination 2008-2009)40, eother countriesNetherlands (b(63%).

75

80

85

90

95

100

2000 2001

%ch

ildre

n va

ccin

ated

aga

inst

DTP

Belgium

Netherla

EU-15

6

ercentage of child

Health data 2012

asonal influenza vrsons defined as>65 years and apregnant womenity; chicken and ion rate of 75% eport which covercoverage of elde

except for elderly , coverage in Beletween 70% and

2002 2003 2004 2005 20

France

ands United Kingdo

dren covered by

vaccination is curs being of influell persons living

n; persons aged pig farmers).38 Tfor the elderly.39

rs the winters 07-rly does not reachresiding in institutlgium is lower tha

d 80%), and simil

006 2007 2008 2009 2010

Germany

om United States

Belgian

main vaccinatio

rrently recommenenza complicatioin institutions; he50-64 years with

The WHO recommThe last Intermu

08 and 08-09, shoh the WHO targettions (83%). Coman in France, UK ar to the EU-15

075

80

85

90

95

100

2000 200

%ch

ild

ren

vaccin

ate

d a

gain

st m

easle

s

n Health System

ons (2000-2009):

ded in 5 ons (like ealthcare h health mends a utualistic ows that t (63% in pared to and the average

AinRfapsinn6reinBbbh

1 2002 2003 2004 2005

Belgium France

Netherlands United Kin

EU-15

Performance

international com

Accessibility of nformal carers)Relative to the 6acilities has remapersons of 65 andsector: the numben the last decade,number of beds in65 000 over the segions. In 2010, nhabitants of 65 yBrussels than in beds does not divbeds in residentiahigher in Wallonia

2006 2007 2008 2009

Germany

gdom United States

mparison

long-term care

5+ population, thained constant ov over in 2010.41 T

er of beds in home, from around 88 0n nursing homes same period. Thethe number of b

years and older wFlanders (Table

verge much betweal facilities in rela

and Brussels tha

2010 0

10

20

30

40

50

60

70

80

90

100

20

%ch

ildre

n va

ccin

ated

aga

inst

hep

atiti

s

B

U

e (residential c

he number of bever the past decaThis stable figure hes for the elderly h000 in 2000 to 64almost doubled, fere are also largebeds in homes fowas considerably 16) while the deeen the regions. Oation to the elderan in Flanders.

000 2001 2002 2003 2004 2

Belgium Franc

United States EU-15

care for elderly

eds in residential de, at 7 beds pehides large shifts has decreased ste 000 in 2011, whifrom around 33 0e differences betor the elderly pehigher in Walloniansity of nursing Overall, the numbrly population is

2005 2006 2007 2008 200

e Germany

5

65

and

care er 100 in the eadily le the

000 to tween r 100 a and home ber of much

9 2010

66

Table 16 – Num

Number of beds/100 inhabitants

Source: RIZIV – I

Data are availarecipient of lonbetween 6% anbetween 4% aavailable for recInformal carersactivities of daimportant cominformal carers of declining fadisabilities and The average p16.2% in Italy. and older is slig(11.7%).5 Other results aavailable on theof care, distribuleave from worelated to informAs there are custill insufficient

mber of accredite

Bed

Wal

s s 65 +

4.9

INAMI 2011

ble internationallyng-term care (LTCnd 7%, Belgium and 5%), and scipients of home cs, defined as p

aily living (ADL) ponent in the lois estimated to demily size, changrising participatio

proportion of inforThe Belgian ave

ghtly higher than t

are available in the web) and includution of care recipork, flexible workmal care giving. urrently no data oto evaluate the ac

ed beds in home

ds in homes for t

lonia

y for the proportioC) in residential is higher than the

similar to the Necare. people providingfor at least one

ong-term care precrease in the comes in residential n rates of women

rmal carers variederage of 12.1% othe overall averag

he documentationde data on share

pients, employmenk schedule, and

on patient needs,ccessibility of long

Belgian

es for the elderly

he elderly

Flanders

2.5

ns of population ocare. With a pere EU-15 averageetherlands. No d

g assistance withour per week,

rocess.5 The numing decades, as

patterns of peon in the labour mard from 8% in Swf the population age of the OECD-c

n sheets (Supplemof women, week

nt rate and hours mental health p

these two indicag-term care.

n Health System

y and nursing hom

Brussels

6.3

over 65+ rcentage e (that is data are

h basic are an mber of

s a result ple with rket.

weden to aged 50

countries

ment S1 kly hours of work,

problems

ators are

A

TpTthcspFsda

n

Performance

mes per 100 pop

Beds i

Wallon

3.4

Accessibility of e

The last indicator palliative care is sThis can denote ehat the decision currently very littlestarted, but the tpatient can providFunds (2006) givesum occurred for death. In 20% application.42,43 Mo

n Patients who

months can babolition of physiotherap8 504 lump s

pulation 65 years

in nursing homes

nia Fl

3.

end-of-life care: t

of accessibility issometimes delayeeither problems o

to start palliative information on ttime when the pde some indicationes some indication

half of the patieof the cases,

ore data are need

o stay at home andbenefit from a “palliapatient co-paymenist. The use of palum in 2004 to 20 17

s and older, per r

s

anders

3

timeliness to sta

specific to end-oed until patients

of accessibility of ve care was takethe real moment w

palliative lump sun.n A study from tns: the applicationents in less than

patients died ded on this indicat

d have a life expecative statute”. It invont for nursing, GP lliative lump sums70 in 2010 (source:

KCE Report

region, 2010

Brussels

3.8

art palliative care

of-life care. The stare in terminal pend-of-life care, een too late. Thewhen palliative ca

um is requested the Christian Sick

n for the palliative a month beforewithin the weeor.

ctancy of less than olves a lump sum an

visits and visits oat home increasedRIZIV – INAMI).

t 196

e

tart of hase. either ere is are is for a

kness lump their

ek of

three nd the of the d from

KCE Report 196

3.3 Key finWorkforce • The densit

than one r/1000 popuExpressed1.95 /1000

• The densit10/1000 pothe healthcare for olnot availab

Financial acce• The cover

(99.5%), du• Between 2

rose from expenditu20.0% in 2amountedcountries total healtcountries Kingdom l

• In 2008, 14postpone glasses orfinancial a

6

dings

ty of practising preimbursed cliniculation in 2000 tod in full-time equ population. ty of practising nopulation in 2009care sector (37%lder persons or ible in the previo

essibility rage of populatioue to compulsor2003 and 2010, th€5.33 to €7.25 bres remained co

2003 and 19.4% in to €665 in 2010.shows that OOPh expenditures) such as France, lying below 10%4% of the househsome of their her lenses, mental accessibility. In 1

physicians (thoscal act) increaseo 2.91/1000 popu

uivalents, medica

nurses in the hea9. On 100% nurse

% in hospitals, ann nursing home us report.

on by health insury affiliation to a he out-of-pocket illion. Their shar

onstant during thn 2010. OOP exp. Comparison wit

P expenditures (ein Belgium are a the Netherlands. holds declared thealthcare (medicahealthcare) due

1997, this percen

Belgian

se who performedd slightly from 2

ulation in 2010. al density decrea

althcare sector wes, 68% were act

nd the rest in rescare). This resu

urance is very higsickness fund. (OOP) expenditu

re in total health e same time per

penditures per cath other Europea

expressed as a %at the higher ends and the United

hat they had to al care, surgery, to problems of

ntage was below

n Health System

d more 2.83

ased to

was tive in

sidential lt was

gh

ures

riod: apita an % of d, with

drugs,

10%.

C•

•

•

•

Performance

Coverage of prev During the la

cancer screeparticipation Wallonia: 7%stabilized aro

Coverage of and 2010 (62annually waschanges in rethe EU-15 av

In general, thvaccination adiphtheria-teincreased ancoverage wa

The WHO-recinfluenza is ntarget. Vaccihigher (82%)

ventive measuresast five years, theening stagnates a between region

%). Overall coveraound 60%, whichcervical cancer s%-63%), while th

s divided by 2 beeimbursement ruerage (63%) but

he WHO-recommare reached in Beetanus-pertussis,nd are now aboves still just belowcommended covnot met: 63% in tnation rates for e.

s e coverage of orgaround 30%, withs (Brussels: 12%age, including alh is far below thescreening was s

he number of tesetween 2008 and ules. Coverage inlower than in the

mended coverageelgium. The cove, poliomyelitis, he 95%. Only for m

w 95% in 2009. verage of elderly the winter 2008-2elderly residing

ganized breast h huge differenc

%, Flanders: 46%l mammograms,

e EU-15 target (7stable between 20sts performed

2010, due to n Belgium is withe UK (around 80

e rates of childreerage rates of

hepatitis B have measles the

vaccination aga2009 against a 75in an institution

67

es in %, , 5%). 007

hin %). n

ainst 5% are

68

Accessibility informal carers• Relative to

care facilitdecade, fr2000 to 70care, Belg5%, and isusers are

• Informal cbasic activweek, are The Belgiareporting toverall ave

Timeliness to s• There is c

palliative sSickness Ffor the palless than aweek of apinternation

of long-term cs) o the 65+ populaties has remainerom 71 beds per 0 beds in 2010. Wium is higher tha

s similar to the Navailable for inte

carers, defined asvities of daily livan important co

an average of 12to be an informaerage of the OECstart palliative caurrently little infostatus is requestFunds (2006) givlliative lump suma month before dpplication. More nal comparison)

care (residential

tion, the numbered more or less c1000 persons of

With 6%-7% of 65an the EU-15 aveetherlands. No d

ernational compas people providining (ADL) for at lmponent in the l.1% of the popul

al carer is slightlyCD-countries (11are ormation about tted. A study fromves some indicatm occurred for hadeath. In 20%, padata are neededon this indicato

Belgian

care for elde

r of beds in residconstant over thef 65 years and ov+ residing in res

erage, between 4data on home caarison. ng assistance wleast one hour pong-term care plation aged 50 any higher than the.7%).

the moment whem the Christian tions: the applicaalf of the patientsatients died withd (trend over timer.

n Health System

rly and

dential e past ver in sidential 4% and re

ith er rocess. nd older e

en a

ation s in in the e,

4Qacinc

44Egwth4Naoinpm4FcapC123C4

Performance

4 QUALITQuality is defined and populations inconsistent with cunto 5 sub-dimenscare and patient c

4.1 Effectiven4.1.1 How did Effectiveness is dgiven the correct who could benefit hus outcome (res4.1.1.1 PreveNo indicator provias updating this soperational objectnclude: declines programme, shiftsmortality of epidem4.1.1.2 CuratiFour indicators hacare: three indicaand one indicatorpatients with a chrCancer Care

. 5-year relative2. 5-year relative3. 5-year relativeChronic care 4. Avoidable hos

TY OF HEAas “the degree t

ncrease the likelihurrent professionaions: effectivenesenteredness.

ness of care d we evaluate the

efined as “the deprovision of evidbut not those wh

ults) indicators. ntive care des information o

set of indicators fotives of this 2012in mortality for c

s in staging at dmics for which vacive care ave been selectedtors related to thr on the effectiveronic condition (in

e survival after bree survival after cee survival after co

spital admissions

ALTHCAREto which health sood of desired heal knowledge”.6 Itss, appropriatenes

e effectiveness oegree of achievindence-based heaho would not ben

on the effectiveneor preventive care2 report. Exampcancer for whichdiagnosis of canccination exits.

d to assess the efhe survival after aeness of ambulathis case: asthma

east cancer, by strvical cancer, by slon cancer, by sta

for asthma

KCE Report

E services for indiviealth outcomes ant is further subdiss, safety, continu

of care? g desirable outco

althcare services nefit”. All indicator

ess of preventive e did not belong tles of such indic there is a scre

ncer and incidenc

ffectiveness of cua diagnosis of caatory services to a).

tage stage age

t 196

duals nd are vided

uity of

omes, to all

rs are

care, to the cators ening ce or

rative ancer,

treat

KCE Report 196

4.1.1.3 LonThree indicatohealthcare: 1. Suicide rat2. Rate of inv3. Participatio

employmenWith regard to are currently aprovide data soelderly being in4.1.1.4 EndSome indicatorpercentage of instance) have data available f4.1.2 Facts


o The Resi

assess thextended Belgium aimplemenfor long-tethe Belgia

p This indicPerformanproposed

6

ng-term care rs are selected

e voluntary committaon rates by peopnt the effectiveness

available at a noon on a selected residential care fd-of-life care rs have been propalliative patientbeen assessed

for this indicator. and figures


dent Assessment

he care needs of twith instruments f

a national pilot proted in all care settinerm care facilities aan situation (details cator is already meance Report 20103,2

by the OECD work

to assess the

als as a percentagple with mental i

s of long-term carational level. Hoindicator: the pre

facility or receiving

oposed by the exs for which physand controlled, b


Instrument (RAI)44

the elderly in institfor different care oject (the BelRAI) ngs: the assessmenand acute care havin Appendix C). asured in the Neth20) and also beloning group on long-te

Belgian

effectiveness of

ge of all hospitalizllness of working

re for the elderly, owever, the BelRevalence of malnug home care (BMI

pert groups, suchsical symptoms (but there are curr


4 is originally devetutions, and has lasettings and subgris ongoing, but is

nt instruments for hove already been ad

erlands (Dutch Heangs to the set of ierm care quality ind

n Health System

f mental

zations g age in

no data RAIo will utrition in I<19)p.

h as the (pain for rently no

resented e on the

eloped to ater been roups. In s not yet ome care, dapted to

alth Care ndicators

dicators.45

4SepcnninecTc2bcTdreaArereuwfoc(Othbrein

q

Performance

4.1.2.1 SurvivSurvival rates aeffectiveness of thprogress in treatincancer was detecnational 5-year reno evolution of renternational compexpressed as “relacorrected for the aThe 5-year breascountries5 and has2009. In Belgiumbetween 2004 acompared to otherThe 5-year cervicdiagnosed betweeelative survival r

average (Figure 1All countries haveelative survival ovelative survival

usually higher for fwith colon cancer or males and 64colorectal cancerq

Figure 11). Only for breast cahan Belgium (datbe able to distingelative survival rnformation which

Survival rates

available in th

val after a cancefter cancer are he healthcare sysng disease over

cted, and the effeelative survival daelative survival caparisons, data refeative 5-year survivage-specific expecst cancer relatives improved in all cm, the 5-year rend 2008 was 8r European countrcal cancer relativen 2004 and 2008rates of patients 1). e also shown imver the years. Thbetween gender females.5 In Belgibetween 2004 an4.6% for female

q are very good c

ancer and colon cta shown in documuish the effect of

rates should be is not yet availabl

s after colorectal cahe OECD Health Da

er one of the k

stem and are cotime. They reflectiveness of the t

ata became availaan be given alreaer to the incidenceval years”, meanincted mortality. e survival rate iscountries betweenelative survival o88%.46 Survival ries (Figure 11). e survival rate w8. Compared to odiagnosed in 20

provement in 5-yere are difference

across countrieum, on the cohort

nd 2008, the relaties. Again, relativcompared to othe

cancer, the US hamentation sheet if early screeningcompared acrosle at international

ancer, and not specata 2012.

key indicators ofmmonly used to ct both how earltreatment.5 In Beable only recentlyady in this reporte year 2004. Rateng that they have

80% in most On 1997-2002 and 2of women diagnrates are very

was 69.8% for woother EU-15 coun

004 are within th

year colorectal caes in colorectal caes: survival ratest of patients diagnive survival was 6e survival rates er European cou

as higher survival in Supplement S1 from the actual s countries by slevel.

cifically colon cance

69

f the track y the lgium y and t. For

es are been

OECD 2004-nosed good

omen ntries, e EU

ancer ancer s are nosed 62.3%

after ntries

rates 1). To care,

stage,

er, are

70

Table 17 – 5Belgium

Cancer type

Female breastcancer Cervical cancer Colon cancer:males Colon cancer:females Source: Belgian C

5-year relative

All patients

I

t 88.0% 99

69.8% 92

: 62.3% 91

: 64.6% 96

Cancer Registry an

survival by sta

II I

.8% 93.3% 7

.2% 63.6% 5

.6% 86.1% 6

.3% 86.1% 6

d Evaluation of Can

Belgian

age, period 200

Stage

III IV

73.8% 29.2%

54.5% 17.0%

61.7% 14.5%

62.1% 16.0%

ncer Plan (Cancer C

n Health System

04-2008:

missing

73.4%

64.6%

54.5%

55.5%

Centre)46


KCE Report 196

Figure 11 – 5-y

Source: OECD HNote: results for c

Effectiveness Asthma, a chrooutpatient basiProper managexacerbation aasthma commoadmission ratescare coordinatio(healthcare quaAcross OECDadmission rateasthma admissalso the case i

6

year relative surv

Health Data 2012 colorectal cancer m

of ambulatory caonic condition, is s through proper

gement of asthmnd costly hospita

only serves as a ps may indicate poon or continuity.5 ality indicator) of th countries, ther

e for asthma. Fesions compared ton Belgium: in 200

vival after breast

males give similar res

are for a chroniceither preventab

r prevention or pma in primary calisations. The hoproxy for primary oor effectiveness This indicator be

he OECD. re is an 11-foldmales have conso males (on avera09, the asthma ad

Belgian

t, cervix and colo

sults for Belgium

c condition ble or manageablprimary care intercare setting can ospital admission care quality. Henof primary care,

elongs to the set

d difference in sistently higher rage 85% higher).dmission rate for

n Health System

orectal cancer fo

e on an rvention.

reduce rate for

nce, high or poor

of HCQI

hospital rates for 5 This is females

wraamc

Eph

Performance

or females: intern

was 52/100 000 inates in the OECD

are slightly abovemight highlight thecare setting.

Effectiveness ofpopulation, invhospitalization an

national compari

nhabitants and 28D Health data (20e the EU-15 avee need for more

f mental healthvoluntary comnd working statu

ison (2004)

8/100 000 inhabita007) show that 48erage (47.2/100 0

effective and tar

hcare: suicide mmittals withinus of persons wit

ants for males. Be8.4/100 000 inhab000 inhabitants). rgeted care in pr

rate in the gen the psychth mental illness

71

elgian bitants

This imary

eneral iatric

s

72

Suicide rate

Despite a slig18.75/100 000 general populacountries. For tWallonia than iwithin regions highest suicideinhabitants) whFlanders (21.4/men than for years).

Figure 12 – Su

Source: DGSIE (

ht decrease (froinhabitants in 20ation is considethe time period ofn Flanders and Bwere also found

e rates are foundhile in Flanders /100 000 inhabitawomen, and hig

uicide rates (num

(Belgium) and OECD

m 20.05/100 000008) the number erably higher thf the analysis, su

Brussels (Figure 1d in previous resd in the province

the highest rateants).47 The suicidgher for middle-a

mber per 100 000

D Health Data 2012

Belgian

0 inhabitants in of suicide death

han in other Eicides rates are h

12). Important diffsearch. In Walloof Namur (25.4/

es are observed de rate is also hiaged adults (age

population) per

2 (international, data

n Health System

1998 to s in the uropean higher in ferences

onia, the /100 000 in East

igher for d 40-64

region (1999-200

a for Belgium only a

Performance

08) and internatio

available in 2004-20

onal comparison

005)

n

KCE Report

t 196

KCE Report 196

Involuntary com

The percentaobservation”; “probation”; “obetween 2000hospitalizationscompared to tWallonia 7.2%7 719 involunta(n=1 579 or 2alcohol abuse share of invol36.31%); schiconditions (n=11998) showed compared to confirmed in an

6

mmittal in psychiat

age of involun“internment”;

ther judicial con0 and 2009 fros (Figure 13). Tthe two other re

%). The three ary committals r20.46%); psychot

(n=723 or 9.37%luntary committazophrenia (n=1

1 270/5 747 or 22that rates of invoother European

nalyses of involunt

tric hospitals

ntary psychiatric”prolongation i

nditions”;) in Belom 5.8% to 8

The rate in Bruegions (Brussels most common

registered in 20tic conditions (n=%). The three coals in 2009 wer

579/6 274 or 22.10%). Results oluntary committan countries. Thetary committal pop

Belgian

c hospitalizationinvoluntary admgium steadily in

8.2% of all psussels is twice

14.2%, Flanderconditions amo

009 were schizo=1 270 or 16.45

onditions with thee paraphilia (5725.17%) and pbased on old dal are very low in ese results havpulation rates.

n Health System

ns (”for mission”; ncreased ychiatric as high

rs 7.7%, ong the ophrenia 5%) and e largest 7/157 or psychotic ata (year Belgium

ve been

Fh

S

Pe

Teeb(s

Performance

Figure 13 – Pehospitals, by reg

Source: FPS Public

Participation rateemployment

The last EU Laboemployment rate oemployment rate obut is ranked loweFigure 14). An up

soon.

0

2

4

6

8

10

12

14

16

2000 20

Invo

lunt

ary

adm

issi

on ra

te (

%)

Belgiu

rcentage of invion (2000-2009)

Health, Minimum P

by people wit

our Force Surveyof people with meof people with other than Norway, t

pdate of this study

001 2002 2003

um Flander

voluntary comm

Psychiatric data (RP

th mental illness

y performed in 2ental disabilities isher disabilities.29

the Netherlands, y (year 2011) is ex

2004 2005 20

rs Brussels

mittals in psych

PM – MPG)

s of working ag

2002 showed thas low compared tBelgium performsSweden and Por

xpected to be rele

006 2007 2008

s Wallonia

73

iatric

ge in

at the to the s well rtugal eased

2009

74

Figure 14 – Ememployment comparison (2

Source: Europea

mployment ratesrate of all p

2002)

an Labour Force Stu

s by health conpeople with d

udy 2002

Belgian

dition, as a ratiodisability: intern

n Health System

o of the national

4•

•

•

•

•

Performance

4.1.3 Key findi The relative s

cervix cance(62% for menrelative survicolon cancerEU-15 averag

Hospital adm2009), and Be

The suicide rEuropean cobetween 1998for women, aFor the perioFlanders and

The percentaBelgium stea8.2% of all pstwice as highFlanders 7.7%(year 1998). Tvery low in B

The last EU lperforms weemployment recent data a

dings survival 5 years r and colon canc

n, 65% for womeival rate in Europr, but the cervicage.

mission rates for elgium is just abrate is considera

ountries, even if i8 and 2008. The

and higher for miod analysed, the d Brussels. age of involuntaradily increased bsychiatric hospith as in the two ot% and Wallonia 7They showed tha

Belgium compareabour survey (inll compared to Erate of people w

are lacking.

after a diagnosiscer is respectiven). Belgium has pe for female breal cancer surviva

asthma are stabbove the EU-15 avably high compart decreased sligsuicide rate is hiddle-aged adultsrate is higher in

ry psychiatric hobetween 2000 andtalisations. The rther regions (Bru7.2%). Results arat rates of involued to other Europn 2002) showed tEU countries conwith mental disab

KCE Report

s of breast cancely 88%, 70% andthe highest 5-ye

east cancer, and al is lower than th

ble over time (200verage. red to other htly in Belgium igher for men ths (aged 40-64 yeWallonia than in

ospitalizations ind 2009 from 5.8%rate in Brussels iussels 14.2%, re based on old d

untary committal pean countries. that Belgium ncerning the bilities, but more

t 196

er, d 63% ear

he

04-

an ears). n

% to is

data are

KCE Report 196

4.2 Approp4.2.1 How dAppropriateneshealthcare is evidence”. The link between ouSeven indicatorScreening out o1. Breast can

(aged 40-42. Breast can

71-79) Application of g3. Follow-up o4. PrescriptioGeographic var5. GeographicMental Health 6. Average

(antidepresAggressiveness7. Proportion

days of the

6

priateness did we evaluate ss can be defin

relevant to the link between effe

utcomes and procrs were selected tof the target groupncer screening fo49) ncer screening for

guidelines of diabetic patientn of antibiotics acriation in surgical cal variation in ca

daily quantity ssants / antipsychs of care at the enof cancer patien

eir life

the appropriatenned as “the deg

clinical needs, ectiveness and apcesses. to measure the apps or women younge

r women older tha

ts (blood and eye ccording to guideliinterventions

aesarean sections

(ADQ) of hotics / hypnotics and-of-life nts receiving chem

Belgian

ness of care? gree to which pgiven the curre

ppropriateness ref

ppropriateness of

er than target ag

an target age grou

exams) nes

per 1000 live birt

medication preand anxiolytics)

motherapy in the

n Health System

provided ent best lects the

care:

ge group

up (aged

ths

escribed

e last 14

4

Tfow

MTtathctoTladloathpm

r

Performance

4.2.2 Facts an


Mammograms coThe national breasargets women aghe extension of categories (70-79)o which the screeThe percentage ofast 2 years was differences acrossower (21% in 201and Wallonia (Fighose mammograpossible to distinmammograms, ba

This include

diagnosis

nd figures


overage outside st cancer screenied 50-69. Two re

this target grou) in Belgium.48, 49

ening is performedf women aged 40stable around 35s regions. For w0), but increasing

gure 15). It shouams are performguish between o

ased on the reimbu

es all mammogram


of the target groing programme se

ecent guidelines hup to younger Those two indica

d outside of the ta-49 who received

5% between 2006women 71-79 yeag, and also with hld be noted that

med for diagnostopportunistic screursement codes).

ms, for opportuni


oups et up since 2001-ave not recomme(40-49) or olderators reflect the erget group. a mammogramr

6 and 2010, with ars old, the ratesigher rates in Brua small proporti

tic reasons47(it iseening and diagn

stic screening an

75

ented n the

-2002 ended r age extent

in the large s are

ussels on of s not nostic

nd for

76

Figure 15 – Ma

Source: IMA-EPS

0%

10%

20%

30%

40%

50%%

female

s 40

-49 y

ears

scr

eene

d

B

ammogram cove

S, KCE calculation

2006 200

Belgium Bru

rage of women a

07 2008

ussels Fland

Belgian

aged 40-49 years

2009 2

ders Wallon

n Health System

s and of women a

2010

nia

Performance

aged 70-79 years

0%

10%

20%

30%

40%

50%

2006

% fem

ales

70-79

yea

rs s

cree

ned

Belgium

s, by year and re

6 2007

m Brussels

egion

2008 200

Flanders

KCE Report

09 2010

Wallonia

t 196

KCE Report 196

Application of and prescriptio

Several situatiochronic patienmanagement orecommend thmonitored prefmonths. It is alsfundus examicomplications. Oreceived a bloalbumin check.over a period consultation. Tregard to glycadiabetic patienconsultation apanalyses showthan 75 years aThe appropriateof the prescript2000s, the authphysicians concbe prescribed opreferably tenamoxicillin shou

6

guidelines: folloon of antibiotics

ons permit evalunts, in particulaof diabetic patienhat glycated haeferably once a yeso recommended nation every yOver a 15-month

ood sugar check. In the last 12 mof three years,

The recommendaated haemoglobints who are not

ppears to be an ied that guideline

and for patients in eness of therapetion of antibioticshorities have beencerning the issueonly where they ad towards first-uld be prescribed

ow up of diabetic (acute care)

uation of the quaar the integratents. For diabetic emoglobin, albumear, and never lethat an ophthalmear in order tperiod, 95% of in

k, 93% a creatinmonths 57% had

20% of patientsations are relativn. The situation is

treated with insussue for one thirs are less well foresidential care.2

utic prescription is according to gun raising awarene of antibiotic resis

are really necessa-line antibiotics. in first intention w

Belgian

c patients (chron

ality of the monited and multidis

patients, the gumin and creatiness often than e

mologist performs ato early detect nsulin-dependent nine check and

undergone a ches had no ophthavely well observs less satisfactoryulin. The ophthard of diabetics. Sollowed for patien26 is evaluated on thuidelines. Since tess among the pustance. Antibioticsary and the choice

For most indwithout clavulanic

n Health System

nic care)

toring of ciplinary uidelines nine are every 15 a dilated

ocular patients 56% an eck and, lmologic

ved with y among lmologic ubgroup

nts older

he basis he early

ublic and s should e should ications, acid.

4aTwfivwhisTamp

GinRinbth1crethfrthatw

Performance

43% of patients wantibiotics during tThe number of dawith 21.2 in 2006)irst-line. For examvery often prescrwould suffice (thehigher rate of press observed in comThere are no interantibiotics prescribmore than twice apop/day versus the

Geographic varnappropriate carResults from intern the majority of Ebirths in 2009. Behan the EU-15 a93/1000 live birth

continuously increevealed a very highe national rate wrom 2004-2007) ahis average.50 Gealso been shown wo procedures fo

who consult a Gthe year. This – hays of treatment ). Furthermore, thmple, a combinatiribed even thoug 45% has been s

scriptions to patienmparison with the rnational data for tbed per capita reas much as the e Netherlands, 11

iation in surgire: the case of canational comparisEuropean countrieelgium has a C-seaverage. In 2009hs. Despite this seasing. Moreover,gh variability betw

was 13.7% (basedand relative differeeographic variabilin Belgium for h

r which Belgium r

P receive at leasigh – figure has bis increasing (23

he antibiotics presion of amoxicillin gh a prescriptionstable since 2006nts over the age oover-75s in generthis specific indica

eveals that BelgiuNetherlands (Bel

1.4 DDD/1000 pop

ical interventionaesarian sectionson show that C-ses, with EU-15 avection rate similar9, the C-section somehow reassu, an analysis of t

ween hospitals; in d on a selection oences ranged frolity for elective suip replacement a

ranks in the top of

st one prescriptioeen stable since 23.9 in 2008 compscribed are not aland clavulanic a for amoxicillin

6). In addition, a of 75 in residentiaral.26 ator, but comparism is in the top 5lgium, 27.5 DDD/p/day).5

ns as evidenc

sections are increverage at 251/100r to France, and rate in Belgium

ring result, the rathe FPS Public Hthe period 2004-2

of low-risk pregnam 61% to 70% arurgical proceduresand knee replacef EU-15 countries.

77

on for 2006. pared lways cid is alone much l care

son of 5, and /1000

ce of

asing 00 live lower

m was ate is

Health 2007,

ancies round s has ment, .5, 51

78

Figure 16 – C-s

Source: OECD H

Appropriateneantidepressan

Average daily q(DDD) per 1000The prescriptioper 1000 popPrescription of

sections per 100

Health data 2012, ex

ess of prests

quantity of antide0 population) n of the averagepulation increasef antidepressant

00 live births: inte

xcept for Belgium 20

scriptions in

epressants prescri

daily quantity aned from 51.4 (

drugs are high

Belgian

ernational comp

009 (FPS Public He

mental hea

ribed (Defined Da

ntidepressants pre(2004) to 68.4 hest in Wallonia

n Health System

arison

ealth)

althcare:

ily Dose

escribed (2010).

a (85.9,

chInacNindm

Performance

compared to 57.1higher for femalesnternational comantidepressant coconclude from thNevertheless, thenternational contedrugs (e.g. over-monitored.

1 in Brussels and (92.8) compared

mparison shows tonsumption (seeese figures if Be

e large differenceext) pinpoint that - and undercon

d 60.7 in Flande to males (43.1).that Belgium ran

e documentationselgium is performes (between sex

the appropriatensumption) needs

KCE Report

ers). It is conside

nks high in terms sheet). We caming better or wxes; between regness of antidepres to be studied

t 196

erably

ms of annot

worse. gions; essant and

KCE Report 196

Figure 17 – De

Source: Pharman

Average daily per day) The prescriptio1000 populatiobetween regionAggressivenesspatients Receiving (or incancer patients

0102030405060708090

100

Dai

ly c

onsu

mpt

ion

of a

ntid

epre

ssan

t pe

r 100

0 po

pula

tion

6

efined daily dosa

net (RIZIV – INAMI,

quantity of antips

n of antipsychoticon) to 2010 (10.5ns (higher in Brusss of care at th

nitiating) a sessios is considered un

Belgium B

Flanders W

age of antidepres

for Belgium) and O

sychotics prescrib

c medication incre5 per 1000 popusels and Walloniahe end-of-life: ch

on of chemotherapnappropriate agg

Brussels

Wallonia

Belgian

ssants per 1000 p

OECD Health Data 2

bed (per 1000 po

eased from 2004 ulation), with diff than in Flanders)hemotherapy for

py near the end-oressiveness of tre

0

10

20

30

40

50

60

70

80

DD

D p

er 1

000

pop

ulat

ion

per d

ay

Belgi

Germ

Unite

n Health System

population per d

2012 for internationa

opulation

(8.0 per ferences ). r cancer

of-life for eatment.

TisFthcwpp

um Fr

many Ne

ed Kingdom EU

Performance

ay: by region (20

al comparison

The percentage ofs an internationaFunds on end-of-lhe highest use of cancer patients wwas 12.1% for ppalliative care unitpatients who died

rance

etherlands

U-15

004-2010) and in

f people receivingally used indicatoife care for cance

f chemotherapy duwho died in hospipatients dying at ts. The lowest usin residential care

0.0 10.0

Italy

Netherlands

Luxembourg

Germany

Spain

EU-15

United Kingdom

Belgium

Finland

Sweden

Portugal

Denmark

DDD

ternational comp

g chemotherapy nor. A study of ther patients (data uring last month otal (23.1%). The home and 11.5

se of chemotherape for elderly (3.4%

40.0

40.6

44

4

20.0 30.0 40.0 5D per 1 000 population per da

parison (2000-20

ear the end of thehe Christian Sick2005)43,42 showed

of life was observeuse of chemothe

5% for those dyipy was seen in ca

%).

4.6

46.7

61.2

61.3

65.9

68.7

68.8

75.8

78.

0.0 60.0 70.0 80.0ay - Antidepressant (2010)

79

010)

eir life kness d that ed for erapy ng in ancer

.7

83.8

90.0

80

Figure 18 – Ch

Source: Results f

Residential ca

Palliative care un

hemotherapy nea

from study “De CM

0

Home

Hospital

re for elderly

nit in hospital

Last week 1m

ar end-of-life for

neemt het levensei

5 10 15%of pe

month ‐ 1 week 3

Belgian

patients with can

inde onder de loep:

20 25 30eople

3‐1 months

n Health System

ncer, by place of

de cijfers” 43

35

Performance

f death

KCE Reportt 196

KCE Report 196

4.2.3 Key fi• Breast can

years. Howscreened Brussels, time showoften a mamammogrand Fland18% in 200

• Over a 15-received aan albumitest and, oophthalmo

• The perceto amoxic(Brussels:very high there are cDefined Dasize exist

• CaesareanBelgium 1births), buSeveral stcaesarean

• The presc2010, withthan in Brthat Belgiu

6

indings ncer screening iswever, there is a before that age (46% in Wallonia

ws no real decliniammography: 21raphy in the last ers 16%). Evolut06). -month period, 9a blood sugar chn check. In the laover a period of tological consultantage of prescripillin and clavulan: 43%, Flanders: internationally inconcerns about caily Doses (DDDbetween countrin rates in Belgium93/1000 live birth

ut increasing, as udies on Belgian

n rates between hription of antide large differenceussels and Flandum ranks high in

s recommended large group of w

(36% in Belgium and 39% in Flaning trend. Older w% of 71-79 yearstwo years (Brusstion over time sh

5% of insulin-deeck, 93% a creatast 12 months 57three years, 20%ation. ption with amoxinic acid) is stable46%, Wallonia: 4

n terms of antibiocomparability of

D), especially if dies. m are lower thanhs in 2009, EU-1in the majority o

n data have showhospitals. pressants also in

es between regioders). Internationn terms of antide

Belgian

for women agedwomen who are

overall, 48% in nders). Evolutionwomen undergos old women hadsels 31%, Wallon

hows rising trend

ependent patientstinine check and7% had undergo

% of patients had

icillin alone (come, around 45% 41%). Belgium raotic prescription

f results in total oifferences in pac

n the EU-15 avera5 average 251/10

of European counwn a large variab

ncreased from 2ons (higher in Wanal comparison sepressant consum

n Health System

d 50-69

n over o less d a nia 28% ds (from

s 56% ne a no

mpared

anks n but of ckage

age (in 000 live ntries.

bility in

004 to allonia shows mption.

•

44SstoeSA1H23

O4

5P6

Fafo

Performance

The use of chdying from cThere are cufrom the Chrobserved forlowest for painterpret thisover time, reg

4.3 Safety of 4.3.1 How did Safety can be defstructures, renderso the user, proenvironment in thisSix indicators to evA generic indicato

. Medical radiatHealthcare Acquir2. Incidence of M3. Incidence of

calculated on Other safety indica4. Incidence of p

calculated on 5. In-hospital moPrescription of ant6. Percentage

antidepressanFour other indicatoare not yet measuor the next perform

hemotherapy duancer is an indicrrently no nation

ristian Sickness Fr cancer patientsatients who died s indicator correcgional difference

care d we evaluate the

fined as “the degs services, and atovider, or enviros definition extendvaluate the safetyr tion exposure of ted Infections

MRSA in hospital post-operative s

hospital dischargators in hospital pressure ulcer in hospital discharg

ortality after hip fratidepressants to eof persons age

nts using an antichors related to saferable, but data fromance report (det

ring the last daycator of the aggrenal data on this inFunds, the highe

s who died in hosin residential ca

ctly, more data aes and internatio

e safety of care?gree to which thettains results in w

onment”.4 Includids the dimension y of healthcare hav

the Belgian popula

sepsis (Patient S

ge databases)

hospitals (Patientge databases) acture

elderly ed 65 years aholinergic antidepety of long-term com the BelRAI wiltails on those indi

ys of life for patieessiveness of candicator. In a stuest use was spital (23.1%) andare (3.4%). To are needed on treonal comparabilit

? e system has theways that prevent ng the providerbeyond quality. ve been studied:

ation

Safety Indicator,

t Safety Indicator

and older prescpressant care for elderly pal probably be avacators in Append

81

ents are. udy

d the

ends ty.

e right harm

r and

PSI,

, PSI,

cribed

tients ailable ix C).

82

4.3.2 Facts


Medical radiatMedical ionisingto a large use level is measuradiation by in(2.29 mSv/pop)exposed are cabove 45 yearimaging is morinternational coare particularly

Figure 19 – Ex

Source: Europea

and figures


ion

g radiation is parof scanner and m

ured in millisieverhabitant increase) and decreased ichronic patients, rs old. Children are frequent and omparisons show high in Belgium (

xposition to medi

an Population Dose


rticularly high in Bmedical imaging inrts (mSv). The a

ed from 2004 to n 2011 (2.22 mSvpatients in reside

are less exposedmore intense in that average dos

Figure 19).

ical radiation per

from Radiodiagnos

Belgian


Belgium, in particn general. The irraverage level of 2009, stabilized

v/pop). The patienential care, and . Prescription of Wallonia.26 Resuses of medical irr

r inhabitant (mos

tic Procedures – Re

n Health System

resented e on the

ular due radiation medical in 2010

nts more persons medical

ults from radiation

Tin

nm

Ey

S

st 20 exams, exp

esults of Dose Data

Performance

Table 18 – Exposn nb mSv): Belgi

20

nb mSv/inhab.

2.0

Evolution year (X+1)/X

Source: RIZIV – INA

pressed in mSv):

med 2 (http://ddme

sition to medicaium (2004-2011)

004 2005 2006

00 2.01 2.11

0.4% 4.6%

AMI

international co

d.eu/_media/results

al radiation per in

6 2007 2008

2.18 2.25

% 3.6% 3.4%

omparison

s:ddm2_results_irpa

KCE Report

nhabitant (expre

2009 2010 2

2.29 2.29 2

1.6% 0.1% -2

a13v2.pdf)

t 196

essed

2011

2.22

2.9%

KCE Report 196

Healthcare-acqHealthcare-acqAccording to th(ECDC, www.ethe EU and abinfection. The urinary tract gastrointestinalthe acute hospiwere infected bavailable at thethe ECDC. In Belgium, su ISP, and is oInfections in Hacute care hosepsis, belongsIncidence of MRA decreasing incases/1000 adreaching 4.3 instatistically signacute care hoduring the secohospitals particdecrease of -0.decrease was application of tactually in revrationalization oNevertheless, tscreening prachospitals.53

6

quired infectionsuired infections he European Cecdc.europa.eu) ea

bout 37 000 of thmost frequent ty

infections, pne infections. In Beitals occurred in 2by a HAI.52 New e end of 2012, ba

rveillance of HAIsorganized by theospitals). For MR

ospitals (since 20s to the set of safeRSA ncidence was foudmissions), after n 2003. Since 2nificant decrease spitals, finally reond semester of ipating at least at29 new cases/10most impressivehe recommendatvision), the natioof the use of antithe interpretation ctices which vary

s (HAI) occur after e

entre for Diseaseach year 4 million

hem die as the dypes of HAIs areeumonia, bloodlgium, the last pre

2007, and showedresults of preval

ased on a commo

s is under the ree NSIH group (RSA, the surveilla007). The third ety indicators from

nd between 1994r which the inc2003, we measur

of the incidenceeaching 1.5 new 2010 (test for lin

t 5 surveillance pe000 admissions, p in the Brussels ions for the contr

onal hand hygiebiotics influencedof the indicator r

y in coverage rat

Belgian

exposure to hea Control and Pre

n patients acquire irect consequenc

e surgical site infstream infectionevalence survey id that 6.2% of the ence are expecteon protocol devel

esponsibility of thNational Surveillance is mandatoindicator, post-o

m the OECD.

4 and 1999 (from idence again inre a slow, const of nosocomial Mcases/1000 adm

near trend for a ceriods since 2003p<0.001) (Figure 2

hospitals. Probarol of MRSA (sincne campaigns, a

d positively this evemains influencedte and intensity b

n Health System

althcare. evention a HAI in

ce of the fections, ns and n half of patients

ed to be oped by

e WIV –ance of

ory in all operative

4.1 to 2 ncreased tant and MRSA in missions cohort of 3: annual 20). This ably, the ce 2003, and the volution. d by the between

NdSo

Performance

No international odifficult. An excSurveillance Systeon nosocomial acq

rganisations incluception is the em (EARSS), but quisition.

ude data on MRSEuropean Antithis European pr

A, making compamicrobial Resisrogram does not

83

arison tance focus

84

Figure 20 – Me

Source: National

0

0,5

1

1,5

2

2,5

3

3,5

4

4,5

5

nosocomial M

RSA/10

00 adm

issions

Source

ean incidence of

Surveillance of Infe

in

4,1

3,23,4

2,6

2

1994

/2

1995

/1

1995

/2

1996

/1

e: National surveilla

Healthcare Acqu

ections in Hospitals

MRcidence of nos

2,2

32,7

2,9

2,1

1996

/2

1997

/1

1997

/2

1998

/119

98/2

ance, B. Jans

Belgian

uired MRSA, per

(NSIH), WIV – ISP

RSA in Belgisocomial MRS

1 2

2,4 2,42,2

2

1999

/1

1999

/2

2000

/1

2000

/2

n Health System

r 1000 admission

an acute caSA (clinical sam

2,6 2,6

3,5

44,3

2001

/1

2001

/2

2002

/1

2002

/220

03/1

Surveil lance pe

Performance

ns (1994-2010)

are hospitalsmples) per 100

3

3,74

33,3

2

2003

/2

2004

/1

2004

/2

2005

/1

200

/2

eriods

s: 00 admissions

2,7

3,4

2,52,8 2,7

2005

/2

2006

/1

2006

/220

07/1

2007

/2

72,4

2,2 2,1 2,2

1

2008

/1

2008

/2

2009

/1

2009

/2

2010

/1

KCE Report

1,81,5

2010

/1

2010

/2

t 196

KCE Report 196

Patient Safety

Incidence of poIncidence of posafety in hospitthe basis of hoon Belgian dataBetween 2000 around 8 casesother Europeanbut it is unclearin coding of secIncidence of preThe occurrencenegative impachospital stay. Pcare.58, 59 This ibe calculated bon the accuracyThe global rate2000 and reachfor both surgicavailable on theOther data thaestimate prevaorganised for tAdvisory Panepressure ulcersincluded 19 96observed. Conmeasurements,incontinence apressure ulcers

6

Indicators (PSI)

ost-operative sepsost-operative septal (Patient Safetyospital discharge da, although with a and 2007, the inc

s per 1000 admissn countries which r whether this is dcondary diagnoseessure ulcer e of a pressure ulct on the individuPressure ulcers cndicator also belo

based on dischary of the coding pra

e of pressure ulcehed 17/1000 staysal and medical he OECD Health Dan administrativelence of pressurethe first time, foll guidelines (spes). This study wa64 patients. A pntrary to previo, no distinction w

associated dermas was 7%.60

sis psis is an internaty Indicator, PSI)54,

data. This indicatslightly different m

cidence of post-opsions. However, w

provided data, Bdue to higher incids.

lcer in a hospitalisual’s health57 andcan be prevented ongs to the set of ge data, but its aactices in hospita

ers in acute hospits in 2007, with inchospitalisations. Nata for Belgium.

e discharge datae ulcers. In 2008lowing the last E

ecific for registratas organized in 8ressure ulcer pr

ous Belgian prewas made betweeatitis. The preva

Belgian

tional indicator of 55, which is moni

tor has also beenmethodology.56 perative sepsis wawhen compared toBelgium ranks rathdence rates or diff

sed patient has ad often leads to a

with appropriatesafety indicators

accuracy largely dls. tals was 12/1000 creasing trends oNo more recent d

abases are avaia prevalence stu

European Pressution and classific

84 hospitals in 20evalence of 12.1

essure ulcer preen a pressure ul

alence of grade

n Health System

f patient tored on

n studied

as stable o the few her high, ferences

a serious a longer nursing that can depends

stays in over time data are

lable to udy was re Ulcer

cation of 008, and 1% was evalence lcer and 2 to 4

InHwfrtesin2hPaWmpaaeUecasgDapWcoeainpd

Performance

n-hospital mortaHip fractures are fwith an importantracture gives direechnical quality osafety, and seconn-hospital mortalit2004 and 2007. Thhospitals.50 Patients aged 65an anticholinergiWhile elderly indimedications, they physiological chanantidepressants wamitriptyline and delderly as they canUse of these ageeffects, including considerable influappropriateness osystem can be inguidelines.61, 62 During the last 5 yanticholinergic sidpercentages are Wallonia (11%) ancomparisons are hof consensus aboeffects.63,64,65 Nevantidepressants wnvestigation. Propsychopharmacolodocumented befor

ality after hip fracfrequent causes ot mortality risk. Bect information abof care, it is first cndly as an indicatty rate after a hiphere was also a h

5 years and oldec antidepressanividuals can be are at greater ris

nges associated with strong antidoxepin) are not n cause orthostatents has been afalls, among eld

ence over this inof prescribing behcreased through

years the prescripde-effects for eld

consistently hignd Brussels (10%hampered by absout what is an anvertheless, the

with (potential) antblems with the aogical drugs in re66 and should be

cture of disability in eldeBecause in-hospbout outcomes anconsidered as an tor of quality-effec fracture was 6.3

high variability in m

er prescribed ant drug (%) treated effectivel

sk of adverse druwith the aging cholinergic effecrecommended fo

tic hypotension, seassociated with hderly patients. Thndicator, as it is haviours by cliniceducation and tr

ption of antidepreerly (≥65 years) her in Flanders

%). It should be nsence of availablentidepressant witrelatively high

ticholinergic side appropriateness

the elderly poe a continuous are

erly and are assocital mortality aftend indirectly abouindicator of in-ho

ctiveness of care% in Belgium bet

mortality rates bet

ntidepressants u

ly with antidepreg reactions due tprocess. In particts (e.g., imipraor ongoing use iedation and confuhigh rates of adhe health systemtreatment-based

cians within the hraining and the u

essants known foris stable (14%).(17%) compare

noted that internae data but also byh anticholinergic prescription rateeffects warrant fuof the prescriptioopulation have ea of attention.

85

ciated er hip ut the ospital . The tween tween

using

essant to the cular, mine, n the usion. verse

m has . The health use of

r their . The ed to

ational y lack side-

es of urther on of been

86

4.3.3 Key fi• The averag

2009, stab(2.22 mSv/patients inChildren amore frequinternationradiation a

• A decreasobserved increased decrease odecrease w

• Incidence patient safdischarge operative Belgium racountries,practices

• Incidence pressure ureached 17for both su

• The in-hosBelgium bhospitals. data are av

• During thefor their anstable (13-compared

indings ge level of medic

bilized in 2010 (2./pop). The patienn residential careare less exposeduent and more innal comparisonsare particulary hsing incidence in between 1994 anin 2003. Since 2

of the incidence was most impresof post-operativfety (PSI) which data. Between 2

sepsis was stabanks high in com but this might bbetween countriof pressure ulce

ulcers in acute h7/1000 stays in 2urgical and medspital mortality rabetween 2004 and

More data are nvailable for bence last 5 years thenticholinergic sid-14%). The perce to Wallonia (13-

cal irradiation inc.29 mSv/pop) andnts more at risk ae, and persons a. Prescription of

ntense in Wallons show that averaigh in Belgium. healthcare-acqund 1999, after wh2003, we measure

of MRSA in acutssive in the Brus

ve sepsis is an inis monitored on

2000 and 2007, thle around 8 case

mparison with otbe due to large des. er is another PSIospitals was 12/

2007, with increaical hospitalisatiate after a hip frad 2007, with largeeded on trends

chmarking at intee prescription of de-effects for eldentages are high-14%) and Bruss

Belgian

creased from 20d decreased in 2are chronic patiebove 45 years ol

f medical imagingia. Results from age doses of me

uired MRSA was hich the incidence a slow and conte care hospitalsssels hospitals.nternational indic

the basis of hoshe incidence of pes per 1000 admiher European ifferences in cod

. The incidence r/1000 stays in 20asing trends overions. acture was 6.3% e variability betw

s over time, and fernational level.antidepressants

derly (≥65 years)er in Flanders (1els (10%).

n Health System

04 to 2011 ents, ld. g is

edical

ce again nstant s. This

cator of spital post-issions.

ding

rate of 000 and r time

in ween few

s known is 6-17%)

44CoaSths

IndtoMmohRmeCp

SaIn1

M2

R3

Performance

4.4 Continuity4.4.1 How didContinuity addressover time, is smoand regions”4, andSeveral aspects ohat continuity is skills, and good co

nformational conduring current pato another and fromManagement contmost commonly worganisational bouhealth problem)69;Relational continumore providers thevents68; Coordination: the professionals or be

Six indicators thatare presented: nformational cont. Percentage o

DMG) Management cont2. Percentage o

within a 6-weeRelational Continu3. Proportion of

most frequent

y of care d we evaluate the

ses “the extent toothly organised w

d to which the entiof continuity havethe result of goo

oordination of care

tinuity: availabilitient encounters; im one health evetinuity: coherent dwhether follow-upundaries (often fo

ity: an ongoing rehat connects care

integration, coordetween provider o

t assess the four

inuity of persons who h

tinuity of hospital discheks period for senuity

encounters that tly: Usual Provide

e continuity of cao which healthcawithin and acrossre disease traject

e been distinguishod information floe.67-72

y and use of danformation links cnt to another70;

delivery of care frop visits are madocus on care pla

elationship betweee over time and

dination and shareorganisations.70

above-mentioned

have a global m

arge followed wnior patients (65+)

were conducted r Continuity (UPC

KCE Report

are? re for specified u

s providers, institutory is covered.1 hed, based on theow, good interper

ata from prior ecare from one pro

om different prove when care cro

an for specific, ch

en patients and obridges discontin

ed information bet

d aspects of cont

edical record (G

ith a GP’s enco)

by the GP consC) index.

t 196

users, utions

e fact rsonal

events ovider

iders, osses hronic

one or nuous

tween

tinuity

MD –

ounter

sulted

KCE Report 196

Coordination 4. Proportion

meeting 5. Number of

schizophre6. Number of

the 3 last m4.4.2 Facts


Informational cSince 2001, thentrust a GP wGMD – DMG inlarge differenceBrussels 28%).(78% coveragreimbursement

6

of cancer pati

f re-admissions penia or (b) bipolar f contacts betweemonths of his/her

and figures


continuity he global medicalwith the task of mncreases progreses between regi The coverage by

ge for the 75+(entitled 54% ver

ients discussed

per 100 patients disorder

en the GP and thelife


l record (GMD –managing their me

sively and reacheons (Flanders 5y the GMD – DMG

+), and personsrsus not entitled 4

Belgian

at the multidis

with a diagnosis

e palliative patien


DMG) allows patedical data. The ued 46% in 2009 8%, Wallonia 31G is higher for thes entitled to in44%).

n Health System

ciplinary

s of (a )

nt during

resented e on the

tients to use of a but with

1%, and e elderly ncreased

F(

S

MLApthrewreckfr

Performance

Figure 21 – PercGMD – DMG), by

Source: RIZIV – INA

Management conLink Hospital-GPsAs hospitalisation person, a GP’s enhe U.K.73 We haelevant in Belgium

with a GP in the wegion, this perce

continuity of care bknow if the GP’s erom the patient’s o

centage of popuy region (2006-20

AMI

ntinuity s

discharge is a pncounter in the 6 wave adapted the m. A majority of eweek after a dischentage is lower (4between the hospencounter followeown initiative.

ulation with a gl009)

pivotal moment inweeks following ddefinition to one elderly (58%) havharge from the ho42.5%). This res

pitals and the first ed a discharge pla

lobal medical re

n the care of an discharge is advis

week, which is ve at least one coospital. In the Brusult is an indicati

line, even if we dan from the hospi

87

ecord

older sed in more

ontact ussels on of

do not ital or

88

Figure 22 – Pand over) foldischarge, by

Source: IMA – EP

Link GPs-speciSince 2007, preimbursement are referred bycertain specialimeasure aims tand to stimulateare free to go specialist consincreased reimspecialists). Thproportion of reattention to a re

Percentage of holowed by a coregion (2003-200

PS, KCE calculation

ialists patients with a of health expend

y a GP. The meaists and to one cto improve the spe a first encountedirectly to the s

ultations identifiebursement is veryis result does not

eferrals between Geimbursement me

ospitalisations fontact with a G

09)

n

GMD – DMG aditures for a spec

asure is limited in consultation per

pecialist-general per with a GP becasecond line. Howd as prescribed y small (around 2t allow drawing aGPs and specialiseasure aimed at fa

Belgian

or the elderly (aP within 1 wee

re entitled to acialist consultation

scope: it appliesyear per special

practitioner’s collaause in Belgium,

wever, the percenby a GP and lea

2% of all consultany conclusion on sts. However, it dracilitating the coor

n Health System

aged 65 ek after

a larger n if they s only to ist. This

aboration patients

ntage of ading to ations at the real

raws the rdination

bph

RAtocsfolooinIntwo2mthresFTpcre

CMmpisgms2d

Performance

between GPs apercentage found heavy administrati

Relational continA longitudinal relao encourage compliance, and bservices and decror patients with ongitudinal continof the most commnterpretation. n the population owo years, aroundout-of-hours conta2009. It reaches 5meet the less strinhe time (UPC ≥ 0egions, with a gr

same GP at leastFlanders (71%) anThese results alsprovider of care iscoverage rates ofelational continuit

Coordination: MuMultidisciplinary temany countries aspatients receive tis evidence-basedguidelines develomultidisciplinary dstaging and treat2003, a clear incdiscussions about

and specialists. in the data are

ive burden.

nuity ationship between

communication, behavioural problerease hospitalisat

chronic diseasenuity with the Usuaon index used. Th

of patients who hd 44% have seenacts). This perce55% for patients ngent criteria of ha0.75). Some differreater proportion t in 75% of the cnd a smaller proposo show that ths good and stablef the GMD – DMGty with the GP.

ultidisciplinary teeam meetings (Ms the predominantmely diagnosis ad, and that thereoped by the Kiscussion is recoment plan of cancrease of its uset how to better

Possible explaa lack of knowle

physician and paimprove sati

ems, and stimulattions and emergee.74 There are al Provider of Cahe advantage of t

ad at least 3 conn the same GP (nentage was stableaged 65-84 years

aving seen the sarences are observof patients havin

cases (UPC ≥ 0.7ortion in Brussels he relational cone over time. It alsoG in Wallonia do

eam for cancer pOC – COM) havet model of cancernd treatment, tha

e is continuity ofKCE and the Commended to decncer patients. Sine is noticed for involve GPs are

KCE Report

nations for the edge by GPs or

atient is acknowleisfaction, medicte receipt of preveency department several measurere (UPC) index ashis indicator is its

tacts with a GP dnot taking into ace in the period 2s. 72% of the pame GP at least 75ved between the

ng encounters wit75) in Wallonia (7(66%).

ntinuity with the o shows that the not implicate a w

patients e been implementr care to ensure that patient managef care.75 In all caCollege of Oncocide on the diagnnce its introductiall cancer types

e currently condu

t 196

low a too

edged cation entive visits

es of s one easy

during count 2003-tients 5% of three

th the 74%),

main lower worse

ted in hat all ement ancer ology, nostic, on in

s and ucted.

KCE Report 196

Overall, about 6in 2008, with labreast cancer pan increasing ufrequently discfollowed by Wa

Table 19 – Perregion, (2005-2

Source: Belgian CNote: all tumours

0%

10%

20%

30%

40%

50%

60%

70%

80%

%M

OC-

COm

Bel

6

69% of cancer paarge variations bpatients, 74% lunguse is noticed for acussed at the MOallonia (63% in 200

rcentage of canc2008)

Cancer Registry ans excl. non-melanom

2005 2

gium Bruss

atients were discuetween types of g cancer, 59% proall three regions, OC – COM in F08) and Brussels

cer patients who

d evaluation of Canma

006 200

els Flanders

Belgian

ussed at the MOCcancer (in 2008:

ostate cancer).46 Acancer patients a

Flanders (74% in(56% in 2008).

had a MOC – CO

ncer Plan46

07 2008

s Wallonia

n Health System

C – COM 84% of

Although are more n 2008),

OM, per

CAhainaHcdpcuTdaara17(eab

CW(ancGfrshoh

8

Performance

Coordination: MeAlthough unforesehealth, mental heaan indicator of poon receiving data, ravailable for this reHospital readmisscomplications follodisorders since thplanning: follow-ucoordinated beforeup visits after discThe re-admissiondisorders within taround the OECDand 15.6% for bipates are the high9.7%) and lowes

7.1%). For schizoespecially in Flan

an increasing trenbipolar disorders a

Coordination: EnWith the regulationat home or in a

needed for the ccontinuity of care. GPs during end-orom different stushows that 72% ohad a contact withof contacts betwehigher in the Nethe

ental health careeen and unavoidalth related emergor coordination of results on the EReport. They will be

sion rates are alsoowing an inpatienthey indicate premup care and sue discharge) or laharge). n rates for patithe 30-days of

D-average of EU-polar disorders). hest in Flanders (st in Brussels (s

ophrenia, there is nders and Wallonnd in Flanders. Tare decreasing in

nd-of-life of pallian of palliative careresidential setting

coordination of sThere are currenf-life of palliative

udies. A study onof the palliative pah a GP during theeen palliative paterlands than in Be

dable emergenciegency room (ER)care and service

R use for mental he analysed for theo widely used as t stay for psychiatature discharge (upport have no

ack of continuity o

ents with schizothe initial hospit

-15 countries (20For both conditio

(schizophrenia 25schizophrenia 10.

an overall increania). For bipolar dThe re-admission

Wallonia.

ative patients e services in the rg) a more prominservices. This is tly no national dapatients but somn Christian Sicknatients who died e last week of theients and their Gelgium.76

es do arise in m) admission is usefailures. Due to dealth problems ar

e next update. proxies for relap

tric and substance(sub-optimal dischot been approprof services (e.g. fo

ophrenia and btalisation are situ

0.2% for schizophons these readmi5.2%; bipolar diso.2%; bipolar disoasing trend in Bedisorders, there isrates for patients

esidence of the pnent role of the G

thus an indicatta on the contactse results can be ness Funds memat home in 2005-ir life.42, 43 The nu

GP appeared how

89

mental ed as

delays re not

pse or e use harge riately ollow-

ipolar uated

hrenia ission orders orders lgium

s only s with

atient GP is tor of s with given

mbers -2006

umber wever

90

4.4.3 Key fi• The contin

stimulatedin Belgiumshows an particularlpersons eimproved,

• The managinterestinghospitalisahave at leaBrussels c

• The relatioparticularl

• The coordmultidiscipatients, wbreast can

• The coordservices (ecommunitpatients waround theFlanders.

• The coordshould be lacking anpalliative psituation t

indings nuity of medical d since 2001 by tm. Since its introd

increasing trendly reaches the vuntitled to increas especially in Brgement continuig indicator, overaation discharge, ast one contact wcompared to the onal continuity wly in the age grou

dination of care foplinary oncology

with large variationcer), and betweedination of mentae.g. assertive coty. The re-admiss

with schizophrene OECD-average

dination of palliatat the level of th

nd some studies patients and theito the Netherland

information manthe global medicduction, the used. Moreover, the ulnerable populased reimbursemerussels and in Wty between hospall for elderly. W a majority of eldwith a GP. Resultwo other region

with the same GPup 65-84 years aor cancer patieny meetings for abons between typen regions. al health care reqommunity care; fosion rate within tia and bipolar di

e, with higher and

tive care at homehe GP. However, showed less conir GP when they ds.

Belgian

naged by GPs is al record (GMD –of the GMD – DMGMD – DMG

ation (elderly andent) but it could allonia.

pital and GPs is aWithin one week a

derly patients (58ts are however lns. P is good in Belgand in Wallonia. ts is organised bbout 69% of canc

pes of cancer (89

quires a broad arollow-up by GPsthe same hospitasorders are situad increasing rate

e or in nursing hnational data ar

ntacts between compared the B

n Health System

– DMG) MG

d be

a after a 8%) ower in

ium,

by cer

9%

rray of s) in the al for ated es in

omes re

Belgian

44PreeAin•

•

•

T1

2

3

Performance

4.5 Patient C4.5.1 How did Patient-centeredneesponsive to ind

ensuring that patieAccording to this ndicators: Acknowledge

right; patientsspiritual suppaspects; comf

Providers skipatients carecourtesy/respto relieve feapoor commun

Patients and care and to mpatients/carersupport; patiepatients involvdecision or sh

Three indicators re. Percentage o

satisfied with 2. Percentage o

controlled 3. Percentage o

or institution)

Centeredness d we evaluate pa

ess is defined as dividual patient pent values guide a

definition, sever

ment of patientss’ needs; preferenport; cultural neefort; social supporll of communicatefully; providersect; spent enough

ar and anxiety; lnication.

carers involvememake informed ders information; ents/carers involvevement in quality

hared decision-maelated to centeredof population abhealthcare servicef adult inpatients

of patients dying i

atient centeredne“providing care thpreferences, neeall clinical decisionral categories are

s needs, wants, nce of care; pain eds; patients’ strrt. tion: providers ab

s ability to exh time to their patianguage; global

ent (enabling patecisions about thinformed conse

ement in services y improvement; paaking. dness are availablbove 15 years oes who reported ho

n their usual plac

KCE Report

ess? hat is respectful oeds, and values,ns”.6 e used to classif

preference: patmanagement; pri

rengths; psycho-s

bility to listen to xplain things client; emotional sucommunication

tients to manageeir treatment opt

ent; self-manageand delivery plan

atients’ participati

le: old who report t

w often their pain

ce of residence (h

t 196

of and , and

fy the

tients’ ivacy; social

their early;

upport skills;

their ions):

ement nning; ion in

to be

n was

home

KCE Report 196

4.5.2 Facts


Patients’ satisPatients have healthcare provthese issues. Apatient’s experused measure iBelgian citizenstheir contact w90% for contacOnly for hospitaDifferences berespect to agebetween socioeLarge differenclocation of the rural areas. Alsalways higher observed in Bru

6

and figures


faction often other ex

viders and their Although patients’ rience with the hin evaluating paties reported in the

with the healthcarcts with GP, dentals the satisfactionetween men and e are limited. Teconomic groups. ces are however patient: satisfacti

so, large differencein Flanders than ussels.


xpectations, wishsatisfaction depsatisfaction is onealthcare systements’ care experieHIS that they are

re system: the satists, specialists an level is lower (87

women are negThe satisfaction l

observed with reon is systematicaes exist between in Wallonia. Low

Belgian


hes and prioritieends of the ans

nly one limited aspm, it is still a veryence.77, 78 e in general satisfatisfaction level iand home care s7%). gligible. Differenclevel also hardly

egard to the geogally lower in citiesregions, as satisf

west satisfaction ra

n Health System

resented e on the

es than swers to pect of a y widely

fied with s above services.

ces with y differs

graphical s than in faction is ates are

Fs

S(

P

PTcth6dwascmcp

Performance

Figure 23 – Degreservice (2008)

Source: Results fromWIV – ISP)

Pain control

Pain control or paThe RN4CAST-prcountries) of nurshe patient survey68%.79 Results shduring their hospiwas always well caverage of 54% fostudy show that 4controlled. Less thmajority of patientcould to help thempatients).

ee of satisfaction

m Health Interview S

ain assessment isroject included a ses and patients. y, with 2 623 patihowed that 69% tal stay and amo

controlled. This plaor the 8 countries47% of the patienhan 2% said thets considered tha

m with their pain (

n with healthcare

Survey, Scientific In

s paramount in aone-off internatioSixty Belgian ho

ients surveyed anof patients need

ong them 41% deaces Belgium vers who participatednts said that their ir pain was neve

at the hospital staalways 71% of pa

e services, by ty

nstitute of Public Hea

a patients’ perspeonal survey (Euroospitals participatnd a response raded medicine foreclared that theirry low compared td. Other data frompain was usually

er controlled. Theaff did everythingatients; usually 23

91

ype of

alth

ective. opean ted in ate of r pain r pain to the m the y well e vast g they 3% of

92

Place of deathPlace of death care. A surveyexpressed a pnational data palliative care certificates (pal(2007) on thes(55.1% of all de(18.3% in 1998remained stableof deaths in nresidential beds

Table 20 – EvBrussels (1998

Period

1998 2007 Source: A study o

There are largedeath of patienhome is very lohigher in the Ne

is considered an

y showed that in preference for dypublished on the

in Belgium. Dlliative or not) in

se death certificateaths in 1998 to 58 to 22.6% in 20e.81 The decline inursing homes cs by skilled nursin

volution of plac8-2007)

Home H

23.0% 522.5% 5

on death certificates

e differences betwnts with cancer. Tow in Norway (1etherlands (45%).

n important indicaFlanders, 71.6%

ying at home.80

e place of deathata are howeveFlanders and in tes showed a sh51.7% in 2007) to007). The percenn hospital beds acan be explainedng beds in care ho

ce of death over

Hospital NuHo

5.1% 181.7% 22s in Flanders and B

ween countries wThe percentage of

3%), higher in Fl

Belgian

ator of quality of p% of persons inte

There are curreh of patients eliger available fromBrussels. A rece

hift from dying in o dying in a nursinntage of deaths aand the increased d by the substit

omes.

r time in Flande

ursing ome

Oth

8.3% 3.6%2.6% 3.1%Brussels 81

with regard to the f cancer patients landers (28%) an

n Health System

palliative erviewed ently no gible for m death ent study

hospital ng home at home number

tution of

ers and

her

% %

place of dying at

nd much

4•

•

•

•

Performance

4.5.3 Key findi There is curr

The few meainformation o

Belgian patiethe healthcaravailable in t

One survey ipain. The vasstaff does ev(always 71%

A recent studshowed a shThe percentalarge differendeath for patdying at hom(28%) and mu

dings rently a real lack surable indicatoof a complex subents are in generre system. Data ohe new wave of n hospitals showst majority of patverything they ca

of patients; usudy on death certiift from dying in

age of deaths at nces between cotients with cance

me is very low in uch higher in the

of data on patieors only providedbject. ral satisfied with of the patients’ ethe Health Interv

wed a relatively gtients considere

an to help them wally 23% of patieificates in Flandehospital to dyinhome remained

ountries with regaer. The percentagNorway (13%), he Netherlands (4

KCE Report

nts’ centerednesd fragmented

their contact witexperience will bview Survey. good managemed that the hospit

with their pain ents). ers and Brusselsg in a nursing hostable. There areard to the place ge of cancer patihigher in Flander5%).

t 196

ss.

th be

ent of tal

s ome. e of ients rs

KCE Report 196

5 EFFIC5.1 How diEfficiency is de(i.e. money, tim(macro-level) amaximum beneThree indicatosystem: 1. Percentage2. Rates of on3. Length of hOther indicatorefficiency of theoutside target g

5.2 Facts a


Utilisation of leThe price of geof the original which a generretail price to thpaid by the prescription ofexpenditures, bon their speciacertain minimuintroduced in 20

6

IENCY IN Hd we evaluate

efined as “the degme and personnand ensuring th

efits or results (calrs measure spe

e of prescription one-day hospitalisahospitalisation for rs already mentioe health system (fgroups for breast c

and figures


ess costly drugseneric drugs is midrug. Low-cost d

ric alternative exihe reimbursementpatient; (2) genf low-costs drugboth for the third-palty, physicians aum percentage o006 and revised (

HEALTHCAthe efficiency gree to which theel, called input)

hat these resourlled output)”.4, 8 cifically the effic

of low-cost drugs iations for surgery a normal delivery

oned above can afor instance the cocancer screening)


s in ambulatory cnimally 31% less

drugs are definedsts and which ht basis so that theneric drugs and s is thus a goparty payer and foand dentists are f low-cost drugshigher) in Decem

Belgian

ARE in healthcare? e right level of reis found for the

rces are used

ciency of the he

n ambulatory sett

y also help to illustoverage of mamm).


care expensive than t as (1) original dave lowered there is no suppleme

copies. Promotood way to limitor the patient. Derequired to pres

, the so-called “ber 2010.

n Health System

esources

system to yield

ealthcare

ting

trate the mograms

resented e on the

the price drugs for ir public ent to be ting the t health

epending scribe a “quotas”,

Bap4w

Performance

Between 2000 aambulatory settingperiod, the propo46.0% in 2010 (2which lowered the

and 2010, the g increased from rtion of low-cost

27.1% from geneir price).

total number of2.76 billion to 4.7DDD continuous

ric drugs and 18

f DDD prescribe7 billion. On the sly increased to r8.9% as original d

93

ed in same reach drugs

94

Figure 24 –ambulatory se

Note: DDD DefinSource: RIZIV – I

Utilisation of hospitalisation

Carrying out elcircumstances etc.) saves moconsidered as aThe Belgian su2008. The coincreasing trend25).

Percentage oetting (DDDs) (20

ed Daily Doses INAMI, Pharmanet

less costly infn)

lective procedure(e.g. inguinal her

oney on bed occan indicator of effiurgical day-case rmparison with ods, with Belgium

of low-cost me00-2010)

frastructures (on

es as day cases rnia repair, circumcupancy and nursciency.

rate grew from 42other European higher than the E

Belgian

edication delive

ne day versus

when allowed bymcision, cataract sing care. It is t

2.1% in 2004 to 4countries shows

European average

n Health System

ered in

classic

y clinical surgery, herefore

46.2% in s similar e (Figure


KCE Report 196

Figure 25 – Pe

Source: OECD H

Utilisation ofhospitalisation

The length of sorganisation acharacteristics to benchmark thIn Belgium, thedecreased from1.5 day above t

0

10

20

30

40

50

60

70

2000

surg

ical

day

cas

e ra

te

6

ercentage of surg

Health data 2010 82,

f less costly ns) tay after a norma

and care providonly (e.g. severityhe efficiency of the duration of hos

m 5 days in 2000 the EU-15 averag

0 2001 2002

Belgium

Netherlands

EU 15 - Average

gical one-day hos

except KCE calcula

infrastructures

al delivery is deterder characteristicy of illness). It is t

he healthcare systspitalization for ato 4.3 days in 20

ge of 2.9 days (Fig

2003 2004 200

France

United Kingdom

Belgian

spitalisations on

ation for Belgium 20

s (shortening

rmined more by facs than clinical therefore a good item. a normal delivery008. This is approgure 26).

05 2006 2007

Germany

United States

n Health System

n all surgical hos

008

classic

actors of patient

indicator

y slightly ximately

2008

United

Performance

spitalisations: int

0% 10

Germany

Spain

Finland

Ireland

EU-15

Belgium

Denmark

Kingdom

ternational comp

25%

0% 20% 30Surgical

parison

%

36%

39%

41%

42%

46

0% 40% 5 day care rate (2008)

6%

50%

58%

0% 60% 7

95

70%

96

Figure 26 – Av

Source: OECD H

5.3 Key fin• The perce

increased • The perce

in one-dayThese incris situated

• The duratidecreasedapproxima

0

1

2

3

4

5

6

2000

aver

age

leng

th o

f sta

ys in

day

sverage length of s

Health Data 2012

dings ntage of low-cosfrom 7% in 2001ntage of surgicay hospital grew freasing trends a

d above the EU-1ion of hospitalizad from 5 days in 2ately 1.5 day abo

2001 2002 2003

BelgiumNetherlands

stay for a norma

st drugs in ambu1 to 46% in 2010.al hospitalisationfrom 42.1% in 200re observed ove5 average.

ation for a norma2000 to 4.3 days

ove the EU-15 ave

2004 2005 2006

FranceUnited King

Belgian

al delivery: intern

ulatory setting

ns that were perfo04 to 46.2% in 20

erall in Europe. B

al delivery slight in 2008. This is erage of 2.9 days

6 2007 2008 2009

Germgdom Unite

n Health System

national compari

ormed 008.

Belgium

tly

s.

9 2010

manyed States

Performance

son

0

United KingdomNetherlands

IrelandSweden

SpainDenmarkPortugal

EU-15Finland

GermanyItaly

LuxembourgAustriaFrance

Belgium

Single spon1

ntaneous delivery -(20

1.81.9

2.12.42.5

2.72.7

3.13.23.2

3

2 3average length of

009)

KCE Report

3.54.04.1

4.34.5

4 5stay in days

t 196

KCE Report 196

6 SUSTASYSTE

6.1 How disystem

Sustainability is• To provide

education a• To be inno• To stay du• To be respFor all four eleThe last indicafinancial sustainMaintenance of1. Evolution o2. Medical gra3. Nursing graMaintenance of4. Acute careInnovation 5. Number of Financial Susta6. Health exp

(Total, repa

6

AINABILITEM d we evaluate

m? s defined as the sy and maintain infrand training, facilivative; rably financed by

ponsive to emerginements of the deator, total healthnability. f workforce over time of the maduates becomingaduates f facilities

e bed days (numbe

GPs using an eleainability penditures accordartition, % gross d

Y OF THE

the sustainabi

ystem’s capacity: rastructure such aties and equipme

collective receiptsng needs. efinition, specific ih expenditures, is

ean age of practisg GPs

er per capita)

ectronic medical fi

ding to the Systdomestic product

Belgian

HEALTH

lity of the healt

as workforce (e.g.ent;

s;

indicators were ss a generic indi

sing GPs

le

tem of Health A(GDP), per capita

n Health System

th

through

selected. cator of

Accounts a)

6

Tfow

MTa2mpin

F

NS

Performance

6.2 Facts and


Maintenance of wThe cohort of activage, as shown by2009 of physicianmeasuring this chpractising. The avn 2009, while it wa

Figure 27 – Age d

Note: only GPs with Source: Performanc

d figures


workforce: GPs ve GPs is changiny the lines superis with over 1 250

hange is to calcuverage age of full as 47.3 years in 2

distribution of GP

more than 1 250 coce of general medici


ng: it is very fast aimposed for the y0 contacts (Figurlate the average time equivalents

2000.

Ps (2000-2004-20

ontacts /year ine in Belgium, a ch


approaching retireyears 2000, 2004re 27). Another w

age of GPs cur(FTE) was 51.4

009)

heck up (RIZIV – INA

97

ented n the

ement 4 and

way of rrently years

AMI)26

98

Table 21 – Mea

Number of GPsmoothed FTEMean age Source: Performa

One of the reasnew GPs. As arelated to the nand, of these, tof newly-gradugraduates entearea in the twoyear study cyc34% in 1996.26

Table 22 – Pro

Graduates afte

number of phyphysicians wit% physicians wphysicians witspecialists (SPgeneralists (G%GP compareSource: RIZIV – I

Compared to ograduates (all) the 11.5/100 00

an age of practis

2000

P E

8 515

47.3 ance of general med

sons for this agein matter of fact, th

numbers of new pthe percentage eated generalists ring general med

o years following gle). This percenta

ogression betwee

er 2 years

ysicians (after 7 ythout specialisatwithout specialisth a specialisatioP) P)

ed to GP +SP INAMI

ther European coof 9 medical grad

00 pop EU-15 ave

sing GPs (2000-2

2004 2

8 472 8

49.2 5dicine in Belgium, a

ng of GPs is the pe non-replaceme

physicians enterinntering general mis calculated by c

dicine to all gradugraduation (upon age currently stan

en 1996 and 2008

years) tion sation on (GP+SP)

ountries, Belgium duates per 100 00erage (Figure 28).

Belgian

009)

2008 2009

8 336 8 28

51.3 51.4a check up (RIZIV –

problematic recruint of older GPs is

ng the medical promedicine. The percomparing the nuates entering a scompletion of the

nds at 30%, whil

8 of graduates in

1

has a number of 00 pop, slightly low

n Health System

9

83

4 INAMI)26

tment of s directly ofession rcentage umber of specialist e seven-e it was

n medicine in the

1996 1998

1 105 1 2193 17%

912 988600312

34%

medical wer than

Performance

e two years follow

8 2000

35 1 172 247 220% 1

8 970 628 6360 3

36% 35

wing graduation

2002

1 180 202 2117% 18%

969 632 684338 2855% 29%

according to typ

2004 20

1 142 811810%

1 024 7756268

26%

KCE Report

pe of specialisat

006 2008

814 941 11014%

704 781 493211

30%

t 196

ion

160 17%

554 227

29%

KCE Report 196

Workforce: nuThere is currenon workforce complemented example of micworkforce studyhospitals nursecompared to ot

Figure 28 – Me

Source: OECD H

0

Netherlands

Spain

Belgium

United Kingdom

Finland

Italy

EU-15

Portugal

Germany

Denmark

Ireland

6

rsing ntly no indicator at

in nursing. Hwith data that re

cro-level data is y based on surves have, on avher EU countries.

edical and nursin

Health data 2012

2 4 6Medical gra

t the macro level tHowever, macro-eflect the situatiothe recent largeey data. It was i

verage, to take 79

ng graduates (pe

8

8

9

9.3

11

11

11.5

12

1

8 10 12duates per 100 000 pop

Belgian

to document the q-level data sho

on at the micro le-scale European llustrated that in care for more

er 100 000 pop): i

5

2

12

16

18

14 16 18pulation (2010)

n Health System

question ould be evel. An nursing Belgian patients

CthsEthn

international com

20

Lu

Unite

N

Performance

Contrary to the GPhe education sidstudents every yeaEU-15 average ofhis figure, as alsonot work in Belgium

mparison (2010)

0.0 1

Italy

uxembourg

Spain

Germany

EU-15

ed Kingdom

France

Portugal

Ireland

Netherlands

Belgium

Finland

Number of Nurs

Ps, the source of de, as Belgium far, where the numf 31.3. A word of o foreign studentm.

16.2

19.9

20.9

2

10.0 20.0 30.0ing graduates per

this problem doeforms a very higmber for 100 000 i

caution is necests are counted, a

8.2

33.2

33.2

34.4

34.8

36.7

40.1

41.7

0 40.0 50.0100 000 population

es not seem to begh number of nuis 41.7, high abovsary when interprnd those will pro

58.7

60.0 70.0n (2010)

99

e from ursing ve the reting

obably

100

Maintenance oThe number opopulation’s neinfrastructure. TIn 2009, there hospitalisation acute care bedand stable sin1 day/inhabitanhigher utilisatio

Figure 29 – Ac

Source: OECD H

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

2000

Num

ber o

f acu

te c

are

bed

days

per

cap

ita

of facilities: numof acute care beeed for acute cThis indicator indicwere 13 million donly, excluding o

d days. This figurnce 2003. The t. Of the neighbn of acute care ho

cute care bed day

Health data 2012

0 2001 2002 200

Belgium

Netherlands

EU-15

ber of acute beded days per cacare beds, and cates how this nedays spent in acuone day). Per care is decreasing bEU-15 average bouring countriesospitals per inhab

ys per capita, int

3 2004 2005 200

France

United Kingdom

Belgian

d days pita is indicativethus about the ed is met.

ute care hospitals apita, this represebetween 2000 anis a bit lower,

s, only Germanyitant.

ternational comp

06 2007 2008 200

Germany

United States

n Health System

e of the needed

(classic ents 1.2 nd 2003,

around y has a

parison

09 2010

s

Un

Performance

0.0

FinlandNetherlands

SpainIreland

ItalyPortugal

nited KingdomFranceEU-15

BelgiumLuxembourg

AustriaGermany

0.5Number of a

1.0acute care bed da

KCE Report

1.5 2.0ays (2009)

t 196

0

KCE Report 196

Innovation: thetheir patients’ The percentagsoftware to ma2004 to 74% in

Table 23 – Pmaintain their

% of GPs who received a lump sum for using an electronic medical records. Source: RIZIV – I

Total healthcsustainabilityTrends in healtthus sustainainternational deOECD’s Systemat measuring coHealth Accounexpenditures inPer capita, this€3430/inhabitandata are also eFinally, the shadomestic produin 2003.

6

e percentage of medical records

ge of GPs usingintain their patien2010.

Percentage of Gpatients’ medica

2004

61%

INAMI

care expenditu

h expenditure areability. For inteefinitions for healm of Health Accouonsumption of heants are only comncreased from €27s represents an int in 2010. To alloexpressed in 200are of Total Heauct (GDP) accoun

GPs using an els

g an electronic nt’s medical recor

GPs using recoal records

2008 20

72% 75

ures as an i

e an important indernational compthcare and healtunts (SHA) are clalth and long-termmparable since 7.6 billion in 2003ncrease from €26ow comparisons

05 US$ Purchasinalth Expendituresnts for 10.5% of G

Belgian

ectronic file to m

file with recomrd increased from

ommended softw

009 2010

5% 74%

ndicator of f

icator of affordabparisons, the shcare expenditurassically used. SH

m care services. 2003. The tota

3 to €37.3 billion 660/inhabitant in between countrieng Power Parities (THE) in Belgia

GDP, compared to

n Health System

maintain

mmended m 61% in

ware to

0

%

inancial

ility, and standard re of the HA aims

l health in 2010. 2003 to

es, these s (PPP). an gross o 10.0%

Performance 101

102

Table 24 – Tota

Absolute amou

Per capita

Per capita (US$

% GDP

Source: OECD H

More than half care (HC.1) or contributors arecomponent, no(mainly pharma

s Roughly s

performingsocial cardaily livingLTC into iprovided tensure cocare, the O

al health expend

nts (in billions €)

$ PPP)

Health Data 2012

of the total healtrehabilitation caree services for lonot the social comaceuticals product

speaking, one couldg activities of dailyre as care helping ig (IADLs) (e.g. shoits health and sociato LTC recipients h

omparability of the SOECD issued speci

ditures according

2003

27.6023

2660.18

3026.8

10.0

h expenditures (5e (HC.2). The follong-term care (LTC

mponent, HC.3, 20ts, HC.5, 17%).

d define healthcarey living (ADLs) (e.individuals perform

opping, laundry, …)al components is chhave both a healthSystem of Health Aific guidelines.24

Belgian

g to the System o

2004 2005

29.4811 30.60

2828.97 2920

3155.5 3246

10.1 10.1

53%) is spent for owing two most imC) (specifically th0%)s and medica

e as care helping ing. dressing, eatinging instrumental ac). In practice, the dhallenging as manyh and social compoAccounts (SHA) for l

n Health System

of Health Accoun

5 2006

064 30.5214

0.84 2893.59

6.8 3277.6

9.6

curative mportant e health

al goods

ndividuals g…), and ctivities of division of y services onent. To long-term

FS

S

E1eh

Performance

nts (2003-2010)

2007 2008

32.2427 34.59

3034.41 3230

3423.3 3698

9.6 10

Figure 30 – HealSystem of Health

Source: OECD Heal

Expressed as a p5 average. But

expenditures, as healthcare expend

2009

992 36.303

.56 3362.48

.4 3911.4

10.7

lth expendituresh Accounts (2010

lth Data 2012

ercentage of the caution is need

the better and thditures, the higher

2010

37.3737

3430.17

3968.8

10.5

s in Belgium by 0)

GDP, Belgium isded when compahe more exhaustr the level of these

KCE Report

main function in

s very close to thearing total healthtive the registratie expenditures.

t 196

n the

e EU-hcare on of

KCE Report 196

Figure 31 – To

Source: OECD H

02468

101214161820

200

Tota

l hea

lth e

xpen

ditu

re a

s %

GDP

Be

Ne

EU

6

otal health expen

Health data 2012

00 2001 2002 200

elgium

etherlands

U-15

ditures as a % o

03 2004 2005 200

France

United Kingdom

Belgian

f GDP: internatio

06 2007 2008 20

Germany

m United St

n Health System

onal comparison

009 2010

y

tates

Un

Performance

n

0%

FinlandIreland

ItalySweden

nited KingdomGreeceEU-15

BelgiumPortugal

AustriaDenmarkGermany

FranceNetherlands

E2% 4%

Expenditure Healt

9%99

6% 8% 1th care - % gross

(2010)

%9%9%10%10%

10%10%11%11%11%11%

12%12%

12%

0% 12% 14%s domestic produ

103

%uct

104

6.3 Key fin• Concernin

challenginis currentlsince 2000ageing of number ofin anotherpercentagand is actu

• The numbhigh in Bepopulationpopulationwill proba

• The analyshigh utilisthere werehospitalisarepresentsEU-15 ave

• The innovthe percenpatient’s m2004 to 74

• Concerninexpendituin 2010. Pe€2 660/inhhealth expaccounts fclose to th

dings ng the Belgian heng since GPs arely 51.4 years. Th0, when it was 47GPs is the problf graduates who r specialty was 7e of graduates inually (2008) 29%

ber of nursing graelgium comparedn compared to thn but the foreignbly not work in Bsis of the mainteation of acute cae 13 million daysation only, exclus 1.2 acute care

erage (1 bed day/ative perspectiventage of GPs usimedical record. T4% in 2010. ng the financial sres increased froer capita, this re

habitant to €3 430penditures in Belfor 10.5%, comphe EU-15 average

ealthcare workfoe aging. The averis average age h7.3 years. One ofematic recruitemspecialize either

781 in 2008. Amon general medici. aduates per 100 d to other EU-15 he average EU-15 students are co

Belgium. enance of the facare hospitals pers spent in acute cuding one day). Pbed days in 2009/inhabitant). e of the health syng an electronic

This percentage

sustainability, theom €27.6 billion presents an incr0/inhabitant in 20lgian gross domeared to 10.0% in e.

Belgian

orce, some resultrage age of FTEshas risen very rapf the reasons of tment of new GPsr in general medng these graduaine was 34% in 1

000 population icountries: 41.7/15 of 31.3 /100 000

ounted although

cilities shows a rr inhabitant. In 20care hospitals (cPer capita, this 9, a bit higher tha

ystem is measurc file to maintain

increased from 6

e total health in 2003 to €37.3

rease from 010. The share oestic product (G2003, which is v

n Health System

ts are s of GPs pidly this

s. The icine or

ates, the 996

s very 100 000 0 they

relative 009,

classic

an the

red by their 61% in

billion

f total DP)

very

7

7

AepewinisT••••••

t

Performance

7 PERFORPROMO

7.1 How did wpromotion

According to the enabling people toprocess of health efforts that a sociewhole range ofnterventions), situs also largely situaThe guiding princip Participation Empowermen Sustainability Multistrategic Equity Multisectorial

In Belgium, t

depending onCommunities

RMANCE OOTION

we evaluate then? Ottawa charter23

o increase controlpromotion is com

ety does to promof interventions

uated for a considated outside the sples of health pro

nt

the “health promotin the Health Admins.

OF HEALT

e performance

3, “health promotl over, and to imp

mplex and can beote the health of t

(e.g., policies, erable part outsid

so-called “health pmotion are the fol

on sector” is reprenistrations and Minis

KCE Report

H

e of health

tion is the proceprove their health”e understood as ahe citizens. It cov

law, environmde the health systepromotion sector”t

llowing:

esented by the strustries of the Region

t 196

ess of ”. The all the vers a mental em. It t.

ctures ns and

KCE Report 196

Several framewindicators. Nutpromotion indicindicators (hea(health literacyoutcomes (heato final health mortality, and sadopted the Ncorresponds laCharter.23 In the context evaluation of hcomplete studyof a limited set we illustrated smost distal frolifestyles are epresent resultshealth promotio

6

works have beenbeam83 has propcators in 4 broalth promotion acty, social influenlthy lifestyle, effecand social outco

social health likeutbeam’s framew

argely to the bro

of this project, itealth promotion i

y in itself. With regof indicators and

some categories oom action outco

easier to documes for more proxion outcomes).

n proposed to cposed a framewoad classes rankions), through hence and policiective health servicomes (physical h

e well-being and work to classify thoad axes and p

t has not been pin Belgium since gard to the limitatunavailability of d

of the Nutbeam’s omes like health nt, we also tried imal indicators (

Belgian

classify health prork that classifiesing from most p

ealth promotion oues), intermediateces and healthy shealth like morbidequity). In this whe indicators, beprinciples of the

possible to perforthis would neces

tions we faced (codata for many indframework. Althooutcomes and

to define indicatas healthy envir

n Health System

romotion s health proximal utcomes

e health settings), dity and

work, we cause it Ottawa

rm a full ssitate a onstraint dicators), ough the

healthy tors and ronment,

Performance 105

106

Figure 32 – ThThe Nutbeam’s

Source: adapted “Health promotion

e Nutbeam’s fras framework

from the Nutbeam n actions”, the last c

mework and sele

framework83 category in the Nutb

Belgian

ected indicators

beam’s framework,

n Health System

to measure perfIn

H•••

InH••••H•••

H•••

is not represented h

Performance

formance of healndicators selected

Health and SocialOverweight anDental health:Incidence of H

ntermediate HealHealthy Lifestyles

Daily smokersAlcohol consuPhysical activiNutrition (fruits

Healthy EnvironmeComposite indPercentage ofOffer of physic

Health PromotionHealth LiteracSocial influencHealthy publiPolicies Scale

here

lth promotion d and classified w

l outcomes nd obesity decayed, missing

HIV

lth outcomes

s umption ity s and vegetables)ent dex of health promf schools with a pacal activity at seco

n outcomes cy: health literacy lce and action: pooc policy and or

e

ithin the Nutbeam

g, filled teeth at ag

)

motion policies in tarticipative healthondary school

level (not measuror social supportrganisation pract

KCE Report

m framework

ge 12

the municipalities promotion team

ed)

tice: Tobacco Co

t 196

ontrol

KCE Report 196

7.2 Facts a


7.2.1 HealthFour important described abovexpectancy, heas they are less

Overweight anAdult populationIn 2008, 47% considered as and almost 14%on the reportedthan in womenwomen. Although the oaverage EU-ratfor age, the rateregions, but theAs for other indlack of physical

6

and figures


h outcomes indicators of ge

ve in the chapter ealth expectancy, s specific to health

nd obesity n (aged 18 years of the Belgian pbeing overweight

% was consideredd weight and hei. For obesity, no

obesity and overte, they gradually e of obese peoplee difference tendsdicators related to activity, a strong


eneral health outcon the health staself-perceived he

h promotion.

or older) population (aged t or obese (Bodyd as obese (BMIight. Overweight differences were

rweight rates areincreased over ti

e is higher in Walls to have decreaso overweight, like social gradient is

Belgian


come have alreadatus of the populaealth and infant m

18 years or oldy Mass Index (BM≥30). Results aris more frequentfound between m

e slightly lower time. After standaronia than in the tw

sed over time (Figpoor nutritional h

s observed.

n Health System

resented e on the

dy been ation: life mortality,

der) was MI) ≥25), re based t in men men and

than the rdization wo other gure 33). habits or

Performance 107

108

Figure 33 – Pe(2000-2008

Source: Health In

Overweight andThe HIS surveoverweight andisp.be/epidemiooverall 18% ofoverweighed abetween gende

Dental health: DMFT is an intof dental cariesprevalence andMissing (M), Fmaximum mean

ercentage of the

nterview Survey, Sc

d obesity in childreey provides inford obesity in youno/epifr/CROSPFRf the young peond 5% was foun

ers.

decayed, missinternational index s in an individuald is obtained by Filled (F) teeth (Tn DMFT score be

adult population

cientific Institute of P

en and adolescenrmation about thng people (2-17

R/HISFR/his08fr/9.ople (aged 2-17 nd to be obese. T

ng, filled teeth (Ddescribing the aml. DMFT numericacalculating the

T). WHO goals slow 1.0 for 12-yea

Belgian

n (aged 18 years

Public Health (WIV –

nts he overall preval

years) (https://w.etat%20nutritionnyears) are foun

There was no di

DMFT) at age 12mount – the prevaally expresses thnumber of Decayset for the year ar-olds.

n Health System

or older) with ob

– ISP), and OECD H

ence of www.wiv-nel.pdf): d to be ifference

alence – e caries yed (D), 2010 a

Ins(inpyaTM

Performance

besity (BMI ≥30),

Health Data for inte

n a national survesample of 30 child1.0) from a previon 2001. Neverthelpermanent teeth. year-olds (n=95). analysis by sex, reThe number of stuMoreover, the sco

, by region (1997

rnational compariso

ey performed in 2dren aged 12 waous study based oless, 43% of theseThe mean DMFTThe very small

egion or by socioeudies performed pe is often limited

7-2008), and inter

on

2009-201084, the mas 0.9 (± 1.37). Ton a large sample e children had sigT score was 1.3

sample does noeconomic status.in Belgium to dat

d to small selected

KCE Report

rnational compa

mean DMFT scorehis confirms the performed in Flan

gn(s) of dental car(± 1.82) for the 1ot allow any stra

te still remains limd areas.85

t 196

rison

e in a result nders ries in 12-14 atified

mited.

KCE Report 196

Incidence of HHIV is an imporserious morbidand shortened since the transmsex, safe injectindicator of the In Belgium, thediagnostic ratelong after the inThe diagnostic100 000 inhabitproportion of nobeing a mix of non-Belgian ca(such as Sub-Snon-Belgian caas a failure oexplanation foranalysis is nee3-4 per 100 000Figure 34 (a aregion from 19rates in Flandeincrease is obsmuch higher thaof a large city, whigh HIV-rate isrates in the twsemi-urban andFor Belgian phomosexual co

6

HIV rtant communicabity, high costs oflife expectancy.

mission is largelytion). Therefore, isuccess/failure of true incidence ra. This is an appr

nfection (the HIV-ic rate in Belgtants. Belgium on-Belgian casesresident and non

ases originate fromSaharan African ses are imported of health promor the large numbeeded. For Belgian 0 inhabitants. nd b) show the e85 to 2010, for a

ers and Wallonia served in Flandean in the other regwith the socio-culs a usual phenom

wo other regions rd urban contexts. patients, the mosntact (see Supple

ble disease in Eurf treatment and cIt is also a perf

y avoidable by beits incidence in af health promotion

ate is not known, aroximation since nfection remaininium for all cashas the particu

s (60% of cases w-resident people.

m countries with acountries). Partscases, and as sution in Belgium.er of imported ca cases only, the

evolution of the dall cases and for are quite comparrs since 1997. Tgions. The Brussetural characteristi

menon observed represent an ave st frequent way

ement S1).86

Belgian

rope. It is associacare, significant mfectly avoidable inhavioural measurdefined populatio

n. and is approachethe diagnostic cag long asymptomses is around larity to have with a known natA large proportio

a high prevalence of this large nuuch cannot be int. There is no cases in Belgium. rate is fluctuating

diagnostic rate ofBelgian cases o

rable. However, aThe rates in Brusels region mainly ics of an urban coin large towns. T

erage of rates fro

of infection wa

n Health System

ated with mortality nfection, res (safe on is an

ed by the an occur atic). 10 per a large ionality),

on of the e of HIV

umber of erpreted clear-cut

Further g around

f HIV by nly. The a steady sels are consists

ontext. A The HIV-om rural,

as male

Performance 109

110

Figure 34 – Dia

Source:Scientific

agnostic rate of

Institute of Public H

HIV by region, fo

Health (WIV – ISP)

Belgian

or all cases (a) an

86

n Health System

nd for Belgian ca

Performance

ases only (b) (1985-2010)

KCE Reportt 196

KCE Report 196

Figure 35 – Ra

Source: OECD H

6

ate of the new HIV

Health Data 2012

V diagnosis per

Belgian

100 000 inhabita

n Health System

ants: Internationa

Performance

al comparison

111

112

7.2.2 Interm7.2.2.1 HeaDaily smokersThe percentagewhich is slightlysince 10 years,from 31% in 19remained stablefound in highlyas high as for tthe data in this 21 and 24 yearsThe comparisoin Flanders than

Alcohol consuThe consumptio• Percentage

excessive men and 1

• Percentagereporting aaddiction b

• Percentagerisky single

The percentagearound 8%. Hbehaviour (tendconsumption bedrinking is highe

mediate health oalthy Lifestyle

s e of daily smokey lower than the E, mostly in men, 997 to 23.7% in e until 2004. The -educated peoplethe rest of the popage group reveals, a priority targetn between regionn in the other regi

umption on of alcohol is ase of men and woalcohol consumpt4 glasses/140g a e of the non-abst

a problematic alcobased on CAGE sce of the populatioe-occasion drinkine of excessive a

However, the radency to addictionehaviour is more est in the 15-24 a

utcomes

ers was around 2EU average. It hain whom the rate2008. The rate idecrease in the

e. The rate of smpulation. Howevels that smoking prt for prevention. ns shows that theions.

ssessed on the bamen aged 15 yeation (more than 2week in women);inent population (

ohol consumption cale, 2+ cut off);87

on (aged 15 yeang (≥ 6 drinks) at lealcohol consumptte of people w

n) is increasing, mtypically masculin

age group.

Belgian

20% in Belgium as significantly de

of daily smokingn women is lowerate of smoking is

moking in young pr, a closer examinrevalence peaks b

e rate of smoking

asis of three indicaars and over repo1 glasses/210g a ; (aged 15 years a(defined as a tend7 ars and over) repeast once a weektion has remaine

with problematic mostly in Brussels.ne. Risky single-o

n Health System

in 2008, ecreased g passed er, but it s mainly

people is nation of between

is lower

ators: orting an week in

nd over) dency to

porting a k. d stable drinking

. Alcohol occasion

To

D

Ebq

Dsw

S

Performance

Table 25 – Alcoholder) (1997-2008

Drinks alcohol in

Exhibits problembehaviour (CAGEquestionnaire)

Drinks 6 or more single occasion aweakly

Source: Health Inter

ol consumption 8)

excess

matic drinking E

drinks in a at least

rview Survey, Scien

habits for the po

1997 2001

7% 9%

7%

tific Institute of Pub

KCE Report

opulation (aged

2004 200

9% 8%

8% 10%

8%

lic Health (WIV – IS

t 196

15 or

08

%

SP)

KCE Report 196

Figure 36 – Pevegetables dai

Source: Health In

0%

5%

10%

15%

20%

25%

30%

Adjus

ted %

of pe

ople

eatin

g 2 fr

uits &

200g

ve

getab

les da

ily

6

ercentage of theily, (d) performin

nterview Survey 200

2004

Belgium Bruss

e population (a)ng at least 30 min

08, Scientific Institut

sels Flanders

Belgian

smoking daily, n of physical act

te of Public Health (

2008

Wallonia

n Health System

(b) with problemivity per day, by

(WIV – ISP)

Performance

matic alcohol coregion (1997/200

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Age-a

djuste

d % of

peop

le pr

actis

ing at

leas

t 30 m

in of

phys

ical a

ctivit

y per

day

Belg

onsumption, (c)01-2008)

2001

ium Brussels

consuming at le

2004

Flanders

east 2 fruits and

2008

Wallonia

113

d 200

114

Consumption The consumptcomplementary• Percentage• Percentage• Percentage

and 2 fruitsThe daily conshas progressevegetables. Altconsumed is fa200g vegetablerecommendatioaccording to thfruits or vegetaPlan90).

Physical activiStrong evidencmore active pedisease, high bcolon and breasactivity is difficuindicators raisechanged in thecurrently availaon physical actiThe global percminutes of any There is a lotmoderate) physwomen. There practising (at leWallonia (27%)

of fruits and vegtion of fruits a

y indicators: e of the populatione of the populatione of the populatios per day. umption of fruits d over time, anthough this is aar too low. Only 2es and 2 fruits dons (which are “he “Actieve Voedables, according t

ity ce demonstrates ople have lower rlood pressure, strst cancers, and dult to measure. Thed many questione next (E)-HIS. Mble. This being saivity in Belgium. centage of peopletype of (at least m

t of room for imsical activity rate

are important reeast moderate) p) or Brussels (22%

getables nd vegetables

n reporting to eat n reporting to eat n reporting to eat

and vegetables nd reaches 65% n encouraging p25% of the peopdaily, which is a“300g vegetables

dingsdriehoek”,88

to the WHO89 an

that compared torates of all-causeroke, type 2 diabeepression.91, 92 Buhe questionnaires

ns and criticism. TMoreover, very feaid, we present th

e (15 years or momoderate) physica

mproving this glois almost twice a

egional differencephysical activity in%).

Belgian

is expressed b

fruits daily; vegetables daily;

t at least 200g veg

(in the whole popfor fruits and 8

progression, the ple reports to eat a proxy of the nus and 2 fruits por five portions o

nd the Belgian Nu

o less active ind mortality, corona

etes, metabolic syut the quantity of s and the developThe questionnaireew international dhe currently availa

ore) practising at al activity per day

obal level. The (as higher in menes with a highern Flanders (45%)

n Health System

by three

getables

pulation) 84% for quantity at least

utritional per day” of either utritional

dividuals, ary heart yndrome,

physical pment of e will be data are able data

least 30 y is 38%. (at least n than in r rate of ) than in

7Ind"SoIt••Tpsdmosa

InTaRwpemhssimv

Performance

7.2.2.2 Healthn Flanders, the Vdeveloped a set ofhealth promotion"

Such indicators fopposed to the ust is in line with two Developing he Developing he

Three specific thphysical activity. Tseen globally as dimensions. Theymunicipalities, whover time can alschools, results caaged Children (HB

ndex of health pThe municipalitiesauthority. Results are only weighted sum ofpromotion policieseating and physmunicipalities scohealthy eating (gloscore=50%). The some municipalitiemportant to furthvariability, in order

hy Environment Vlaams Instituut vf global indices ai" in several settinfocus on public ual measures of ho axes of the Ottaealthy public policealthy environmenhemes were anaThose indicators a summary resul

y can be used asich can comparelso be followed an also be obtaineBSC) studies in W

romotion policies represent the m

available for Flaf “good” answerss at municipality-sical activity), r

ore low for tobaccobal score=36%),average scores

es doing nothing,er analyse the rer to intervene effic

voor Gezondheidsming to measure ngs (schools, wor

health authoritiehealth behaviour).awa charter:23 cies nt alysed: smoking,of health promotlt, or can be decs an (auto)-evalue themselves to t

(with caution). Fed from the Health

Wallonia and Bruss

es in the municipmost close-to-the-

anders. The scores to questions -level (in the fielrange between co prevention (gl, a bit better for phide a large disp, and others perfeason for those

ciently.

KCE Report

spromotie (VIGeZthe level of intens

rk, and municipales responsibilities.

, healthy eatingtion in settings cacomposed into spuation indicator fothe others. The trFor the indicatorh Behaviour in Scsels.

palities -citizen level of p

es, that represenrelated to the hd of tobacco, he0 and 100%.

lobal score=37%)physical activity (gpersion of scoresforming very welllow rates and fo

t 196

Z) has sity of ities). s (as

and an be pecific or the rends rs on chool-

public

nt the health ealthy

The ) and global s with . It is

or the

KCE Report 196

Percentage of The percentagcalculated sepaphysical activitpromotion as aHowever, the seFor Flanders, report:93 • The existe

the secondeating andgroup are “the health

• Whatever tcomposed team as su

• However, feedback oand parentin the decsuggestion

From the VIGepromotion is imparents are selexist. The authimplemented. In Wallonia and(HBSC) studycollaboration wyoung people'scontext. A parenvironmental directors.

6

schools with a hges of schools arately for 3 themety. The existencea whole cannot eparate indicatorsthe following res

nce of such a wodary schools (42%d 54% for physic“to give advice topromotion policiesthe theme, in themostly of teacher

uch. other participatio

of the discussionsts. In almost half

cisions. In 38% tns. eZ report we can mplemented in a ldom part of thos

hors conclude tha

d Brussels, the Hy is a cross-nawith WHO-Europe.s health, well-bert of the survey context of the s

health promotionwith activities ines: smoking prevee of a working gdirectly be dedu

s are a good proxysults are extracte

orking group is rat% for smoking preal activity; the m

o the Direction” ors of the schools”.

e majority of schors; parents and st

on mechanisms es of the working gof the schools, thhey only can giv

conclude that a majority of scho

se groups, other pat the participatio

Health Behaviour ational research. The HBSC aims

eing, health behais devoted to th

school, and is a

Belgian

n working groupn health promotention, healthy eagroup working onuced from those y of the situation.

ed from the VIGe

ther good implemevention, 64% for

main roles of the r “taking part in se

ools, the working tudents are not pa

exist for the studgroup is given to she students can tve their opinion o

working group foools. While studeparticipation mec

on culture is quite

in School-aged h survey condus to gain new insaviours, and thehe health strateganswered by the

n Health System

tion are ating and n health

results.

eZ 2009

mented in r healthy working

etting up

group is art of the

dents: a students ake part or make

or health ents and hanisms e largely

Children cted in

sight into ir social

gies and e school

In2hreAHspTisd

OPSpth

Performance

n the French spe2010, 44 secondhealth related proetained as perform

Almost half of the However, it seemstudents are onlyparticipation are mThis point could bes an essential dimension should

Offer of physical Physical activity inSchools can offephysical activitieshe VIGeZ 2009 re

eaking part of Bedary schools direojects conducted mance indicators schools report th

ms that the particiy implied in 7.7%maybe present, be explored more pdimension in thbe further improv

activity at seconn young people iser many opportu. For Flanders, theport93.

elgium (Wallonia ectors were interin the school. Socould be extracteey have a permaipation of student

% of the cases. but were not partprofoundly in the e success of h

ved.

ndary school s an important heanities to young he following resu

and Brussels) srviewed regardingome indicators thaed from the report.nent health cell (4ts is quite poor, Other mechanismt of this questionfuture. As particip

health promotion,

alth-enhancing acpeople to engag

ults are extracted

115

urvey g the at we . 40%). since

ms of naire. pation , this

ctivity. ge in from

116

Table 26 – Offe

Education

Supply

Reglementatio

Participation

Networking

Total

Note: The table ppromotion dimenresulting from thescore of “supply”score of the physpercent), represeof physical activitand 100, and shohealth promotion Source: VIGeZ re

In summary, wphysical activityare generally inthe dimension Nearly 100% oinsufficient spacmore problema2006, the acces

er of physical ac

N Minim

416 .00

416 .00

on 416 1.21

416 .00

416 .00

416 8.74

provides an overviewsions. Those partiale weighted sum of “gis one of those par

sical activity policy inents a global intensity, in all respondentould be interpreted apolicy).

eport93

we can conclude y in Flemish schontegrated in a glo

“supply” revealsof schools have ce available. Howatic. Although thessibility of facilities

ctivity in seconda

mum Maximum

10.00

8.59

10.00

10.00

10.00

84.27

w of the partial scorl scores are calcula

“good” answers to artial scores. The globn the secondary schity of the health promt schools. The globaas a “percentage” o

that health promools are in progreobal school policys that infrastruct(access to) a g

wever, the availabe range of activits could improve.

Belgian

ary schools in Fl

m Mean StdDe

6.0643 2.0

5.4758 1.2

6.9500 1.7

5.3100 2.3

4.7332 3.4

56.3475 14

res for several healtated as a 0-10 index long questionnairebal score, called “Tohools” (calculated amotion policies on thal score ranges betwof a perfect score (in

motion policies reess, score quite gy. A separate anature scores quitegym but with somility of a swimmingties has increase

n Health System

anders

d. eviation

08702

29252

74638

31019

41978

4.46473

th x . The otal s a he theme ween 0 n terms of

elated to ood and alysis of e good. metimes g pool is ed since

DTssDthWre77HItinrereUto7SShmosFsoalolo

Performance

Data for BrusselsThis report showssport facilities, anschools, the childrData on the availahe physical activWallonia and Brecommendations

7.2.3 Health P7.2.3.1 HealthHealth literacy is ot can be defined nformation relatedelated to the “eepresentative asp

Unfortunately, noo adequately mea7.2.3.2 SocialSocial support Social support is ahelps individuals tmodalities, like emof social support somatic illnesses aFifteen percent ofsocial support in 2of social support association with eowest educationaower in Flanders t

s and Wallonia as that 20% of thend that another ren are going to anability of (extra) phvity in the globarussels in order.

Promotion outcomh Literacy one of the most im

as “the individuad to health, healtempowerment” dpects of health prodata exist in Belg

asure health literal influence and a

a protective factoto deal with the d

motional support, have been link

and mortality. f the population 2008. There is nois gradually incre

educational level al level versus 1than in the other r

are extracted frome responding scho10% had no spnother place to hahysical activity anl school-policy sr to conclude a

mes

mportant indicatoral skills to understh determinants, imension, which omotion.95 gium yet. At interncy are still under v

action

r in times of stresdifficulties of life material aid, info

ked to increased

aged 15 years oo significant gendeeasing with age. T(age-adjusted rat0% in the higheregions, especially

KCE Report

m the HBSC survools had no adeqort facilities. In ave the sport lessnd on the integrathould be collectand eventually

rs for health promstand and managand health care”is one of the

national level, the validation.96, 97

ss. It is a resource(according to diffrmation…). Low l

rates of depres

or older reported er difference. TheThere is also a ste equals 22% ost). The rate is y in Brussels.

t 196

vey.94 quate those ons. ion of ed in make

otion. ge the . It is most

tools

e that ferent levels ssion,

poor e lack strong n the much

KCE Report 196

7.2.3.3 HeaThe Tobacco CThe concept policies arose policy initiative“Tobacco Contrcomparable levcomposed of th• Price incre

products; • Bans/restri• Better cons

media cove• Comprehe

products, lo• Large, dire

tobacco pro• Treatment

access to mBelgium is situ50/100. The sc(Greece) and golden opportuthe parliament The new law stsmoking is stilstrict rules. Dat2010 do not reother side, Belgwarnings in 20packs in 2011”.

6

althy Public PoliControl Policies of multi-prongedfrom governmen

es during the 90rol Policies Scalevel of the Toba

he following elemeeases through hig

ctions on smokingsumer informationerage, and publicinsive bans on theogos and brand nect health warninoducts; to help depende

medications. uated on the 10thcores of the more77 (UK). The au

unity to adopt commodified legislat

till permits smokinl allowed in somta from the Minis

espect the weak rgium was the firs06 and to print th

icy Scale

d and “comprehnts’ and non-gov0s. The interest e” is to provide a cco Control Pol

ents98: her taxes on ciga

g in public and won, including publiising research finde advertising andames; ng labels on cig

ent-smokers stopp

h place out of 32e extreme countruthors conclude mprehensive smoion in December ng in bars, discoth

me public places try of Health shorestrictions whichst EU country to he number of the

Belgian

ensive” tobacco vernmental organ

of the compositglobal and internicies in a count

arettes and other

ork places; c information camdings; promotion of all

garette boxes an

ping, including in

2, with a global sries were respectthat “Belgium m

oke-free legislatio2009 (articles 4

heques and casinin smoking-roomw that half of the applied to them.introduce pictoria

e quit line on all c

n Health System

control nisations’ te index ationally

try. It is

tobacco

mpaigns,

tobacco

nd other

ncreased

score of tively 32

missed a on when

and 5). nos. Also ms under e bars in . On the al health cigarette

Performance 117

118

Figure 37 – Int

Source: A survey

ternational comp

y of tobacco control

parisons on the T

activity in 31 Europ

Belgian

Tobacco Control

pean countries in 20

n Health System

Scale in Europe

01098

Performance

e (2010)

KCE Report

t 196

KCE Report 196

7.3 Key fin• In 2008, 47

obese. Theoverweigh65, and areobesity rathe highersmall.

• The numbpopulationIn a 2009-2missing, fgoals set f1.0 for 12-samples.

• The rate oEuropean diagnosis imported cthose of ththe other rhomosexuBelgian catransmissby other w

• The perce2008. It hamen than decreasingbelow the

6

dings 7% of the populaese percentages

ht and obesity ince strongly assocte in the lowest er educational lev

ber of studies pern is scarce and a2010 study, the milled teeth) scorefor the year 2010year-olds). Howe

of new HIV diagno(EU-15) mean. Aare made in non

cases, with diffehe Belgian casesregions, represeual transmission ases. The numbeion way is increa

ways is not diminntage of daily sm

as significantly din women, in all g in men than in EU-15 average r

ation was in overs are increasing ocrease sharply wciated with educaeducational leveels. Differences

rformed in Belgiuare often limited mean DMFT (dene was 0.9. This sc0 (maximum meaever, more data a

osis in Belgium A large proportion-Belgian peoplerent patterns of ts. The rate in Brunting an urban p is the main way

er of cases resultasing; the numbenishing either. mokers was arouecreased since 1age groups. How women. The Berate.

Belgian

rweight, and 14%over time. Both

with age until theational level. The

el is twice as highbetween regions

um on oral healtto small selected

ntal health: decaycore meets the W

an DMFT score bare needed on la

is a bit higher thn of those new

e. Those are probtransmission thaussels is higher tphenomenon. Thy of transmissionting from this er of cases trans

und 20% in Belgi10 years. It is higwever, the rate islgian rate is slig

n Health System

% was

e age of e h as in s are

h of the d areas. yed, WHO below arger

an the

bably an than in e male

n for the

smitted

um in gher in s more htly

•

•

•

•

Performance

In 2008, 8% oalcohol over-common in ydifferences apeople reporregions. The dependency)Brussels. Thglasses) amo

In 2008, almowhich is an iconsumptiononly 26% of twith even low

The global peany type of pwomen. It is regions, and surprisingly

When assessthe Global Toposition.

of the population-consumption. O

young people (agare observed in trting over-consuproblematic alco

) seems to increae regular risky song young peoplost two-third of tmprovement com

n was still higherthe people ate 2 wer rates in Wallercentage of peo

physical activity much higher in Fis especially lowdeclining in Walsing the global pobacco Scale, Be

n was consideredOver-consumptioged 15-24 years).his age group, wmption in Flandeohol consumptioase in all regions

single-occasion dle is of concern.he population atmpared to 2004. r than that of fruifruits and 200g vonia (F: 28.5%, B

ople practising aper day is low, aFlanders (45%) tw in Brussels. Thlonia.

public policy on telgium is ranking

d to have a weekon is already . Regional

with more young ers than in the oton (trends to s and mostly in drinking (more th

te fruit every dayThe daily vegetaits (84%). Howevvegetables dailyB: 24.6%, W: 18.2t least 30 minute

at 38%. It is lowerhan in the two othe rate is also

tobacco control wg at an intermed

119

kly

ther

han 5

y, ables ver, , 2%). es of r in ther

with iate

120

8 EQUIT8.1 IntroduEquity is a keysystem.1 It is aand political pobeen proposed“The place ofsystems.” Being aware ofwith two comple1. In a first subthe inequalitiesBelgium acrossoperationalisatiequity in healthdeterminants ba social hierarc2. In a secondcan highlight ispurpose of thesystem at a glo

8.2 Socio-e8.2.1 How dSocio-economicstatus/health ddisfavour of thposition on theis consistent inequalities haslevel priority taProgramme104

reducing socialand to monitmeasurements)

TY AND EQuction y feature in the ealso a controversiosition. A broad rad, and are discusf equity in asse

f this feature, we ementary ways: chapter, called “S

s in health, healths the socioeconoon and measure

h as “the absenceetween social grohy”. subchapter, we

ssues of equity ine second part of bal level”.

economic ineqdid we evaluate c health inequdeterminants/utilizhe social groups social scale. Theand has long bs long been a prioarget at Europeaand in the US

l inequalities in htor if they cha).

QUALITY

evaluation of the al normative issuange of perspect

ssed in the Suppessments of the

have approached

Socio-economic in determinants an

omic position. Indments, Braveman

e of systematic ineoups who have di

have proposed cn healthcare at athe chapter, cal

ualities socio-economic

ualities refer tozation of health

that are alreadye presence of sobeen recognizedority for the WHOan level, with thSA.105 To assesshealth, it is imporange over time

Belgian

performance of ue, referring to judtives and definitiolement S2 of this

performance of

d the dimension o

nequalities“, we dod healthcare utiliz

deed, for the purn99, 100 suggests equalities in healtifferent social pos

contextual indicata global level. Thled “Equity of the

c inequalities? o disparities in

services, most y disadvantaged cio-economic ine

d.101, 102 TacklingO.103 It has becom

e DG Sanco 2ds the progress rtant to measure e (by repeating

n Health System

a health dgement ons have s report: f health

of equity

ocument zation in rpose of defining

th/health sitions in

tors that is is the e health

health often in by their qualities

g health e a high

d Health towards them100,

g those

T••

CTinesSeFethpclawEsascwFgFRpvp

u

Performance

The measurement a characterist one or more

indicator(s).

Characteristics uThe social groups ndividual or eveeducational level, some of those varSocial groups’ deeconomic variableFor the indicators economic (SE) vahe highest educapartner was choseconsidered to be argely available, lwas coded accoEducation (ISCEDschool diploma), land higher educaservices for financhosen as proxy when explaining pFor the indicators grouped into 5 groFor the indicatorsRIZIV – INAMI, thproxy for the SEvariable, the BIMpeople with a low

BIM: Bénéfi

reimburseme

t of health inequaltic defining the soce synthetic inequ

used to define thecan be defined b

en geographical the occupation, aiables. finition varies acc

es in the different dissued from the H

ariables are availaational level attainen to define the sothe most compa

less sensitive andording to the InD) summarized as lower secondary ation. For the in

ncial reasons”, thfor the SE level.urely financial barof Life and Health

oups (no educations calculated fromhe status of increE level. Two socMu (increased reim

income level) and

iciaire à Interven

ent); BO: Bénéficiair

lities requires chocial groups uality measures

e social groupsby different charac

levels: the hoa deprivation inde

cording to the avdata sources we uHealth Interview Sable. For most ined by the referenocial position. Ind

arable and robustd prone to bias thternational Standlower education education, higher

ndicator “delayed e income level o. Indeed, this chorriers. h Expectancy, then and primary lev

m the Permanenteased reimbursecial categories wmbursement, mo

d BO (normal reim

ntion Majorée (bere Ordinaire

KCE Report

oosing:

in the health-re

cteristics at houseusehold income

ex, or a combinati

vailability of the sused. Survey, different sdicators of this re

nce person and heed, this informatt choice, becausehan the income levdard Classificatio(no diploma or prr secondary educ contacts with hof the householdoice is more per

e educational leveel were split). t Sample or from

ement was chosewere defined withostly correspondinmbursement).

eneficiary of incr

t 196

elated

ehold, , the ion of

socio-

socio-eport, is/her tion is e it is vel. It on of rimary cation health d was tinent

el was

m the en as h this ng to

eased

KCE Report 196

Measurement In a first step, wfor all the indicacan be found inIn a second steindices, allowinsummary indicenature (absolupairwise measuonly two groupspublic health pgroups are moinequality on thThe following in• For the Life

o The ahighes

o The Rconcenbetweeby the

• For the indo The a

levels)o The ab

• The Populahealth (or healtlevel if all the ggroup. It is compopulation andoverall rate in thIn this chapterrelative risk (RR

6

of inequalities we showed the disators for which dan the documentatioep, we summariz

ng quantifying thees can be used.1te versus relativ

ures (like the rates are easy to comperspective, moreore useful sincee population heal

nequality indices ae/Health Expectanabsolute differencst educational groelative Concentrantration index is ten each group ansize of each grouicators issued fro

age-adjusted rate ) bsolute differenceation Attributable th determinant) r

groups experiencemputed as the d

d the rate in the he population. r, we highlighted R) as large as 1.2

sparities across thata were availableon sheets in the Szed the detailed ie size of the inequ106 They differ byve), their scope e difference, or thempute and to undee complex meas

e they measure th.107

are described in thncy: ce in years betwups

ation Inequality Indhe sum of the diffnd the highest edup, and divided bym the Health Interatio (between

e in age-adjusted rFraction (PAF): t

rate that would beed the rate of thedifference betwee

more advantage

the indicators fo(or 0.83 when the

Belgian

he socio-economice (this detailed infoSupplement S1).nformation by coualities. A wide vy several properti

and complexity:e relative risk) coerstand. Howeversures involving a

the total impact

his chapter:

ween the lowest

dices (CII rel): theference in life expducational level, wy the life expectanrview Survey the extreme edu

rates (idem) this is the relativee expected at po

e more advantageen the overall rated group, divided

or which we obse gradient was rev

n Health System

c groups ormation

omputing variety of es: their : simple

omparing r, from a

all social t of the

and the

e relative pectancy weighted ncy

ucational

e gain in opulation ed social e in the

d by the

served a verse).

LTdTSththnFalesrephthWininsa

Performance

Limitations The inequalities codata on social posTherefore, our conSome issues knowhis work (like thehe topics specificnext report. For the indicators available. It is diffevel with the BIM status for financepresenting less

preferential reimbhandicap but no fhe next survey. We did not performn the indicators.nequalities relatescope of this workanalysed on a sma

ould not be meassition. This is the nclusions for this dwn to be related t waiting time for

cally linked to the

from the Permaneficult to measure status. Indeed, p

cial reasons arethan 5% of the

ursement status financial disadvan

m an analysis of Such a represe

ed to ecological pk. Moreover, the dall scale, because

sured for all the incase for many of

dimension are largo social inequalitisome interventioninequalities shou

ent Sample (EPSthe impact of ineeople with a prefee people with e population. Onalso comprises p

ntage. The definiti

the small scale gentation is a wapoverty indices. data originating fre of the size of the

ndicators due to laf the quality indicagely incomplete. ies were not studns). A deeper focld be performed i

), only two statuteequalities at popuerential reimbursea very low inc

n the other handpeople with a phyion could be refin

eographical dispaay to highlight hThis was beyond

rom the HIS canne sample.

121

ack of ators.

ied in cus of in the

es are lation

ement come, d, the ysical

ned in

arities health d the

not be

122

8.2.2 Facts


8.2.2.1 IneqLife and HealthTo assess ineqof data on mortthe most receninequalities in lin health expeclevels are reposecondary highextreme groupsindicators, maklarge. Concentbecause they taTable 27 show2001. Large ineare observed ibetween a partinequalities is oyears in men. women, the sabetween each eThe gap betweand the Relative

and figures


qualities in indich Expectancies

qualities in life andtality, social positt and robust dataife expectancy109

ctancy.111 As merted in 5 categori

her, and higher eds are compared wking the differencetration inequality ake into account t

ws the life expectequalities in life en both sexes, deticular educationaobserved. The diff

The Relative Coame tendencies weducational level en the extreme ee Concentration I


cators of Genera

d health expectanion and disability

a in Belgium conc, 110 and the year

entioned, in both es (no diploma, pducation). With thwith the pairwise es between the cindices are mor

the share of the soancy at 25 years

expectancy betweefined as the diffeal level to the higfference between oncentration Indewere observed aand the highest w

educational levels ndex in men was

Belgian


al Health Status

cies, complex proare needed.108 C

cern the year 200r 2004 for the ine

studies, the eduprimary, secondarhis way of groupinindices than for tcompared appearre appropriate mocial levels. s by educational een the educationerence in life expghest level. A grathe extreme leve

ex in men was 3s for men, but th

were smaller thanwas 5.9 years in3.7 %.

n Health System

resented e on the

ocessing Currently, 1 for the qualities

ucational ry lower, ng, more he other ring very

measures

level, in al levels

pectancy adient of els is 7.5 3.7%. In he gaps in men.

n women

Tain

D

HShSloPNT CCS

T2mindCeTwmthti

Performance

Table 27 – Life eabsolute differennequality indices

Diploma

Higher Secondary higher Secondary ower Primary No diploma Total

CII absolute CII relative Source: Deboosere

Table 28 shows th2001. Inequalities much larger thannequalities whendifference betweeConcentration Indexpectancy. In woThe gap betweenwomen. The Relameans that peoplhose with a highime in good health

expectancy at 25nce to highest es (CII) (Belgium 2

Men

Total Diff tolevel

55.0 52.5 -2.5

51.3 -3.7

49.3 -5.7 47.6 -7.5 51.4 -3.7 1.9 3.7

et al.112

he health expectabetween the edu

n for life expectan the educationan the extreme lev

dex in men is 15.omen, the same n the extreme eative Concentratile with low educa educational leveh.

5 years by sex aeducational leve2001)

W

o the highest T

55

5

555

ancy at 25 years bcational levels in ancy. Again, a gal level decreasevels is 18.6 years.3%, which is mutendencies were educational levelon Index in womational level not el, but also that t

KCE Report

nd educational el and concentr

Women

Total Diff to highest l

59.9 58.5 -1.4

58.0 -1.9

56.2 -3.7 54.0 -5.9 57.1 -2.8

0.8 1.4

by educational levhealth expectanc

gradient of increes is observed. s in men. The Reuch larger than foobserved as for s was 18.2 yea

men was 16.6%. only live shorter

they spend much

t 196

level, ration

the level

vel, in cy are asing

The elative or life men.

ars in This

r than h less

KCE Report 196

Table 28 – Helevel, absoluconcentration

Diploma

Higher

Secondary higher Secondary lower Primary

No diploma

Total

CII absolute

CII relative

Source : Van Oye

The self-perce

Important inequdifference of 2educational levAttributable Frathe whole poputhe rate of subjeInfant mortality Belgium, only passociation wa

6

ealth expectancyute difference

inequality indice

Men

Total Diflev

46.33 0.0

41.54 -4.

39.71 -6.

36.65 -9.

27.75 -18

40.5 5.9

6.2

15

en et al.113

eived health

ualities are obser29% is observedvels (Table 29); action is 11%, meaulation would be 1ective health of this also known to

partial data exist aas found in Brus

y at 25 years bto highest e

es (Belgium 2004

ff to the highest vel

0

.8

.6

.7

8.6

9

2

5.3

rved in self-perced between the the relative risk aning that the glo11.2% if all educahe people of the ho be linked with sand confirm this fssels between th

Belgian

by sex and educeducational leve4)

Women

Total Diff highe

47.1

41.27 -5.8

42.01 -5.1

36.27 -10.8

28.92 -18.2

40.4 6.7

6.7

16.6

eived health. An alowest and the is 67%. The Pobal increase of th

ational levels expeighest educationasocio-economic sfact. For instancehe number of ho

n Health System

cational el and

to the est level

8

2

absolute highest

opulation e rate in erienced al level. tatus. In , a clear

ousehold

inth8Thleinre7Incsreha0Foabthsssba

Performance

ncomes and infanhis report. 8.2.2.2 InequaThe percentage ofhealth system forevel, with 27% of n the householdselative risk of 6.2

71%. nequalities of smcervix cancer. Lowsocio-economic seimbursement). T

highest educationand cervix cancer 0.76. For the indicators of the elderly), a against influenza better coverage inhey reside more osystematic. For thsurvey in childrenstatus (measured better coverage tassociation was no

nt mortality.114 Th

alities in the indif households repor financial reasondelay in the hous

s of the highest 2. The population

maller size are obswer coverage ratestatus (identifiedThe absolute diffeal levels were resscreening. The r

on vaccination (reverse phenom

in the elderly, mn the patients witoften in institutionhe vaccination ra in Wallonia (200with the educat

than children froot found in Flande

hese data are not

icators of accessorting to have delns was strongly seholds of the lowquintile (Table 2

n attributable frac

served for the sces are observed d by their entiterence of coveragspectively 14.3%

relative risks were

vaccination of chmenon was obseeasured with theth BIM. It could bns for elderly, wheate in children, in09), children with tional level of theom higher socio-ers.

t presented in det

sibility ayed contacts witrelated to the in

west quintile versu29). This represection was as larg

creening of breasfor patients with tlement to increge between lowes

and 15.3% for be respectively 0.77

hildren and vaccinrved. The vaccin

e EPS data, showbe due to the facere vaccination is n the last vaccinlower socio-econ

e mother) had sl-economic level.

123

tail in

th the come

us 4% nts a ge as

st and lower

eased st and breast 7 and

nation nation wed a ct that

more nation nomic lightly

This

124

8.2.2.3 IneqData by social care. Socio-econom• The follow

percentagerisk was 0.

No important in• Prescriptio• Physician e• % of peopl• Percentage

Provider ofReverse InequSome interveninterventions sicancer screenincoverage is higalso worse in thMissing data Unfortunately, fsocio-economicconsidered as l

v Cancer 5

relative suafter colonwithin onadmission(per 1000 admissionIncidence fracture (%(MDT) me

qualities in the instatus were only

mic inequalities cw-up of diabetic e of patients with 83, and the PAF wequality was obsen antibiotics accoencounter after hoe with at least a ce of people with f Care > 0.75)

ualities tions are not apigns a lack of apng outside the tarher in the advant

his group.

for a large numbc inequality couldargely incomplete

5-year relative survurvival rate after cern cancer; Deaths dune week after stans for asthma in adu

live births); Incidenns); Incidence of p

of pressure ulcers%); Patients with ceeting (%); Numbe

ndicators of quaavailable for som

ould be observepatients: the aba correct follow-

was 7.4%. erved for the follow

ording to guidelineospital discharge fcontact with a GP a high fidelity to

ppropriate. Hencepropriateness. Th

rget groups (< 50 aged social group

ber of interesting d not be measuree. The missing dat

vival rate after brervix cancer; Cancerue to suicide (/100 art of palliative cult patients (/100 00nce of hospital acqupost-operative sep

s in hospitals (%); Icancer discussed ar of contacts betwe

Belgian

ality of care me indicators of q

ed in: bsolute differenceup was 10%, the

wing indicators: es for eldery patientsin the year their GP (Index o

e, a high rate fohis is the case foor ≥ 70 years). S

ps, the appropriat

indicators of quaed. Conclusions ta concern 14 ind

east cancer; Cancer 5-year relative sur000 pop); Patients

care service (%); 00 pop); Caesareanuired MRSA infectionsis (/100 000 discn-hospital mortality

at the multidisciplineen the patient and

n Health System

quality of

e in the e relative

s (65+)

of Usual

or those or breast Since the eness is

ality, the must be icators.v

er 5-year rvival rate who died Hospital

n sections ns (/1000 charges); after hip

ary team d the GP

8DasdofophpTpoFgreth0imSosre

Performance

8.2.2.4 IndicaDaily smoking andand 2.11) betweesmoking, the absodaily smoking andobserved (-36.1 %or those 2 factopopulation health, health if all sociprevailing in the mThe rate of overwpresents more moof 14.7%. For the determinagenerally observeelative risk will nohe consumption 0.74, and PAF=1mportant, with a RStrong inequalitieof the people fromsupport, versus oepresents a RR o

during the 3 patients with

ators of the Healtd obesity presen

en the lowest andolute difference in d obesity, a high P% for smoking anrs, the inequalitieand that a large g

ial classes expemore educated groweight people (deoderate inequalitie

ants having a posed in the more ow be lower than of at least 200g 3.1%). For physi

RR of 0.56 and a Pes are observed im the lowest edonly 10.1% for tof 2.4, and a PAF

last months of life

pain always contro

th promotion domt a high relative

d highest educatiorates is as high a

Population Attributd -34.8% for obees have a large gain could be obta

erienced the leveoup. efined as the peoes, with a relative

sitive impact on heducated classe

1. We observe imof vegetables an

ical activity, the PAF 12.3%. n the level of socucational level rethe people of thof -34.8%.

e; Pain control durlled).

KCE Report

main risk (respectivelyonal groups. For as 8.9%. Moreovetable Fraction (PA

esity). This meansglobal impact o

ained in the popuel of smoking/ob

ople with a BMI risk of 1.45 and a

health, a higher raes, meaning tha

mportant inequalitiend 2 fruits daily inequalities are r

ial support, with 2eporting a poor she highest level.

ring hospitalisation

t 196

y 1.68 daily

er, for AF) is s that n the lation besity

≥ 25) a PAF

ate is at the es for (RR= rather

24.4% social

This

(% of

KCE Report 196

No or weak ineThe daily consimportant link wThe link betweclear. Data by socio-efilled teeth at (/100 000 pop).

Table 29 – Ineq

General HealthLife Expectancy aLife Expectancy aHealthy Life YearHealthy Life Year% of the populativery good iii

Accessibility oDelayed contactreasons (% of hoBreast cancer scCervix cancer scr

Appropriatene% of adult diabeof regular retinal

Health promot% of the populati% of the populati

6

equalities sumption of fruits

with the social stateen the consump

economic status age 12 (mean s

qualities express

h Status at 25 in men, 2001 at 25 in women, 200rs at 25 in men, 200rs at 25 in women, 2on (aged 15+) that

of care ts with health se

ouseholds) iv reening (% women reening (% women

ess etes patients receiviexams and blood te

tion on (aged 15+) that on (aged 15+) repo

s or vegetablestus. tion of alcohol a

were not availabscore at age 12

sed with absolut

i; ii 01 i; ii 01 i; ii 2001 i; ii assess their health

ervices because o

aged 50-69) v aged 25-64) v

ing appropriate carests v

reports to smoke daorting a poor social s

Belgian

once a day sho

nd social status

le for: Decayed/ 2) and Incidence

te difference, relaOvervalue

51.3857.0940.4740.42

as good or 76.8%

of financial 14.0%

60.1%61.8%

re, in terms 54.0%

aily iii 20.5%support iii 15.5%

n Health System

owed no

was not

missing/ of HIV

ative difference, all e (f)

Value inlowest sgroup (f

8 47.56 9 53.98 7 27.75 2 28.92 % 57.4%

% 27.0%

% 48.6% % 48.9%

% 48.0%

% 22.0% % 24.4%

Performance

and summary mn social f)

Value in higher sogroup (f)

55.03 59.9 46.33 47.1 85.7%

4.0%

62.9% 64.2%

58.0%

13.1% 10.1%

measures

cial Absolute d

(lowest vs

-7.47 -5.92 -18.58 -18.18 -28.3%

23.0%

-14.3% -15.3%

-10.0%

8.9% 14.3%

difference

s highest)

Relat

(lowehighe

n.a.n.a.n.a.n.a.0.67

6.75

0.770.76

0.83

1.682.42

tive Risk

est vs est)

Summmeasuor PAF

3.73% 1.43% 15.30%16.56%11.6%

-71.4%

4.7% 3.9%

7.4%

-36.1%-34.8%

125

mary ure (CII F)

% %

%

% %

126

% of the adult po% of the adult obese (BMI ≥ 25)% of the populat2 fruits per day iii

% of the populatiper day iii i in years; ii 5 edurates are not adjuthe other indicatoSource: Health InPA: physical activ

pulation consideredpopulation conside

) iii ion reporting to eat

on reporting to prac

ucational levels; iii 4 usted for age; summors nterview Survey andvity

d as being obese (Bered as being ove

t at least 200g vege

ctice at least 30 min

educational levels; mary measures= CII

d EPS (WIV – ISP a

Belgian

BMI ≥ 30) iii 13.8%erweight or 46.9%

etables and 26.0%

nutes of PA 38.1%

iv 5 income levels; vI (Concentration Ind

and KCE calculation

n Health System

% 19.2% % 57.8%

% 21.7%

% 24.0%

v 2 reimbursement cdex of Inequalities) r

ns)

Performance

9.1% 40.0%

29.4%

42.8%

categories; relative for life and h

10.1% 17.8%

-7.7%

-18.8%

health expectancy,

2.111.45

0.74

0.56

PAF (Population At

KCE Report

-34.1%-14.7%

13.1%

12.3%

ttributable Fraction)

t 196

% %

for all

KCE Report 196

8.2.3 Key fiWith regard to• Life expec

social poshealth exphealth.

• Inequalitieinequalitieconditionsidentified

With regard to• Very large

financial r• Moderate

screening• On the con

disfavoure(with somegood poin

• Also the cless advan

With regard to• For most o

be measur• Moderate

people. With regard to• Very impo

obesity (w30%). As ohigher morepresents

6

indings o general health sctancy presents asition. This gradipectancy. Inequa

es in those globaes in factors influs, health determiand tackled.

o accessibility: e inequality is obreasons. inequality is obs. ntrary, for vaccined group is at leae partial data sho

nt for the action ocoverage of the gntaged groups.

o the quality of caof the indicatorsred. The conclusinequality was o

o health promotioortant inequalitieswith a Populationobesity and smoorbidity, tackling s a top priority.

status: a strong increasent is still much

alities are observ

al and “end of couencing them: soinants, health sy

bserved in the de

served in breast

nation, it seems ast as good as inowing even a beof preventive heaglobal medical re

are: , socio-economi

sions are incompobserved for the

on indicators: s are observed f Attributable Fraking are stronglythe inequality in

Belgian

ing gradient withmore important

ved in self-percei

ourse” indicatorsocial and living ystem. Those sho

elay of health car

and cervix cance

that the coveragn the favoured gretter coverage). Talth services. ecord is better in

c inequalities coplete. surveillance of d

for daily smokingaction of more thy associated wit

n those factors

n Health System

h the with

ived

s reflect

ould be

re for

er

ge in the roup

This is a

the

ould not

diabetic

g and han h a

•

•

88

EsatheshhbaaaptheTome

Performance

Inequalities afruits and vegphysical acti

Very importa

8.3 Equity of 8.3.1 How did

global leEquity is a controvsomething”. Howeapproaches. Indeehe unequals andequals. An exampso that everyonehorizontal equity ihave the same nebetween the richean attempt to approaches haveamong individualsprefer to equalize hought and showessentially normatTo establish equityof a healthcare symust reflect societequity of the health

are also observegetables, and in vity.

ant inequalities a

the health systd we evaluate theevel? versial dimensionever, there is aed, vertical equity horizontal equity

ple of vertical equi pays taxes bass the attempt to eeds. Equity impl

est and the pooresreconcile solida

been proposed. Some propose toutcomes119-121.

w how the definitiotive issues and they indicators in theystem requires antal choices. In thishcare system in a

ed for overweighta lesser extent f

are observed for

tem at a globae equity of the h

n. Generally, equita large heterogey is defined as they is defined as eity are tax systemsed on ability to provide the sameies therefore somst, between the harity and perso to define what to equalize resourThese theories o

on of fairness anderefore philosoph

e context of a repon approach as nes chapter, we havan indirect (or cont

t, eating enoughfor practising

the social suppo

l level ealth system at

ty refers to “equaeneity in the diffe unequal treatmeequal treatment o

ms which are orga pay. An exampe care to patientsme degree of solihealthy and the sional responsibilshould be equa

rces116-118, while offer interesting lin how to achieve iical issues. ort on the performeutral as possibleve evaluated the gtextual) way.

127

ort.

a

lity of ferent ent of of the nized

ple of s who darity ck. In lity115, alized others nes of it, are

mance e and global

128

Belgium backentitlement to itaken to promoavoid “catastropcategories of pSeveral BelgiaSupplement S2performance of

8.3.1.1 GloTwo contextual• the progres• the Gini coThe progressivbefore using thsharing” at thenon-reimbursabfinance the p(regressive) whsense) is incredefined as propcharacterize thfinancing of thprogressive thathe indirect taxeof the financingredistribution ebecause such aconsumption ofThese data arewith other counDoorslaer haveequity in financnot mention Be

kground: In Belgncreased reimbu

ote the financial aphic” health expepatients, such asan studies, and 2 of this report: “Tf health systems.”

obal or contextua indicators are dessivity of the finan

oefficient of inequaity of financing thhe system. By p

e point of care (i.ble drugs, premiupublic system. Ahen the average easing (decreasinportional when thehe relative progrehe Belgian healthan the social contes. Simple ratios ag for the period 2effect of the finanan evaluation impf care, all financine not totally availantries is not possie contributed in acing and deliveringlgium in their wor

gium, some spersement and the accessibility. The nditures and othe patients with chtheir results, are

The place of equ

al indicators escribed below: ncing of the healthality in income he healthcare sysprogressivity, we e. supplement, cms to private insuA financing is rate of “taxation”

ng) with the income average rate of

essivity of the mohcare system: thetributions which aare computed to d

2005-2011. We doncing and use olies the knowledgg sources and abable for Belgium ible due to lack oa substantive wayg of healthcare bk.122-128

Belgian

ecific measures sOmnio status hamaximum billing

er measures are thronic illness or ce discussed in dity in assessment

hcare system

stem translates thdo not mean th

co-payment, coinsurance …) but thedefined as pro” (considered in me. And the finaf taxation is constost important soue direct taxes are more progressdescribe the progo not evaluate th

of the healthcare ge of individual dabout the available and a robust com

of data. Wagstaff y to the evaluatiobut, unfortunately,

n Health System

such as ve been aims to

targeting children. detail in ts of the

he equity he “cost surance, e way to gressive a broad

ancing is tant. We urces of re more

sive than gressivity he global

system ata about

income. mparison and van

on of the they do

Wmaointobin8

Tfow

TthcinbtrTetatathNcaTstasp

Performance

We contextualize measured by theassociation betweobjective or subjenterpret and to coo characterize thebeen recently recondicators for the "8.3.2 Facts an


The disparities of he indicators of contextual equity nequality) showsbecomes less proransfers) makes oThe public financiessentially for twoaxes) is increasinaxes and special hese two evolutioNevertheless, thecompare the Gini allowances). These two results substantial incomaxes and financesystem) using reprogressive.

also the equity ise Gini coefficien

een the income inective health.100, 1

ompute for Belgiue income inequaliommended by a WHealth 2020 targe

nd figures


health status andthe other dimeindicators (prog

s that the publicogressive and thour country one ofing of the healthc

o reasons: (1) the ng and (2) the pcontribution for s

ns make the finane Belgian society coefficient pre a

are not contradice redistribution u

e a specific colleesources (taxatio

ssue by means ofnt. Some authornequality and som129-131 The Gini cm and internationty in an internatioWHO workgroup ets".132


health consumptensions. The comressivity of the f

c financing of thhat our redistribuf the most egalitarcare system becopart of the regre

part of the progresocial security) isncing less progresy is one of the mand after taxation

tory because the using a large sysective sector (i.e. on and contribut

KCE Report

f the income ineqrs have showedme indications of coefficient is simpnal organizations onal perspective. which was workin


tion are presentedmputation of thefinancing and inhe healthcare syution system (taxrian in the world. omes less progressive receipts (inessive receipts (s decreasing. Glossive. most egalitarian n and transfers (s

society can organstem of transfersthe public health

ions) which are

t 196

quality d the f poor ple to use it It has ng on

ented n the

d with e two come ystem x and

essive direct direct

obally,

if we social

nize a s and hcare

little

KCE Report 196

Table 30 – Pro

Indicators of p

Ratio proportioRatio progressRatio regressivTotal Source: Vade me

Figure 38 – Gin

Source: DGSIE (Note: the Gini cothere is perfect in

6

ogressivity indica

progressivity

onal receipts/totsive receipts/totave receipts/total

ecum de la sécurité

ni coefficient bef

(Belgium) and OECDefficient is a coeffic

nequality, the coeffic

ators of the finan

tal receipts al receipts receipts

sociale, RIZIV – IN

fore and after tax

D Health Data 2012ient for inequality ofcient is 1 (one perso

Belgian

ncing of the publ

2005 (final accounts)

20ac

71.1% 7118.9% 1910.0% 10100.0% 10

NAMI, KCE calculatio

xation and transf

2 (international compf income in a populaon has all the reven

n Health System

ic healthcare sys

006 (final ccounts)

200acc

1.0% 72.09.0% 18.00.0% 10.000.0% 100on

fers (1998-2010)

parison) ation. When there is

nues). A lower coeffi

Performance

stem (2005-2011

07 (final counts)

2008(provacco

0% 70.6%0% 17.3%0% 12.1%0.0% 100.0

: Belgium and in

s perfect equality (eficient indicates a m

)

visional ounts)

200(proacc

% 69.4% 17.2% 13.40% 100

nternational comp

everybody has the sore equal distributio

09 ovisional counts)

201(bu

4% 64.2% 19.4% 15.0.0% 100

parison

same income, the coon of the incomes.

10 udget)

2011 (budg

.8% 61.4%

.4% 18.4%

.8% 20.2%0.0% 100.0%

oefficient is 0). Whe

129

get)

% % %

%

en

130

8.3.3 Key fiEquity in finan• Public fina

progressiv• The intern

because oIncome inequa• Income ine

redistribut• Thanks to

the most e• The high l

distributioon Belgian

indings ncing ancing of the Beve, certainly sinc

national comparisof the great diverality equality in Belgitive impact of taxthe system of ta

egalitarian countevel of income r

on of disposable n population hea

lgian healthcare ce 2005. son of the progrersity of systems.

um is relatively hxes and transferaxation and transtries. redistribution andincomes should

alth.

Belgian

system become

essivity is not re

high before the rs. sfers, Belgium is

d the more egalitd have a positive

n Health System

es less

elevant

s one of

tarian impact

9

Inimrebresae

AaTpthammpbhfu

FWinsaremhm

Performance

9 TOWARHEALTHASSESSSHORTC

n this section, wmprove the evaluelate to the lack

better indicator oesult from the ma

section “Indicatorsavailable on the experts.

An indicator ofavoidable/amenaThe previous reppremature mortalithe age of 70 yearaction and was nomortality expressemeasurement of tproject establishebetween countriehealthcare systemuture set of perfor

Financial accessWhile the coveragn terms of the pservices is paid dand 14% of the peasons (with a str

mechanisms werhealthcare systemmaximum billing

RDS A MORH SYSTEMSMENT: ADCOMINGS

we identified 10 liuation of the hea

of suitable indicr for more detaiany indicators for s under developmKCE website), a

f global health able mortality port included onety, expressed as rs. This indicator wot retained in this ed by group of cahe effectiveness d the list of cond

es are likely to ms.133 This indicatormance indicators

ibility: need for ae of the compulsoproportion of theirectly by patientspeople report to rong gradient withre introduced to

m. Examples are lusystem (MAB).13

RE COMPR PERFORMDDRESSIN mitations that sh

alth system perforators, the lack ofls. Some of the which we could

ment” in Supplemand from the disc

status with p

e indicator of heapotential years ofwas too general, report. Instead, th

auses could be mof health servicesditions for which

reflect variationor could replace ps.

a more comprehory health insurane population coves. Out-of pocket pdelay healthcare

h household incomo maintain a ump sums for the

34 In addition to

KCE Report

REHENSIVMANCE NG CURRE

hould be addressrmance. Those isf data, the need following conclu

not find any datament S1 of this recussions with Be

potential for ac

alth status whichf life lost (PYLL) blimiting the poten

he avoidable/ameore informative fos. A recent EU fuvariations in mo

ns in performancpremature mortalit

ensive picture nce is quasi exhauered, part of covpayments remain e because of finame). Several protefinancially acces

e chronically ill anthese publicly-fu

t 196

E

ENT

ed to ssues for a

usions a (see eport, elgian

ction:

h was before tial of nable or the unded ortality ce of ty in a

ustive vered high,

ancial ection ssible

nd the unded

KCE Report 196

mechanisms, inservices. A pretransparency ininsurances (thewhat is specific

Workforce couon the need siAn effective heglobal policy takData on the supCurrent head cimprovement othe medical wmedical doctorsector or not). Hinto account. Swhich evaluatephysicians. Fopractising nurseHowever, the interpret, as ndefined. Internainterpretable wvaries across coData on the neeWorkforce planinformation thatIndeed, severamet, at least asthat there is gecontinuously riageing populaexpectations, re

6

ndividual private erequisite to guiden ambulatory supe percentage of pally covered by th

unts: better datade still lacking

ealthcare workforcking into account pply side counts of practisf the information orkforce was estrs (regardless of However, the rea

Since 2009, this ces the number or the first timees by sector of acdensity of prac

no optimal densiational compariso

without taking intoountries. ed side nning also requiret is currently scarcl informal sources

s far as the nurse eneral lack of nurssing and changiations, technoloequire a larger an

insurances reimbe policy within thipplements as we

people with privatehese private insura

a on the supply

ce planning shoulsupply and patien

sing physicians ucompared with ttimated by the t

f whether they wal activity level of count is conducteof full-time equi, preliminary co

ctivity are now avactising healthcarety to meet popuns are of little hel

o account the org

es information once. s point out that thworkforce is conc

ses in the Belgianing demand for ogical advancesd more skilled nu

Belgian

burse several hes domain is an imell as in private e hospital insuranances).135, 136

side available, b

ld be considered nt needs.

ndoubtedly reprehe former situatiototal number of worked in the hephysicians was ned by the RIZIV –valents (FTE) ounts of the num

ailable. e workers is difulation needs halp here since theyganisation of care

n the need/dema

he needs are insucerned. It is wideln hospitals. Moreo

health services, s and higher rsing workforce.13

n Health System

ealthcare mproved hospital

nce, and

but data

within a

esent an on when licensed

ealthcare ot taken – INAMI, of active mber of

fficult to as been y are not e, which

nd side,

ufficiently y known over, the

due to patient

37

MrelailfotojoNre

Mc

InthcsminownInc“A12

34

5

Performance

Macro-level data eflect the situationarge-scale Europlustrated that in Bor more patients co be dissatisfiedob.79,138 No indicators of teflection should c

Mental healthcachanges in the se

n the field of menhe recent major ccentury, a strong dsector has led to model, the “balndustrialized couoffered wheneverwhen ambulatory needs. n Belgium, the mcare model focusArt. 107 project”) . Prevention an

2. Intensive, comchronic physic

3. Rehabilitation4. Intensive res

problems that5. Specific resid

or home-repla

on the needs shn at the micro leve

pean nursing worBelgian hospitals compared to othe

d with their job a

he needs have bcontinue on this to

re: current indector

ntal health, the curchanges in the sede-institutionalizat

the developmenanced care” mntries.139 It implie

r possible, while care cannot pro

most recent reform on the developmoriented to 5 func

nd promotion of mmmunity based, trcal conditions; teams focusing o

sidential teams ft require inpatient ential facilities in

acing environment

hould be complemel. An example of

rkforce study basnurses have, on

er EU countries.79

and have the in

been defined yet opic.

dicators do not

rrently available inector. Indeed, sinction movement in

nt of new modelsmodel is gaininges that communihospital services

ovide a good an

m efforts to attain ment of “care nectional modules:

mental health; reatment teams fo

on social integratiofor acute and ctreatment; which care can bt.140

mented with dataf micro data is a rsed on survey da

average, to take9 More nurses repntention to leave

in this report, bu

t reflect the re

ndicators do not rce the end of the the mental health

s of organization.g influence in ty services shous should be avanswer to the pat

a balanced integetworks” (the so-c

or acute as well a

on; chronic mental h

be provided in a

131

a that ecent ata. It e care ported

their

ut the

ecent

reflect e 20th hcare One most ld be

ailable tient’s

grated called

as for

health

home

132

Some indicatorpercentage of expenditures spmental health limitations in the(e.g. suicide ratepisode (e.g. reAt internationainitiatives, a recsuicide rates another data weorganizations shealthcare. Howoften limited. Fyears prescribedrug (%)” in thno operationalpublished studanticholinergiccomparison ofhampered.

Continuity andnew pathwaysThe fact that nchronic renal faevaluated, showmakers.142 We edition of this reSome other rele• The experi

care. SomGermany, surveys to is currently

• The availabby all care

rs can be propospatients with

pent on communicare). They co

e current data. Instes) or indicators

e-admission ratesal level, despitcent survey of twnd the number of ere scarce.141 Euch as the OECDwever, the operatFor instance, desed antidepressante OECD shortlist development odies disagree a

side effects.63,

f mental health

d coordination ofs in ambulatory cnew pathways inailure patients wews the importanc

plan to include eport. evant indicators hence of the patien

me countries suCanada, U.S. oanswer that ques

y still not measurebility of the wholee providers is a c

sed to monitor thcase managemeity care comparedould not yet bestead, we had to focusing on the p

; involuntary commte several perf

wenty-five EU coupsychiatric beds w

Efforts are undeD62 to propose indional developmenspite the inclusiots using an anticht for mental healtof this indicator. about what is

64 As a concare system pe

f care: new data care, but still mann ambulatory carre recently startee of the coordinathe results of th

have been identifient with regard to tch as the Netr Australia20, 143

stion. This indicatoed in Belgium. e health informatiocentral question,

Belgian

hese evolutions (ent; the percend to total expendi measured becarely on general inpsychiatric hospitmittals). formance measntries noted that were readily availertaken by intericators specific fo

nt and data availan of “Persons agholinergic anti-depthcare indicators,

What’s more, an antidepressa

nsequence, intererformance is s

soon available wny gaps remainre for type 2 diad and are currenttion of care for th

hose projects in t

ed, for instance: the coordination oherlands, Francehave performed

or, although being

on of a patient at alinked to the on

n Health System

(e.g. the ntage of tures on ause of

ndicators talization

urement data on

lable but rnational

or mental bility are ged 65+ pressant there is the few

ant with rnational seriously

with the

abetic or tly being he policy the next

of his/her e, U.K., specific

g central,

any time e of the

PPdainm••

InssacuowObPhTcaq

Performance

patient electrindicators unpractices withpatients for wis accessible as the “Réseand pilot pro(http://www.viand currently e-Health platfo

Patient centerednPatient centeredndata, because it answer to the partnvolvement. To methodological ap Self-report me External obse

behaviour codn Belgium, the Hself-reported by tsatisfaction with thabove, but which concepts and onunderstanding on on satisfaction wilwith ambulatory hOECD questionnabe included in the Patient centerednhealthcare systemThree of them arcommitment of tapproach. More dquality.

ronic medical reder development

h access to the howhich information o

at any setting. Soeau Santé Walloojects are beingtalink.be/), but wiwithout much da

orm should have

ness: many initiaess is intrinsicallis related to the ticular needs of th

effectively mepproaches used:14

easures of doctorservation of consuding system.

Health Interview Sthe population. Ithe health systemis subject to ma

n the measures patient experiencll be replaced by healthcare servicaire.15 Patient expfollowing update ess is neverthele

m: several initiatire described belothe healthcare detailed analysis

ecord, and to tht reflect this issu

ospital data of theion medication pre

ome initiatives areon” (https://www.rg run, such as thout many conne

ata to evaluate thean important role

atives but few day difficult to meahealth system’s

he patient or to eeasure this, th44 s’ patient-centeredltation process: r

Survey (HIS) is at provides a mea

m, an indicator thany critiques, bothof satisfaction.77

ces, in the next waa question on th

ces (GP or specperience with amof this report.

ess a matter of coves have been ow. These 3 initsystem to the should be perfor

KCE Report

he access to it. ue: the % of geir patient, and theescribed at any s

e already in place,reseausantewallon

Vitalink in Flanections between tem. In this matteto play.

ata asure with quanti

ability to succesencourage the pathere are two

dness;145 rating scales or v

major source ofasure of the patat has been discuh on the validity o7, 78 To improveave of the HIS thehe patient’s expercialists), based obulatory care will

oncern for the Belaunched in Beliatives emphasizpatient centered

rmed to evaluate

t 196

Two eneral e % of etting such n.be/) nders them,

er, the

tative ssfully tient’s main

verbal

f data tient’s ussed of the e our e item rience n the l thus

elgian gium. e the dness their

KCE Report 196

First, since 20complaints in pmotive of compthe follow-up oversus 9 026 icarefully: morealso to more availability, compatients’ culturdevelop a simresolution procoperational. Second, since financial suppomediation coornegative impacmediators havemode of organavailability durinhours in case oHealth ensuresassessment enbooklet editing.needs and rescomply to all laare taken carestarted recentlconferences). Iwith interculturaThis project willThird, some pithe patients' inquality managethe participatioMeasurement o

6

03, an ombudsmpublic hospitals. Tplaints each year of the complaints.in 2006. Howeve registered comp

effective ombumprehensivenessre of complaints.ilar indicator for

cess in general p

1999, general anort to create a pordinator. Linguistct on access ane done more than nization is hospitang office hours onof an emergencys the follow-up ancompasses patie.. However, an asponses quality isnguage translatio of in some hospy (2012) to allon this pilot projecal support and all be evaluated eaclot projects are rvolvement in dec

ement systems. Inn of patients’ rep

of quality indicator

man service existThis service recobut does not as

In 2010, 16 907er, these numberplaints can refer udsman servicess of the recordin There is also aassessing the e

practice146-148. In

d psychiatric Belgost of interculturaltic and cultural nd quality of car80 000 interventi

al dependent: onenly or also very exy. The coordinatioand the assessmeents encounters,ssessment of reas lacking. Moreovons (no less than pitals). In this co

ow mediation suct, a network is slso local medical ch year. recently launchedcision concerning n 2013, several ppresentatives in trs is soon expecte

Belgian

ts for managing ords the number sess the justifica

7 records were rers should be intto declining serv

s in terms of vg… or a changean international existence of a coBelgium, this is

gian hospitals canl mediator or intebarriers have in

re. In 2009, inteons in 17 language or several medxceptionally duringon cell of the FPSent of the reques

care providers l patients’ (or phyver, it remains di170 different nati

ontext, a pilot propport by interneset up between hhome or health

in Flanders to stheir disease in

public hospitals wtheir board of goed in this domain.

n Health System

patients’ and the tion and

egistered erpreted

vices but visibility, e in the trend to omplaint not yet

n ask for ercultural ndeed a ercultural ges. The diator(s); g out-of-S Public sts. The training,

ysicians’) fficult to onalities

oject has t (video

hospitals centres.

stimulate hospital

will allow overnors.

LB

LnlotoSdinepndinAdTccUs(cdth

w

Performance

Long-term care: BelRAI assessme

Long-term care ineeding assistancong-term care relaopic have been diSome indicators disabled elderly pan residential careelderly physically pressure ulcers annot been measurdomain. Howeverndicators. At the internationdeveloping a projeThe proposed framcare services wilcountries (AustralUnited States). Tsafety as key qincluding respons

coordination and development of pohe shortcomings.

w The Residen

assess the cextended witBelgium a nimplemented care, for longto the Belgiaperformance

no data currentent n this report ref

ce (mainly in residated to mental heiscussed above. have been chosatients, as the pree or receiving ho

restrained, the nd the problem ofred, which highli, the BelRAIw wil

al level, a workiect specifically fomework for monitol be based on tia, Canada, Engl

This framework pquality dimensionsiveness, empow

integration. Tholicies to achieve The release of th

nt Assessment Inscare needs of the th instruments for

national pilot projec in all care setting

g-term care facilitiesan situation. Data a

report.

tly, waiting for fi

fers to long-termdential care or recealth problems. In

sen to assess thevalence of malnu

ome care (BMI <1prevalence of fa

f polymedication. Tights the currentll soon provide d

ng group from thor long-term care4

oring and improvithe national framland, Finland, theprioritised care efns, followed by werment and com

e final phase quality in long-ter

he report is planne

strument (RAI)44 is elderly in institutiodifferent care sett

ct (the BelRAI) is gs. The assessmens and acute care haare expected before

irst results using

m care for the eceiving home caredicators from the

he long-term carutrition in elderly 19), the percentaalls, the incidencThose indicators t lack of data inata on some sel

he OECD is cur45, focusing on qung quality in long

mework of six Oe Netherlands anffectiveness and patient centered

mmunication) and in the report isrm care and to aded for the end of 2

originally developons, and has later tings and subgrouongoing, but is no

nt instruments for ave already been ade the edition of the

133

g the

elderly e) and

latter

re for being ge of ce of could

n this ected

rrently uality. g-term ECD-d the user

dness care

s the dress

2012.

ped to been

ps. In ot yet home

dapted e next

134

Efficiency desObviously, efficfew indicators efficiency meascould certainly

End-of-life carThe few indicatpatients dying palliative care patients eligibleavailability. Moron accessibilitylocal studies (eon restricted nuover time, and aim is to be repof care, end-of-international org

Health promotalready availabHealth literacy in health managto understand aindividuals the as a priority of atools have beenhealth literacy build and validaof health literaBelgium did not

erves more attenciency in healthca

selected in thissures which explbe an interesting

re: many local stutors measured in from cancer, orat home. This d

e for palliative creover, so far no

y nor on quality ofespecially from Flumber of patientshence cannot be

produced every fe-life care is little oganisations.

tion: data on heble in other Eurois a relatively newgement. It can beand manage factoopportunity to maaction for the 200n used in the worhas developed a

ate 12 indicators. acy. A first survet participate.97

ntion in future rere cannot be suffs work. Internatiicitly identify inpuarea of research.

udies in Belgiumthis report are ba

r on the populatidoes not cover are, which highlidata at national lef end-of-life care landers) are well

s, do not allow stue included in a peew years. Compaor not at all repres

alth literacy are opean countries w concept considee defined as the iors interacting withake healthier cho

08-2013 Europeanrld to measure it. a comprehensiveThose intend to

ey occurred in Eu

Belgian

eport iciently assessed onal literature puts and outputs.8

m, but few nationased on the popuion of patients rthe whole populights a real gap evel have been pin Belgium. Resuavailable, but ar

udying evolution oerformance repor

ared to the other dsented in databas

lacking, while t

ered as a crucial rndividual skills neh one’s health. Th

oices. It has beenn Union strategy. DThe European pr questionnaire ameasure various urope in 2010-20

n Health System

with the proposes 8, 16 This

al data ulation of receiving lation of in data

ublished ults from re based of trends rt whose domains ses from

they are

resource ecessary his gives defined Different roject on iming to aspects

011, but

1TpsrepqItminessBsfoseeRmadpmo

Performance

10 GENERAThis report preseperformance of thstudy. By means eport intends to

performance, poinquestions for furtht represents a submore comprehensndicators. Moreoevolution. Also, imsince the last editsurvival. Belgium is not thesigning of the 200ormally committedsystem performanexperience with example for this rReport. One of measurement (alsavailability of up todynamic publishinproblem. Yet, this makers commit thof the performance

AL CONCLents the resultse Belgian health of seventy-four

o provide an ovnting to some direer follow-up or resbstantial improvemsive and by updaover, it allows important previoustion, like the caus

e first country hav08 Tallinn Charter d themselves to tnce. Several neihealth system preport. This is cethe weaknesses

so identified in foro date data. Regung of results onis only one of the

hemselves to a sye of the Belgian h

LUSION of a first globsystem, building indicators with n

verall overview oections for policy asearch. ment over the pre

ating the former sn some cases s gaps in basic se-specific mortal

ving exercised thon health system

the monitoring anighbouring countperformance meaertainly true for ths hampering surmer Dutch perfoular updating of a

n a website coue options that can ystematic measurealth care system

KCE Report

bal evaluation oon a former feas

numerical valuesof the health syactions and gener

evious report, by set with more relthe measuremedata have been ity rates or the ca

his challenge. Witms, the Member Snd evaluation of htries, having yeaasurement servehe Dutch Performccessful performrmance reports)

administrative datald partially solvebe considered if p

rement and monitm.

t 196

f the sibility s, this ystem rating

being evant nt of filled

ancer

th the States health ars of ed as mance mance is the a and e this policy toring

KCE Report 196

APPEAPPENDTIER OF Health Status

• Life expec• Health exp• Self-perce• Infant mor

Dimension

Accessibility

6

ENDICESIX 1. LIST THE HEAL

ctancy pectancy eived health rtality rate

DomGen

•

•

•

•

•

S OF INDICA

LTH SYSTE

main of care neric

Number of practphysicians (per population) Number of practnurses (per population) Coverage hinsurance statuthe population Amount of payments and opocket payments% of people delay con

Belgian

ATORS MEEM, DOMA

Preventiv

tising 1000

tising 1000

health s of

co-ut-of-

s who

ntacts

• Covecance

• Covecervicscree

• Covevaccicover

• Coveinfluevaccielder

n Health System

EASURED AIN OF CAR

Healthcare

ve Care Cu

erage breast er screening

erage cal cancer ening erage nation rage children

erage enza nation for ly

Performance

IN THE 20RE AND DI

e

urative Care

12 REPORIMENSION

Long-t(elderlyhealth)• Nu

resfacpoye

• % ovrepinfo

RT, CLASS

term care y/mental ) umber of beds in sidential care cilities per pulation 65 ars and older

of population er 50 years old porting to be an formal carer

IFIED BY

End-of-Life Ca

• % of pawho died wone week start palliative service

135

are

atients within

after of

care

136

Quality - Effec

Quality - Appropriatene

Quality - Safet

tiveness

ess

y •

because of finareasons

Medical radi

Belgian

ancial

• %aged old wmamwithinyears

• % aged old wmamwithinyears

iation

n Health System

•

•

•

•

of women 40-49 years

who had a mogram n the last two s of women 70-79 years

who had a mogram n the last two s

•

•

•

•

•

Performance

5-year survival ratebreast cancestage 5-year survival ratecervix cancestage 5-year survival ratecolon cancestage Hospital admfor asthma Prescription antibiotics acto guidelines % of adult dreceiving appcare, in terregular retinal and blood testsGeographic vain caesarean s(per 1000 live bAverage daily qof me(antidepressanantipsychotics,hypnotics anxiolytics) prescribed Incidence of

relative e after er, by



missions

• Su• Ra

copehope

• Paby mewoem

of ccording

iabetics propriate rms of

exams s ariability sections births) quantity dication

nts, ,

and

hospital

uicide rate ate of involuntary mmittals as a rcentage of all spitalizations r year

articipation rates people with

ental illness of orking age in mployment

KCE Report

• % of capatients receiving chemotherin the lasdays of life

t 196

ancer

rapy st 14 e

KCE Report 196

Quality - ContiCare

Quality - Patiecenteredness

Equity

Efficiency

6

inuity of •

•

nt •

•

•

•

exposure of population

Coverage of gmedical record Usual providercare index

Satisfaction health care servic

Indicators of progressivity of phealthcare financGini coefficient band after taxationtransfers % prescription of

Belgian

the

global

r of

with ces

the public cing efore n and

f low-

n Health System

•

•

•

•

•

•

•

•

Performance

acquired infections Incidence of operative sepsIncidence of pulcers in hospitIn-hospital mafter hip fractu% of persons65 years or prescribed antidepressantan antichoantidepressant% of cancer discussed amultidisciplinarmeeting % of phencounter hospital dischaelderly patients

Assessment olevel hospitalization

% surgical day

MRSA

f post-sis pressure tals

mortality re s aged

older

ts using olinergic t drug patients

at the ry team

hysician after

arge for s (65+)

• % fropareapsypaocda(scbip

of pain during

y-case

of discharges om psychiatric in-tient care admitted to ychiatric in-tient care that curred within 30 ys

chizophrenia, polar disorder)

• Number contacts between patient andGP in the months of

• Patients in their place residence

137

of

the d the last 3 life

dying usual

of

138

Sustainability

Health Promot

Type of indica

Health outcom

Intermediate healthy lifesenvironments

Health promot

•

• • •

•

tion

tor

mes

health outstyles and

tion outcomes

cost drugs

Medical gradubecoming GP Mean age of GPNursing graduate% of GPs usinelectronic medicaHealth expendi(total, distributioof gross domproduct, per capi

Indicat

• % • Av• Inc

tcomes: healthy

• % • % • % • % • % • % • % • % • To

Belgian

uates

es g an al file tures n, %

mestic ta)

tor

of overweight or verage number of cidence of HIV of daily smokers of problematic alcof daily consumpof daily physical aoffer of physical ahealth promotionof schools with hof persons with p

obacco Control Sc

n Health System

•

•

obese adults decayed, missing

cohol drinkers (3

ption of fruits and vactivity activity at primary policies in the muealth promotion d

poor social supporcale

Performance

Average lengstay for delivery Acute care be(number per ca

g, filled teeth in ch

indicators) vegetables

y and secondary leunicipalities

dimension in their rt

gth of normal

ed days apita)

hildren at age 12

evel in schools

school project

KCE Report

t 196

KCE Report 196

APPENDThis section list

Indicator in 20

Accessibility

A1: Number ofNo data availa

A4: Coverage

A5: AdditionalNo data availa

Quality

QA1: Prescripacute otitis meNo data availa

QA3A: Utilisat(laparoscopic

6

IX 2. LIST ts the modification

010 report

f physicians andble for the numb

of preventive ch

illness-related cble in 2010

ption according tedia, uncomplicable in 2010

tion of minimal acholecystectom

OF CHANGns that were done

d nurses ber of nurses in 2

hild health care

costs for chronic

to guidelines (Uated hypertensio

and non-invasiveies, PCIs)

Belgian

GES TO INe to indicators sinc

2010

cally ill people

rinary tract infecon)

e surgical techni

n Health System

NDICATORce the 2010 report

Status in

Some da

RemovedRationaleaim was tcriteria) onational accessibi

RemovedRationalepeople wstudy of feasible w

ction, Modified

iques RemovedRationaleoperativeefficiencypatients minimal-i(sustainainterventi

Performance

RS COMPAt. Indicators for w

n 2012 Report

ta available in 20

d in 2012 e: this indicator wto focus on infant

or infants from milevel were availaility.

d in 2012 e: The calculatiowould require a go

each identified cwithin the time-fra

in 2012

d in 2012 e: the use of mine complications, ley. However, thesand careful patienvasive techniqu

ability). In 2012, laons.

RED TO THhich no data were

12

was defined as ants from underprivilgrants. The previ

able, which makes

n of additional iood definition of chronic disease. me of the present

imal-invasive techength of stay andse techniques arent selection is es is also considaparoscopic chol

HE 2010 Re available in 2010

n indicator of accleged families (deious report showes it less interesti

llness-related cochronic diseasesThis is a projectt project.

hniques is a mead costs. It is there not considerenecessary. The

dered to be an inecystectomies an

EPORT 0 are in red.

cessibility, as its iefined according ted that only resulng as an indicato

osts for chronicals and a cost-of-illt in itself, and is

ans for reducing prefore an indicatod appropriate fouse of these nedication of innovand PCIs are stan

139

nitial o six lts at or of

ly ill ness s not

post-or of

or all ewer ation dard

140

QA4: Percentguidelines oprocesses

QA6: Hysterec

QC1: Number

QC2: Average

QE03: ColorecNo data availa

QE06: Acute influenza

QE07.3: Salt co

tage of institutiutlining proced

ctomy by social c

of people who a

length of stay (L

ctal cancer screeble in 2010

care hospital

onsumption

ons that use sdures for hig

class

re not registered

LOS) in acute car

ening

ization rates f

Belgian

special protocogh-risk or com

d with a GP

re hospitals

for pneumonia

n Health System

ls or mplex

RemovedRationaleindicatorsBelgian hdata will b

RemovedRationalesocial clapublicatio

Modified Rationale DMG, thwith a Gpercentag

Modified ChangedRationaleof care. efficient tspecific dused by t

Some da

and Modified Rationalethe mostvaccinatioredundanwhich is a

RemovedRationalestudy pub

Performance

d in 2012 e: this indicator, os, could only be ehospitals, and wasbe available in the

d in 2012 e: the results for 2ass, and hystereons on which this

in 2012 e: as the concept is indicator was r

GMD – DMG”. It ge indicates bette

in 2012 to more specific

e: this indicator waHowever, expertthe healthcare sydiagnosis was chothe OECD.

ta available in 20

in 2012 e: this indicator ist effective preveon, which is alrent. It was modifiealso an indicator u

d in 2012 e for exclusion: tblished in 2008, w

originally from thestimated via the ds furthermore base near future.

2010 showed no ctomies rates haindicator was orig

of “registered withredefined more sp

was also changer coverage).

LOS for normal das previously sees were convince

ystem is. Instead osen: LOS for nor

12, but data still to

s a measure of eention measure eady an indicatoed into “Acute cused by the OECD

he results for thiwhich will not be re

e Dutch healthcardiffusion and use osed on non-valida

differences in hyave been declininginally based.

h a GP” in Belgiumpecifically as “perged into a posit

elivery n as an indicator d that it was moof all hospitalizat

rmal delivery, whic

oo premature to p

effectiveness of pagainst influenzaor for influenza, are hospitalizatioD.

is indicator were epeated.

KCE Report

re performance sof clinical pathwa

ated results. No b

sterectomies rateng steadily since

m refers to the GMcentage of populative indicator (hi

of the good contiore indicative of tions in acute carch is also an indic

perform evaluation

preventive care. Sa and pneumoni

makes the indicon rates for asth

based on a Be

t 196

et of ys in

better

es by e the

MD –ation gher

nuity how

re, a cator

n

Since ia is cator ma”,

lgian

KCE Report 196

QE08: Breast f

QE09: Annual

QE10: DecayedNo data availa

QE11: CardiovNo data availa

QE12: Colon CNo data availa

QE13.1: PremaNo data availa

QE14: Breast CNo data availa

QE15: CervicaNo data availa

QE16b: In-hos(CAP)

6

feeding at 6 mon

check-up at the

d, missing, filledble in 2010

vascular screeninble in 2010

Cancer 5-year suble in 2010.

ature mortality. ble in 2010

Cancer 5-year suble in 2010

al Cancer 5-year sble in 2010

spital mortality a

nths of age

dentist for child

d teeth at age 12

ng in individuals

rvival rate

urvival rate

survival rate

after community-

Belgian

ren

s aged 45-75

-acquired pneum

n Health System

RemovedRationaleproposedexclusivein Belgiumand ONEONE: 24

RemovedAfter a thpossible t

Some da

This indicRationalespecific nnew GMD

Data avaSource: B

RemovedPrematurcorrelatedhas no Avoidable

Data avaSource: B

Data avaSource: B

monia RemovedRationaleafter hip

Performance

d in 2012 e: a new set of indd, and experts dide breast feeding ism. Moreover, the

E were not compaweeks).

d in 2012 horough examinatto isolate prevent

ta available in 20

cator was removee: this indicator wanomenclature codD – DMG+, which

ilable in 2012 Belgian Cancer Re

d in 2012 re mortality, expd with indicators potential for actie mortality would



d in 2012 e: this indicator wfracture”, both be

dicators to assessd not retain this ins hardly compatibl

previous report sarable, due to diffe

tion of the nomenive care at the de

12

d. as not measurabl

des. Since 2011 cwill be monitored

egistry

pressed as Potealready in the seion, as it does be a better indica

egistry

egistry

was linked to the eing indicators in

s performance of ndicator, mainly ble with the length showed that data erent time frames

nclature codes, it ntist for children.

e in the 2010 repcardiovascular pred.

ential Years of t (infant mortalitynot highlight the

ator.

indicator “QE16ancluded in feedba

health promotion because six month

of the maternity lefrom Kind and G

s used (KG: 3 mon

appears that it is

ort because of lacevention is part o

Life Lost (PYLL, life expectancy)e potential proble

a: In-hospital morack on quality of

141

was hs of eave

Gezin nths,

s not

ck of f the

L) is and ems.

rtality care

142

QS1: Incidence

QS2: Incidence

QS4: Incidence

QS5: Incidencindividuals at No data availa

Sustainability

S1.1: Amount

S2: Qualificatio

S4: Yearly amo

e of serious adve

e of healthcare r

e of post-operati

ce of pressure urisk ble in 2010

reimbursed by th

on levels of heal

ount of the Spec

erse effects of b

related infections

ive surgical site

lcers in long-ter

he maximum bill

lthcare providers

cial Solidarity Fun

Belgian

lood transfusion

s

infections

rm care facilities

ling system

s

nd (SSF)

n Health System

sent by thteam decindicator the 2010

n RemovedExtremely

RemovedChangedRationaleincidenceredefinedinfection”

ChangedRationaletype of osepsis”, national cindicators

s and Data not Source: B

Removed

Modified

RemovedRationaleand decisincluded capacity t

Performance

he FPS Public Hecided that the latthan mortality aftereport).

d in 2012 y rare events, so

d in 2012 to prevalence of

e: this indicator is e of all healthcad more specifical”, which is measur

to post-operativee: this indicator haperations coveredwhich can be mcoverage and a ws.

yet available in 20BelRAI

d in 2012

in 2012.

d in 2012 e: the SSF acts assions to reimbursein the previous sto be responsive

ealth to Belgian hotter indicator, moer CAP, to assess

difficult to interpre

HAI, currently no not measurable (

are related infectly as “the inciderable.

e sepsis as low coverage, d. It has been cha

measured by admwider range of inte

012 (but soon).

s a safety net, bese treatment are bset as a sustainato emerging need

ospitals. During thortality after hip fs safety of care (a

et evolution over t

data. no surveillance sytions). This indic

ence of hospital-a

in terms of numbanged into “incideministrative data, erventions. It is a

sides the compulsbased on a case pability indicator, sds. However, trea

KCE Report

he review processracture, was a band not efficacy, a

time.

ystem can monitocator has thus bacquired bloodstr

ber of hospitals anence of post-opera

and hence inclulso included in O

sory health insuraper case basis. It showing the systetments reimburse

t 196

s, the better as in

or the been ream

nd of ative udes ECD

ance, was

em’s ed by

KCE Report 196

S6.1: Number

6

of acute care beds (per 1000 pop

Belgian

pulation)

n Health System

the SSF (EMA), aThis is thsystem.

RemovedRationaledays, numoccupanc

Performance

are usually thosand are reimbursehus not a very re

d in 2012 e: this is a secondmber per capita”.cy rate and length

se waiting for aped by compulsoryelevant indicator

dary indicator link. The latter was p

h of stay.

pproval by Europy health insurancof the sustainab

ked to the indicatopreferred because

pean Medical Agece after this approility of the health

or “S6 acute caree it also account

143

ency oval.

hcare

bed s for

144

APPENDMEASURThis appendix evaluate the pewill be availableto present thoseFor each indicaare indicated. Health Promotio• % of peop

DMG+) (preventiveThe globalGP. The additional cplay a majstate of p(vaccinatioGMD – DMcoverage promotion.Source of d

Continuity of ca• Percentag

chronic caencounterchronic caPathways fof these papatients wphysicians registrationregistered participatiothere were

IX 3. LIST RABLE IN A

lists the indicaterformance of the e in a near futuree results in the ne

ator, a short ration

on ple (aged 45-75) (specific consue care) medical record iGMD – DMG+,

component of preor role in health pplay of risk fac

on and screening)MG+ is a tool to

of the GMD –

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and other hn in a pathway

in the pathwayson in this public inve 20 176 register

OF INDICAA NEAR FUtors that were sBelgian health sy

e (i.e. in a 3-yearsext issue of this renale is provided, a

with a global multation on h

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DMG+ is thus

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healthcare profesis voluntary, the

s of care is a ivestment. Accorded pathways for

Belgian

ATORS UTURE selected as pertystem, and for whs time frame). Theeport. and (future) source

edical mecord+ealth promotio

centrally managedApril 2011, contath promotion. Thehe right person to

preventive intervr healthy behaviothis task. Monitoan indicator of

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ambulatory path

gium since 2009. nd collaboration b

practitioner, sssionals. Becau

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ding to the RIZIV –diabetes and 15

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tinent to hich data e idea is

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renal failure currently unknwhich aims tobe presented Source of data

% of visits mental healthAlthough unfohealth, mentaindicator of pcommunity trmental healthutilization ratehigh.150 Highlyto enter treatneed for emeeffective liaisoresources redservices/clienvisits are nocommunity. overcrowding likelihood of mIn the US, it hroom visits arthe importanchealth in emenumber of visspecialist in eshould be a accessible forSource of datRCM – MKG)not be measu

on 31 October 2nown. This item wo evaluate the pain May 2013. a: ACHIL project to the Emergenh and/or substanoreseen and unaval health related poor coordinationreatment system h related problees of emergencyy accessible outpment before reacergency room vison between emeduces the use ots. High rates of

ot only a concerIt is also a c

results in decrmedical error.150

has been illustratere on the rise for mce of the availabrgency rooms to mits for psychiatric

every emergency minimum protoco

r immediate care fta: RHM – MZG s. Due to delays inred in this report.

011.142 But the will be estimated thways for chroni

ncy Rooms in gnce-related problvoidable emergen

emergency roomn of care and se

to support servems is regarded y departments of atient care is con

ching the crisis stsits.149 In additiorgency rooms an

of emergency roomental health rel

rn for members concern that emeased quality of

ed that mental heamore than one de

bility of expertise manage these criproblems, availabroom may not b

ol by which menfor every citizen.15

since 2008 (informn accessing the da

KCE Report

exact denominat by the ACHIL pic care. Evaluatio

general hospitallems cies do arise in mm use is used aervice failures.149

vices for peopleas ineffective

general hospitalnsidered to help ptage and minimiz

on, it is assumednd mental health oms for mental hlated emergency of the mental h

mergency departf care and incre

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in the field of mses. Depending obility of a mental h

be practical. Still, tal health expert52 mation not availabata, this indicator

t 196

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on will

s for

mental as an 9 The with when s are eople

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health tment eased

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mental on the health there ise is

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KCE Report 196

Patient-centere• Patient ex

Patient-cencommunicaaddressed A good com(listening, questionnathe quality the Healthinstrument Source of d

Long-term CareThe majority of

x The Resid

assess theinstrumeninstitutionacare, acustructuredplanning different itthe elderly

In Belgiumimplemencare and are adapte

The interstandardizpreferenceinstitutionaconsistentassessmethe functiouse of caspecific tr

6

edness periences with antered care is ation so that patieand patients und

mmunication is noexplaining, court

aire on patient exof the consultatio

h Interview Survdedicated to the

data: next Health e indicators will be

dent Assessment Ie care needs of the

nts for different caal mental healthcaute hospital care d and standardized and quality monitotems, resulting in a y. m a pilot project (thted in all care setfor long-term care ed to the Belgian sitrRAI for long-terzed instrument to ees of the residents al setting) and aimt assessment sys

ent instrument givesonal capacity, the mare of the individuriggers for care p

ambulatory servisupported by

ents’ needs and wderstand and partot easy as it requitesy…) In 2011 txperiences with soon.15 The WIV –vey (2013) the patient experiencInterview Survey,

based on the Bel

nstrument (RAI)44

e elderly in institutionare settings and sare, ambulatory mand persons withassessment aims t

oring. Different caremultidisciplinary ap

he BelRAI) is ongoittings. The assessmfacilities, for acute tuation. rm care facilitiesevaluate the needsin a long-term care

ms to stimulate thstem and a paties a description of thmental and physica

ual resident, wherelanning. Next to t

Belgian

ces good provide

wants are understticipate in their owres several compthe OECD has eome questions reISP decided to inmodule of the

ces with ambulator, WIV – ISP

lRAI project x

was originally devens, but is later extenubgroups (post-acu

mental healthcare, h mental disabilitieto realize a high-que providers can aspproach of the care

ing and is not yet nment instruments fcare and for pallia

s (interRAI-LTCF)s, the competencese setting (care homehe continuity of caent-focused approahe most important aal health, the needseby most items funhe assessment ins

n Health System

r-patient tood and wn care. etencies edited a elated to nclude in OECD ry care.

eloped to nded with ute care, palliative es). The ality care

ssess the needs of

nationally for home ative care

153 is a s and the e or other are via a ach. The aspects of s and the nction as strument,

•

•

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Evolution ovinstitution)Source: BelRA

Prevalence oOlder personcomplicationsand swallowincognitive funindicator will belongs to thproject.45 Source of data

analysis protinterRAI-LTFDutch and FrThe InterRAassessment patients but ahospitalisatiopreferences oclient. The (standardisedSome items risks for funcCAPs. Theseand for indivdomains anmultidisciplinathe priority ofsituation and

ver time in utiliz

AI of malnutrition byns are particulars such as changesng problems, chanction and deter

be available in he set of indicato

a: BelRAI

tocols are developeC has been adapte

rench (BelRAI-LTCFAI for home care

system to guide also for patients wit

on). The evaluatioof the client indicate

interRAI-HC cod scoring scheme) of the instrument fctional deterioratione CAPs contain gevidualized care an

nd each triggeredary consultation to f each CAP. The intranslated into Dutc

zation of BelRA

y elderly (BMI <1rly vulnerable tos in appetite and

ange in nutritionalriorating vision.15

the BelRAI datrs in the OECD

ed as guidance for

ed to the Belgian situF). e (interRAI-HC)154

the home care plth post-acute care n of the needs, e the functioning anonsists of the

and the CAPs (clifunction as triggersn and link the inteneral guidelines fo

nd services. The 3d CAP needs todetermine the neceterRAI-HC has beech and French (BelR

AI (home care an

9) o malnutrition du

energy level, chel requirements, lo55 The data fortabase. This indlong-term care q

r the care planninguation and translate

4 is a person-cenanning for chronicneeds (for examplethe strengths an

nd the quality of life assessment instrunical analysis proto for specific probleerRAI-HC to a serr the further asses

30 CAPs cover difo be discussed dessary care service

en adapted to the BRAI-HC).

145

nd in

ue to ewing oss of r this icator

quality

g. The ed into

ntered c care e after d the of the ument ocols). ems or ries of sment fferent during

es and elgian

146

• Percentagthe last 7 dRestraint-frHowever, ilong-term cOECD longSource of d

• PercentagFall incideelderly. Peincidents. T12 monthsan accidencause of thand in persthe fall cauBelRAI-LTCdeterminescare qualitrelated fracsafety.45 Source of d

• Incidence individualsThe occurrserious nega much prwith good qit will be pindicator is

ge of residents wdays ree care should n reality, physicacare.156 This indicg-term care qualitydata: BelRAI

ge of residents wents are a commersons who fell onThe most recent H

s preceding the innt resulting in a mhe accidents weresons of 65 years aused a fracture. WCF and the Bels the risk on fututy project the indctures is proposed

data: BelRAI of pressure ulc

s at risk (home crence of a pressgative impact on rolonged hospitalquality nursing capossible to evaluas also included in

who were physi

be the aim of hl restraints are co

cator belongs to thy project.45

who had a fall durmon cause of mnce, have an incHealth Survey Int

nterview 7% of thmedical consultatioe falls (54%) and and older. In moreWithin the domainlRAI-HC, a subdure fall incidents.dicator on the incd as example of a

cers: a. in long-tcare) sure ulcer in a hothe individual’s h stay. Pressure re.58, 59 Currently ate this indicator n the set of OEC

Belgian

ically restrained

igh quality nursinommonly used in he set of indicato

ring the last 30 dorbidity and mor

creased risk on futerview reports the Belgian populaon.157 The most cwere common in e than 40% of then of state of healtdomain on fall i In the OECD locidence of falls aa quality outcome

term care faciliti

ospitalised patienealth57 and often ulcers can be prno data are availausing BelRAI da

CD indicators in q

n Health System

d during

ng care. geriatric rs in the

days rtality in uture fall at in the tion had common children

e elderly, th of the ncidents ong-term and fall- on user

es b. in

nt has a leads to

revented able, but ata. This quality of

•

E•

Performance

long-term careSource of data

Prevalence oThe WIV – ISbe avai(http://www.nsSource: WIV –

Efficiency Chronic care

patients withThere are diffThe patients peritoneal diatransplant, eittransplantatiowhenever posSubstitution oless expensivcentres and pmany other comechanisms modified the fof introducingis categoriseddialysis is notis also considSource of datthe EPS, but draw any condatabase.

e.45 a: BelRAI

of MRSAs in nursP is currently finailable at sih.be/nursing_ho– ISP

e: patients with h dialysis ferent treatment o

can be dialysealysis. In both casther from a decean is considered

ssible. of the more expeve alternatives sucperitoneal dialysisountries. This is tfor dialysis. Sinc

financing system incentives for sud in the performat indicated for all pered an indicator ta: IMA. Preliminathe sample of p

nclusion. Analyses

sing homes alizing a study, of

the enomes/inleiding_fr.a

home dialysis a

options for patiened, either with hses patients can

ased or a living dod to be the mo

ensive haemodialych as low-care has has been slowhought to be partce 1995 the Bela couple of times

ubstitution. For thiance dimension epatients with end-of appropriatenes

ary analyses for tatients under dias will have to be

KCE Report

f which the resultd of asp).

s a percentage

nts whose kidneyhaemodialysis or

also receive a konor. Ultimately, kost preferable o

ysis in hospital baemodialysis in sawer in Belgium thtly due to the finalgian governments, with the explicits reason, the ind

efficiency. Since -stage renal diseass. his report were ru

alysis was too smdone on the tota

t 196

ts will 2012

of all

s fail. with

kidney kidney ption,

by the atellite an in

ancing t has t goal icator home ase, it

un on mall to al IMA

KCE Report 196

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