The face of national health care in Belgium

This is the face of national health care in Belgium. CM is one of 8 nonprofit health and social service firms in the country. Everyone is required to join one of these social insurance firms (SIF). CM has its roots in the Christian Democratic movement, (the moderately conservative political force in Europe, note the Christ and the cross in the CM name and logo) though no longer formally affiliated. The socialists, the farmers and other groupings have their equivalents.

These firms manage health care and payments to doctors and hospitals. People with income have co-payments, but these are capped at a relatively low amount and many people buy supplemental policies to cover those or other costs (like private room in hospital, etc.) The SIF are non-profit but want to succeed as enterprises so they have offices everywhere and compete with lots of services that help with home care, exercise equipment, youth groups, etc. To do this they have to keep customers happy without going broke with excessive treatment costs. So they focus on prevention, rehabilitation and getting people out of hospitals quickly and following up to insure recovery.

The hospitals are all nonprofit and/or religiously affiliated. At least earlier in the decade almost all doctors are in solo practice.

Patients get to choose their medical providers, though I suppose that if a SIF falls out with the doctor of your choice, you may need to change to a different SIF – you can do so quarterly.

How is it paid for? Employees and firms pay tax to government. The tax does not vary according to health care cost risks. If you change jobs or move, you can keep the same SIF. Government pays money to the SIFs based on how many they have enrolled. If you are elderly, disabled, unemployed, you sign up with a SIF and the tax system also covers your costs, including your co-payments.

What is the difference between what this has and what is being debated in the U.S.? This is nearly single payer – government collects taxes and pays most of the costs. Individuals and private insurance cover a relatively small %. The SIFs seem to have a good management role with incentives to keep and get people well. There is no screening for pre-existing conditions, confusing and patch-work coverages. My guess is that they may employ more accountants and clerks than the French or British system but far fewer SIF people are focused on getting healthy people into the company, keeping sick people out and fighting to find ways not to pay the bills of sick people, than we see in the U.S..

There is a political process in which the SIFs, doctors and other medical providers and government negotiate the national budget for health care and thus have some cost controls. A little bit like how the federal medicare system sets reimbursement rates for costs of medicare patients, though far more comprehensive. So, I am sure that doctors, drug companies, SIF CEOs, hospital administrators and the like are not as highly paid in Belgium as in the U.S.. I also will bet that institutions consider very carefully before getting into races to have the absolutely latest technology, upgrading the quality of carpets in their waiting rooms, etc.

So far as I can tell, there is nothing here like the VA medical system that, through clinics, hospitals and an insurance system (Tricare) seems to have grown to be both generally high quality and cost-effective. I wish that model would be more carefully considered in the U.S., but I am OK with keeping the medical providers independent from the government. There is much to be said to just hiring staff to provide a service rather than having the many layers of institutions and costs that the U.S. system now enjoys. That's why we still have a public police department, paid for with taxes and managed by professionals with a goal of public safety, not private profit.

Healthcare and life expectancy are high here in Belgium.

Unfortunately, the Dingell bill for single payer healthcare, that would take the profiteering out of the payment collection and distribution system (insurance companies) seems to be DOA in Congress. If a government plan is included in the reform effort in the U.S. we may make some steps forward. I think that the coop idea is a diversion. Any alternative to the big health insurance “system” will also need to be big in scope to have any impact. And, Group Health, now Health Partners in Minnesota started as a coop but I think is now effectively captured by a management system that is little different from its for profit competitors.

Health care is good and life expectancy is high here in Belgium. According to Reuters, Belgium spends 10.2% of GDP on health and the U.S. 16% (50% more than Belgium as a portion of the economy.) The World Health Organization ranks Belgium at # 21 and the U.S. at # 37. France, spending just a little more as % of GDP (11%) is ranked #1 in the world. It can't be just the great beer and wine in Europe
that makes the difference.

Oh, and by the way, one of my Belgian contacts wants to be sure that we know that the "Palin Death Panels" are still only sitting in profit-making insurance company offices, not in the national health programs in Europe. Her 92 year old relative is scheduled for heart surgery soon.