WEEK3

Question 1

Background Healthcare System Belgium
- Compulsory health insurance
- Role of NIHDI
- Provision of healthcare
- Patient Payments
- Belgian political system

Answer 1

• Compulsory health insurance
  (almost) entire population is covered
  low membership costs
• Role of NIHDI
  distributes resources between health insurers
  ‘rules of the game’
• Provision of healthcare
  fee-for-service
  patients are free to choose provider
• Patient Payments
  patients pay full price and get reimbursed
  maximum expenditure depends on household income
• Belgian political system
  federal level

Question 2

Supply-side rationing: closed end budgets + enforcing (Belgium)

Answer 2

Setting of a global budget
Growth norm: maximum expenditure increase

Enforcing: clawback clausule

Question 3

Demand-side rationing: Insurance structure (Belgium)

Answer 3

Patients pay copayment, but there is a maximum expenditure
The system tries to limit moral hazard, but is also concerned with unmet needs for healthcare
Poor react more to cost-sharing

Question 4

Features LMCI’s

Answer 4

• Fewer resources
• Higher out-of-pocket expenditures
• Reliance on external aid
• Large inequalities
• Higher disease burdens

Question 5

Universal Health Coverage (LMIC)

Answer 5

All people have access to the full range of quality health services they need.
Track the performance of countries over time

Question 6

Primary Health Care (LMIC)

Answer 6

Service delivery system or platform, together with the human and other resources needed for it to function effectively

Question 7

Structure of healthcare UK
- Budget
- Insurance
- Access system

Answer 7

• Budget
  fixed annual budget
• Insurance
  general taxation, and small component funded through national insurance
• Access system
  Through a GP

Question 8

Rationing by waiting time (UK)

Answer 8

Budget leads to several physical limits > long waiting times > people die

Question 9

Measures to shorten the waiting time (UK)

Answer 9

• Waiting list targets (with or without penalties)
• Increasing competition
• Prioritizing waiting lists (bigger potential health gain are processed quicker)

Judging:
- Worse health outcome
- Individuals might lose income
- Inflexibility

Question 10

Rationing by location (UK)

Answer 10

• All medicines are free
• Different policies > postcode rationing
• Wealthy areas attract more health professionals

Judging:
- Inequalities
- Local differences in need

Question 11

Rationing by socio-economic status (UK)

Answer 11

• Knowledge helps people navigate through system
• Private health insurance

Judging:
- Private option (inequal)
- Monitoring specialists’ waiting lists

Question 12

Rationing by science (UK)

Answer 12

• Tackle postcode rationing
• ‘Value for money’

Judging:
- Denying access
- Cost-effectiveness of therapies
- Political will

Question 13

Health Technology Assessment (UK)

Answer 13

• Comprehensive
• Standardized
• Current technologies & emerged technologies
• Clinical- and cost-effectiveness

Question 14

ICER

Answer 14

(cost (new) - cost (oud)) / (effect (new) - effect (oud))

Question 15

Assessment (beoordeling) of incremental costs per QALY (UK)

Answer 15

• Provides a standardized apporach
• Recognizes the budget constraints
• Relatively transparant
• Flexibility
• Different indications & subgroups

Question 16

Shortcomings of QALYs (UK)

Answer 16

• Individual valuations of health states
• Based on assumptions
• Do not reflect all social value

Question 17

Quotas in Belgium

Answer 17

1) numerus clausus: fixed number of medical students
2) quota on some hospital/inpatient services: number of hospital beds
3) quota on number of hospitals that can provide certain types of care: enough expertise