ࡱ> J l( / 00DTimes New Roman|d0|Wo 0DArialNew Roman|d0|Wo 0" DCourier Newman|d0|Wo 010DWingdings 3man|d0|Wo 0 ` .  @n?" dd@  @@`` 4G&"   "Zpppg      %c $@Qr ʚ;9ʚ;g4BdBd0pbp@ p<4KdKd 0,<4dddd 0, <4BdBd. 0,H___PPT9, a"? %eIFIRST ANNUAL MEETING OF THE INSEAD-EHLP-class 2002 Brussels, May 23, 2003JJI  THE PERSPECTIVE OF THE PROVIDER !!$! Introduction 2. Short history of organized interest groups 2.1. Creation of Sickness Funds and Medical Trade Unions 2.2. Physicians resistance and strike 3. Elements of the law of August 9, 1963 on Sickness and Invalidity Insurance 3.1. The system of conventions 3.2. Representativity of Medical Trade Unions 4. Representation of medical organizations in official organs 5. Our principles and objectives 6. Conclusion(" 2 .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (1)//. The 19th century proletarianism led to the creation of societies of mutual assistance for the working class Legal basis April 4, 1851 Allowing the formation of alliances by the law of June 23, 1894 Governmental support since March 19, 1898 Remained unchanged until December 31, 1990 .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (2)//. BLaw of December 12, 1944 : creation of a mandatory sickness and invalidity insurance system for employees Implementation by Decree of the Regent of March 21, 1945 creating a national committee of directors including : - 8 employees representatives - 8 employers representatives - 5 representatives of the sickness funds - 3 government commissioners : ministry of health care, social security and finance No representation of health care providers Publication of a provisional tariff list by Ministerial Order of April 19, 1945*{"! .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (3)//. Till +/- 1950 : lots of small professional societies July 15, 1954 : creation of the Grouping of Belgian Professional Societies of Medical Specialists (VBS-GBS) and futile attempts reach an agreement with sickness funds October 10, 1954 : creation of the General Syndicate of Belgian Medical Doctors (ASGB) by Dr. Marcel DE BRABANTER -> shared management of the system -> shared financial responsibility -> generalized and compulsory system of third party payment >5ZZZZ .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (4)//. fA huge majority of physicians refused the ASGB proposals creating the possibility of rationing of careggf  .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (5)//. February 14, 1961 : prime minister Gaston EYSKENS Law of Union leads to a near-revolution Introduces an Institute for medical control (art. 33) Authorises the King to impose tariffs if no convention is concluded (art. 52, still existing, but somewhat modified in art. 50 11 of the coordinated law on medical care and allowances) End 1963 : creation of the Belgian Association of Medical Trade Unions (BVAS-ABSyM) in opposition to the minister of Social Affairs, E. LEBURTON, by Dr. A. WYNEN0_ZZZ .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (6)//. BVAS-ABSyM regroups the - syndicalist chamber of Lige and Luxemburg (created May 17, 1962) - syndicalist chamber of Walloon Brabant, Hainaut and Namur (created March 22, 1963) - syndicalist chamber of the Brussels metropolitan area (created May 31, 1963) - syndicalist chamber of Antwerp, Limburg and Flemish Brabant (created August 23, 1963) - syndicalist chamber of East and West Flanders (created August 29, 1963) J@( /T   0SHORT HISTORY OF ORGANIZED INTEREST GROUPS (7) 110 Stiff resistance from physicians against the LEBURTONS Law with refusal of - a state-controlled medical care - financial responsibility for the medical care being offered - imposed tariffs - and demand for a social security system for physicians, leading to a general medical strike from April 1 to April 18, 1964,*LD`` .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (8)//. Jfollowed by the St. John s agreement of June 25, 1964 between - the government - representatives of the Medical Trade Unions, mainly BVAS-ABSyM - representatives of sickness funds - employers - employees trade unions The St. Johns agreement remains the basis of the current system X>F NA%$   S3. Elements of the law of August 9, 1963 on Sickness and Invalidity Insurance TT(S  3.1. The system of agreements 3.1.1. Basic principles The law of February 15, 1993 - strengthens the role of the government social partners - employers - employees trade unions - maintains the impact of the sickness funds - diminishes the influence of the providers For example : the convention physicians- sickness funds needs the approval by : - the general NSIII council - the Insurance Committee - the Budgetary Control Commission$    3.1.2. The Medical Technical Council elaborates the nomenclature of medical services 27 M.D.-members + 1 president 9 sickness funds 7 university 11 medical unions tX4  +3.1.3. Erosion of free choice in the course of the years Same reimbursement for patients treated by physicians in/out the convention still remains but the legislation is curtailing the therapeutic freedom more and more introducing for example reference prices for some hospitalised patients :,+  TAPR-DRG s SURGERY : number and description++ * #73 Lens procedures w or w/o vitrectomy Tonsillectomy & adenoidectomy procedures 179 Vein ligation & stripping 225 Appendectomy 228 Inguinal & femoral hernia procedures 263 Laparoscopic cholecystectomy 302 Major joint & limb reattach proc of lower extrem exc for trauma 313 Knee & lower leg procedures except foot 318 Removal of internal fixation device 482 Transurethral prostatectomy 513 Uterine & adnexa procedures for ca in situ & nonmalignancy 516 Laparoscopy & tubal interruption 540 Cesarean delivery 560 Vaginal delivery z(Z " ZZ''' ''''''')''!''D'',''('' ''?''%''''''0             )   /     , (                     hAPR-DRG s internal medicine : number and description55 4 p045 Cva w infarct 046 Nonspecific cva & precerebral occlusion w/o infarct 047 Transient ischemia 134 Pulmonary embolism 136 Respiratory malignancy 139 Simple pneumonia 190 Circulatory disorders w AMI 202 Angina pectoris 204 Syncope & collapse 244 Diverticulitis & diverticulosis 464 Urinary stones w esw lithotripsy 465 Urinary stones w/o esw lithotripsy qZ''9'''''''''' ''''''$''%'''''                      ?3.1.4. From fee for service to agreed lump sum payments (1)@@$?  Fee for service remains for most medical acts Slowly introduction (since 1988) of agreed lump sum payments - laboratory medicine : 75 % - radiology : +/- 31 %*n6  ?3.1.4. From fee for service to agreed lump sum payments (2)@@$? 4More lump sum payments for - accreditation system (all physicians) - global medical record (G.P. s) - disposability (G.P. s) - medical record software programmes (G.P. s) - local G.P. s circles organizing grand duties (- subsidizing general medical pratices) BZgZ0ZZ J3.1.5. Acceptance of convention between physicians and sickness fundsKK$J  A convention is not accepted if > 40 % of the physicians refuse or if > 50 % medical specialists refuse or if > 50 % G.P. refuse Counting is elaborated by each legal district.#--%---/-   4Refusals to join the convention of December 12, 200255 4  XPercentage of refusals to acceed the convention between physicians and sickness funds (YV##H  5   Refusals to join the convention physicians  sickness funds of December 19, 2002 (in %) ZZ# ,W  "33.2. Representativity of medical associations (1)44$3 To be legally representative, a medical association must : Have both medical specialists and G.P.'s Have members in at least 2 of the 3 regions Exist at least 12 months Count at least 1.500 affiliated individual members, registered with the NSIII < #33.2. Representativity of medical associations (2)44$3 Only 2 organizations fulfil the 4 Criteria : BVAS-ABSyM (D + F; G.P.'s + M.S.) Cartel * Confederation of Belgian Doctors - Belgian Gouping of G.P.'s (F, G.P. s) - Belgian Syndicate of Medical Specialists - General Syndicate of Belgian Medical Professions (D; G.P.'s + M.S.) * Syndicate of Flemish General Practitioners (D)D.Z)ZRZ0Zhg $33.2. Representativity of medical associations (3)44$3 ^counting of members failed since 1964 elections at four years intervals were incorporated in the law in 1996 and carried into effect since 1998 the results determine the number of seats in the NSIII councils, committees, commissions & for example in the National Commission Physicians-Sickness FundsZ&ZZjZZ[ZCZ0/ :Composition National Commission Physicians-Sickness Funds ;;# 9  #Participation in medical elections &$"# !" QResults of the medical elections June 30, 1998 and June 25, 2002 (in percentage) RR#x%33.2. Representativity of medical associations (4)44$3 Numerous other medical associations are not representative Medical specialists - Grouping of Belgian Professional Societies of Medical Specialists (G.B.S.-V.B.S.) - numerous scientific societies General Practitioners : strongly dispersed and regionalized - Flemish and Francophone local circles of G.P.'s grouped in UHAK and FAG - a Flemish and a Francophone scientific society (WWVH and SSMG) - a Parliament of Flemish G.P.'s v=ZZ_0Z"Z<Z0ZZ ' B4. Representation of medical associations in official bodies (1)CC B H4.1. At the NSIII Service of Medical Care - Insurance Committee - Budgetary Control Commission - National Commission Physicians-Sickness Funds - National Council for the Promotion of Quality - Accreditation system including - Accreditation Management Group - Joint Committee by Speciality - Working Group on Ethics and Economy - Technical Council for Accreditation - Appeal Commission - Commission of Profiles - Evaluation Committee on Medical Practice relating to Medication Service of Medical Assessment and Control - Service Unit - Committee - Appeal BoardZ0Z0ZiZG0Z*0Z-0Z+,H (!B4. Representation of medical associations in official bodies (2)CC B 4.2. At the Federal Public Service, Public Health, Safety of the Food- chain and Environment Certification of M.D.'s Legislation on hospitals Others on - nursing care paramedical professions clinical biology & rbJ + - `J+ )".5. Principles-objectives (1) Ten basic rules ://$. The patient has a central position The physician respects the Code of Medical Ethics and in particular Article 36 "The physician is free as to his/her diagnosis and therapy. He/She will refrain from prescribing useless examinations or expensive therapies or to perform superfluous acts" The patient is free to choose his medical doctor The physician is free to decide between diagnostic and therapeutic alternatives The protection of medical confidentiality is crucial  " 7""O""0"O"4"n"  0 O 4 *#.5. Principles-objectives (2) Ten basic rules ://$. 6. Physicians ensure the continuity of quality care 7. There is an equivalence between general practitioners and medical specialists 8. There is an equivalence between medical specialists as such 9. An identical pathology gives rise to identical fees, irrespective of the place * Academic or non academic institution * Region * Hospital care or out-patient care 10. In other words, the implementation of a just and objective legislation on the entire territory.  23"P">""c"n3 P >  c +$5. Principles-objectives (3)$ For the new government to be appointed, we reiterate our vision Stop the creation of costly and overlapping structures Give support to the co-operation agreements existing on a small scale between health care providers belonging to the same profession and between providers pertaining to several professions (general practitioners - medical specialists - physicians - nursing staff - paramedics - physiotherapists& ) Restrict the interference of the State in health care Stop excessive standards and bureaucracy AA6"("5"("fA 6 ( 5 ( ,% 6. CONCLUSION$  Continuing the concertation model between health care providers and sickness funds, under supervision of the State, is the best option to maintain and promote the high reputation and international level of the Belgian health care system  -& GWords to remember : "Pas de mdecine sans mdecins" Dr. Andr WYNEN)HHG %  ` ` ̙33` 333MMM` ff3333f` f` f` 3>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> YQ(    6,X D  e1Cliquez pour modifier le style du titre du masque2 2:  0Z D  vCliquez pour modifier les styles du texte du masque Deuxime niveau Troisime niveau Quatrime niveau Cinquime niveau4 w  0, D  X*  00     Z*  07    Z*H  0޽h ? ̙33 "Modle par dfaut@ `(    0Ї P    X*   0d&     Z*   6ܗ `P   X*   6 `   Z* H  0޽h ? ̙33 _W0(  x  c $D1D  x  c $*@   s  08  Marc MOENS, M.D. Vice-president of the Belgian Association of Medical Unions (BVAS-ABSyM) Secretary-general of the Association of Belgian Professional Societies of Medical Specialists (VBS-GBS)   0p  : 2   0P  3Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 200344 3   0% Q1 2  H  0޽h ? ̙33-  @m(    S v3       0$@3  4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003  4 25 3   03p Q2 2  H  0޽h ? ̙33  MEP(  r  S 3D  3 r  S 3D 3   0T!3@ S 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0z3@ Q3 2  H  0޽h ? ̙33G  `(  r  S @DP   r  S ,!D    0ĽW 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 04 24 $3   0|` : 2   0  Q4 2  H  0޽h ? ̙33  MEpp(  pr p S D   r p S lD`   p 0@S 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3  p 0h  Q5 2  H p 0޽h ? ̙33  MEt(  tr t S D   r t S @D    t 00 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3  t 0\] Q6 2  H t 0޽h ? ̙33  NF$(  $r $ S  D`   r $ S D   $ 0@ 5Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (5 25 3  $ 0,7@ Q7 2  H $ 0޽h ? ̙33  MEd(  dr d S <D   r d S $=D   d 0>p 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3  d 0lDp@ Q8 2  H d 0޽h ? ̙33  ME0(  0r 0 S  0   r 0 S D   0 0Z@S 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3  0 0,^@ Q9 2  H 0 0޽h ? ̙33  NFx(  xr x S D   r x S tP   x 0 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3  x 0S  R10 2  H x 0޽h ? ̙33*  j(  r  S /3D 3   0d 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0 @P  X10 bis 2  H  0޽h ? ̙33$  hd(  hr h S     h 0mp 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3  h 0sp  R11 2  H h 0޽h ? ̙332  |r(  | | S  {t`   | 0G 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3  | 0 @H R12 2  H | 0޽h ? ̙33$  d(  r  S D    0 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0,.P  R13 2  H  0޽h ? ̙33V  ,(  ,r , S t(D    , S z@D   "P@08X , 0\Np0  : 2  , 0 Q 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3  , 0V@ R14 2  H , 0޽h ? ̙33  91 4(  4r 4 S D   r 4 S JD   4 0z@  3Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 200344 3  4 0p R15 2  H 4 0޽h ? ̙33  NF0(  r  S |D   r  S D    0H @ 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0p R16 2  H  0޽h ? ̙33  91@(  r  S `D   r  S D    08 3Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 200344 3   0FpP  R17 2  H  0޽h ? ̙33  NFP(  r  S    r  S D    0` 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0 p R18 2  H  0޽h ? ̙33  `6<^(  <r < S  D    < 05@pS 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3  < 0  h Table 1 2  F  # < d @ ~  <~ |@  < < 6P  \ , #  Z < s *@  < < 68 Number @ ## Z < s *@ ~  <~  < 6b  Number refusals @ ##  Z < s *~ |@ L <L < 6L \ , #  Z < s *L@ L <L < 6"8L ` 0 #  Z < s *L@  L < L < 6 L  absolute @  ## Z < s * L@  ~ L < ~ L < 68X b L in % @ ## Z < s * ~ L@ Lx <LxB < 6HeLx *General practitioners Medical specialists Z ## ## ,  Z < s *Lx@ Lx <Lx* < 6 8Lx 17.913 22.753 ^ ## ## ,  Z < s *Lx@ L x <L x( < 6x L x  2.804 4.439 ^ ## ## ,  Z < s *L x@  L~ x < L~ x( < 6 Lb x  15,65 19,51 ^ ## ## ,  Z < s * L~ x@ x <x < 6x |Total < ##  Z < s *x@ x <x < 6 8x 40.666 @ ##  Z < s *x@ x  <x  < 6&x  7.243 @ ##  Z < s *x @  x~  < x~  < 6,, xb  17,81 @ ##  Z < s * x~ Z < s *> # < 0x3  : 2  < 05pP ` R19 2  H < 0޽h ? ̙33X  p!Y@(  @r @ S `0    @ 0h'  3Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 200344 3   @ 06` E b* Document Moreaux 2   =@ 0QP = }- Table 2. 2. - F   X@ s  @   V@ |@ , G@, >@ 6e, \ , #  Z F@ s *,@ , I@, ?@ 6,j, All physicians @ ##  Z H@ s *,@  , K@ , @@ 6Pp  , General practitioners @ ##  Z J@ s * ,@  , M@ , A@ 6v , Medical specialists @ ##  Z L@ s * ,2@ , O@, B@ 6,  10.12.1990 18.12.1992 (*) 13.12.1993 11.12.1995 () 03.11.1997 (r) 18.12.2000 19.12.2002 f\ ## ## ## ## ## ##                  Z N@ s *,4@ , Q@, C@ 6D, , 12,57 51,50 19,27 16,50 15,60 14,77 17,81 + ## ## ## ## ## ## ## ##         Z P@ s *,5@ ,  S@,  D@ 6 ,  - 9,78 37,80 18,42 16,18 14,28 11,85 15,65 , ## ## ## ## ## ## ## ##         Z R@ s *, 4@  ,  U@ ,  E@ 6 ,  , 16,35 63,73 20,02 16,77 16,71 17,16 19,51 + ## ## ## ## ## ## ## ##         Z T@ s * , Z W@ s *>  Y@ 0p@@ R20 2  H @ 0޽h ? ̙33X  ,D(  Dr D S x    RD 0ĵPc 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3 mF I  D G@ D  DD |@ , D, D 6$, \ , #  Z D s *,@ , D, D 6, All physicians @ ##  Z D s *,@ s , Ds , D 6HW , General practitioners @ ##  Z D s *s ,@ s D, Ds D, D 6T (, Medical specialists @ ##  Z D s *s D,@ , D,0 D 6, 6 Flemish region Walloon region Brussels region 5 ## ## ## ## ## ##     Z D s *,@ , D, D 6N,  13,87 21,04 24,20  ## ## ## ## ## ## Z D s *,@ ,s  D,s  D 6],W   7,23 24,58 25,94  ## ## ## ## ## ## Z D s *,s @ s ,D Ds ,D D 6m ,(  19,25 18,12 23,08  ## ## ## ## ## ## Z D s *s ,D@   D  D 64  ~Total < ## Z D s * @   D  D 6,  17,81 @ ## Z D s * @ s  Ds  D 6W  15,65 @ ## Z D s *s @ s D  Ds D  D 6t> (  19,51 @ ## Z D s *s D Z D s *>I  D 0pE0 `m WTable 3 2   D 0G ] R21 2  H D 0޽h ? ̙33  PH(  r  S bD   r  S @cD    0p 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0NP M T22 2  H  0޽h ? ̙33  PH(  r  S 9D   r  S x: P    0pE # 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0 ; T23 2  H  0޽h ? ̙33  PH(  r  S cD   r  S @p0DP     0dh 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0l6p` 0 T24 2  H  0޽h ? ̙33  {,\(  \r \ S uD    \ 0Gp# 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3  \ 0t|0 ` WTable 6 2  F  ^  \ `r.@  X  \ X @  \ \ 6D7 w Physicians 0   #   Z \ s *@   \  \ 63  {Sickness Funds 0 #  Z \ s * @  \/ \ 6t ABVAS General practitioners 2 BVAS Medical specialists 5 , " A# 0   Z \ s *|@   \  \ 6w  \ , #  Z \ s * @ , \, \ 6l, "Total BVAS -ABSyM 7 ," "# ! Z \ s *,|@  , \ , \ 6 , \ , #  Z \ s * ,@ ,2 \,24 \ 6Ԝ,2 FCartel General practitioners 4 Cartel Medical specialists 1 ,"% F# 0! # Z \ s *,2|@ , 2 \, 2 \ 6, 2 \ , #  Z \ s *, 2@ 2 \2 \ 6 2 +Total Cartel 5 ,+ +# * Z \ s *2|@ 2  \2  \ 62  \ , #  Z \ s *2 @ X  \X  \ 6ఁX  )General total 12 ,) )# ( Z \ s *X @  X  \ X  \ 6T X  o12 0 #  Z \ s * X Z \ s *jJ ^  \ 0軁  T25 2  H \ 0޽h ? ̙33DG  FFqUF(  Tr T S ؁D    pT 0pځ  4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3  T 0܁ M X Table 4 2   VCF  N  U  B@  I  U I @  nU JU 6< ` 0 #  Z mU s *@  pU KU 6 }1998 > ## Z oU s *@   rU  LU 6(r  }2002 > ## Z qU s * @ M tUM MU 6M ` 0 #  Z sU s *M@ M vUM2 NU 6xM Number of ballots sent Z  ## ## ,  Z uU s *M@ M xUM OU 6M Number of ballots received > ##  Z wU s *M@  M zU M0 PU 60B M Number of ballots sent Z ## ## ,  Z yU s * M@   M |U  M4 QU 6G  M Number of ballots received Z  ## ## ,  Z {U s *  M@ MT ~UMT RU 6lOMT ` 0 #  Z }U s *MT@ M\T UM\T SU 6TM@T Absolute number > ##  Z U s *M\T@ \MT U\MT TU 6D[xMT  % of total >   ##   Z U s *\MT@ MTT UMTT UU 6aM8T Absolute number > ##  Z U s *MTT@ TMT UTMT VU 64hpMT  % of total >   ##   Z U s *TMT@ ML T UML T WU 6,5M0 T Absolute number > ##  Z U s *ML T@ L M T UL M T$ XU 6th M T  % of total Z ## ## ,  Z U s *L M T@  M T U M T YU 6(} Mp T Absolute number > ##  Z U s * M T@  M T U M T$ ZU 6h M T  % of total Z ## ## ,  Z U s * M TZ@ T UT [U 6T :. General practitioners Medical Specialists - ## ## ## ## Z    Z U s *Tv@ T\ UT\ \U 6T@ V 16.919 20.464  ## ## ## ## ## p Z U s *T\t@ \T U\T ]U 6,xT T 45,26 54,74  ## ## ## ## ## pZ U s *\Tv@ TT UTT ^U 6T8 V 11.755 14.659  ## ## ## ## ## pZ U s *TTt@ TT UTT _U 6pT T 69,48 71,63  ## ## ## ## ## pZ U s *TTv@ TL  UTL  `U 6T0  V 17.872 22.218  ## ## ## ## ## pZ U s *TL t@ L T  UL T  aU 6h T  T 44,58 55,42  ## ## ## ## ## pZ U s *L T v@  T  U T  bU 6 Tp  V 10.341 12.241  ## ## ## ## ## pZ U s * T t@  T  U T  cU 6 T  T 57,86 55,09  ## ## ## ## ## pZ U s * T @ I  UI  dU 6$]I  |Total : ## Z U s *I @ \I  U\I  eU 6t@I  37.383 > ## Z U s *\I @ \I  U\I  fU 6tyxI  ~100,0 > ## Z U s *\I @ TI  UTI  gU 6p8I  26.414 > ## Z U s *TI @ TI  UTI  hU 6pI  ~70,66 > ## Z U s *TI @ L I  UL I  iU 60 I  40.090 > ## Z U s *L I @ L  I  UL  I  jU 6ܑh  I  100,00 > ## Z U s *L  I @   I  U  I  kU 6 p I  22.582 > ## Z U s *  I @   I  U  I  lU 6<  I  ~56,33 > ## Z U s *  I Z U s *> N  U 0أ` T26 2  H T 0޽h ? ̙33WB  BAzfYA(  Xr X S D    yX 0pP 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3 h>F  W dY   =@  Q bY Q@  Y X 6Hx ` 0 #  Z Y s *@  Y X 6 ` 0 #  Z Y s *@ T  YT  X 6 8  q1998 0 # Z Y s *T @ T  YT  X 6 p  q2002 0 # Z Y s *T @ L YL X 6xL  BVAS-ABSyM 0   # 0 Z Y s *L@ & !Y& X 6\& ~General practitioners , # Z  Y s *&@ T & #YT & X 6W 8 & q39,7 0 # Z "Y s *T &@ T  & %YT  & X 6#p  & q28,1 0 # Z $Y s *T  &@ & 'Y& X 6& |Medical specialists , # Z &Y s *&@ &T  )Y&T  X 6 &8  q89,2 0 # Z (Y s *&T @ T &  +YT &  X 6p &  q87,1 0 # Z *Y s *T & @ L -YL X 6TL ntotal , # Z ,Y s *L@ T L /YT L X 6 8 L 67,1 @ # # Z .Y s *T L@ T  L 1YT  L X 6p  L 60,1 @ # # Z 0Y s *T  L@ L  3YL  X 6Lx   Cartel 0  # 0Z 2Y s *L @ L 5YL X 6HL ~General practitioners , # Z 4Y s *L@ LT  7YLT  Y 6 L8  q59,0 0 # Z 6Y s *LT @ T L  9YT L  Y 6p L  q69,1 0 # Z 8Y s *T L @ r  ;Yr  Y 6r  |Medical specialists , # Z :Y s *r @ T r  =YT r  Y 6 8 r  s 9,9 0 # Z Y s *T  r @ r   AYr   Y 6dr   ntotal , # Z @Y s *r  @ r T   CYr T   Y 6 r 8   31,7 @ # # Z BY s *r T  @ T r   EYT r   Y 6p r   36,9 @ # # Z DY s *T r  @   GY  Y 6 x  Invalid/blank 0 # 0  Z FY s * @    IY    Y 6   ~General practitioners , #  Z HY s *  @  T  KY T   Y 6h  8   0,6 0 # & Z JY s * T @ T   MYT    Y 6dp   r 1,3 0 # Z LY s *T  @  + OY +  Y 6 + |Medical specialists , # Z NY s * +@  T + QY T +  Y 6  8 + s 0,6 0 # Z PY s * T +@ T + SYT + Y 6p + r 1,7 0 # Z RY s *T +@ + UY+ Y 6+ ntotal , # Z TY s *+@ +T  WY+T  Y 6L +8  s 1,2 0 # Z VY s *+T @ T +  YYT +  Y 6p +  r 3,0 0 # Z XY s *T + @ Q [YQ Y 6xQ ` 0 #  Z ZY s *Q@ Q ]YQ Y 6Q ` 0 #  Z \Y s *Q@ T Q _YT Q Y 6 8 Q p100 0 # Z ^Y s *T Q@ T  Q aYT  Q Y 6tp  Q p100 0 # Z `Y s *T  QZ cY s *jJ W eY 0  - YTable 5 2   fY 0@ T27 2  H X 0޽h ? ̙33  PH(  r  S D   r  S DP    0@@@S 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0M T28 2  H  0޽h ? ̙33  PH(  r  S |ˁ    r  S $́D    0́p 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0ӁpP T29 2  H  0޽h ? ̙33  PH(  r  S \z   r  S {PD    04up 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   00d  T30 2  H  0޽h ? ̙33  f^ (  r  S 8ȁD     S @ P  "p`Pp  0B@S 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0Fp T31 2  H  0޽h ? ̙33  f^0(  r  S āD     S L> P  "p`Pp  0$Z@PS 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0  T32 2  H  0޽h ? ̙33  PH@(  r  S 4PD   r  S ثp     00p  4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0Hp T33 2  H  0޽h ? ̙33  PH (  r  S xD   r  S  D    0dp 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 (4 24 3   0ؐ T34 2  H  0޽h ? ̙33  PU(  r  S XaD    6${60 3Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 200344 3   0@ R35 2  H  0޽h ? ̙33rpul7z#Ȇ a ` @;e")QUP "@m'p;_%-jl( / 00DTimes New RomanF|d0|Wo 0DArialNew RomanF|d0|Wo 0" DCourier NewmanF|d0|Wo 010DWingOh+'0 `h   , 8DLJFIRST ANNUAL MEETING OF THE INSEAD-EHLP-class 2002 Brussels, May 23, 2003lAnn VandermeulenINGJosiane BULTREYSING41iMicrosoft PowerPointOF @0!@ ^0@p !~ Gg  ; R& &&#TNPP2OMi: & TNPP &&TNPP    --- !---&5j&qw@ LSwUSw0- &j& --L6-- @Times New RomanLSwUSw0- .+2 `FIRST ANNUAL MEETING OF    $   . .2 g THE INSEAD . . 2 L- . . 2 XEHLP. . 2 - . .2  class 2002  . .(2 Brussels, May 23, 2003  $  .--Yu`-- @Times New RomanLSwUSw0- .2 {THE PERSPECTIVE %  # # # . .2 |OF THE PROVIDER % % #%## #.--kl-- @Times New RomanLSwUSw0- .2 Marc MOENS, M.D.   . . 2 Vice . . 2 -. .O2 0president of the Belgian Association of Medical              . .2   Unions (BVAS   . . 2 -. .2 ABSyM) . .2  Secretary2   . . 2 -. .@2 &general of the Association of Belgian           . .R2 y2Professional Societies of Medical Specialists (VBS            . . 2 =-. . 2 DGBS) .--P-- --)8-- @Times New RomanLSwUSw0- .2 J Marc MOENS, M.D.     . .2 Z INSEAD  . . 2 Z:-. . 2 Z?EHLP . .2 j Brussels 2. .2 z May 23, 2003 .--vXp-- @Times New RomanLSwUSw0- . 2 lz1.--"System 0-&TNPP &0DTimes New Roman0|d0|Wo 0DArialNew Roman0|d0|Wo 0" DCourier Newman0|d0|Wo 010DWingdings 3man0|d0|Wo 0 ` .  @n?" dd@  @@``  6U'  "Zpppg     !"#&'c $@Qr ʚ;9ʚ;g4BdBd0pbp@ p<4KdKd 0,<4dddd 0, <4BdBd. 0,H___PPT9, a"? %eIFIRST ANNUAL MEETING OF THE INSEAD-EHLP-class 2002 Brussels, May 23, 2003JJI  THE PERSPECTIVE OF THE PROVIDER !!$! Introduction 2. Short history of organized interest groups 2.1. Creation of Sickness Funds and Medical Trade Unions 2.2. Physicians resistance and strike 3. Elements of the law of August 9, 1963 on Sickness and Invalidity Insurance 3.1. The system of conventions 3.2. Representativity of Medical Trade Unions 4. Representation of medical organizations in official organs 5. Our principles and objectives 6. Conclusion(" 2 .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (1)//. The 19th century proletarianism led to the creation of societies of mutual assistance for the working class Legal basis April 4, 1851 Allowing the formation of alliances by the law of June 23, 1894 Governmental support since March 19, 1898 Remained unchanged until December 31, 1990 .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (2)//. BLaw of December 18, 1944 : creation of a mandatory sickness and invalidity insurance system for employees Implementation by Decree of the Regent of March 21, 1945 creating a national committee of directors including : - 8 employees representatives - 8 employers representatives - 5 representatives of the sickness funds - 3 government commissioners : ministry of health care, social security and finance No representation of health care providers Publication of a provisional tariff list by Ministerial Order of April 19, 1945*{"! .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (3)//. Till +/- 1950 : lots of small professional societies July 15, 1954 : creation of the Grouping of Belgian Professional Societies of Medical Specialists (VBS-GBS) and futile attempts reach an agreement with sickness funds October 10, 1954 : creation of the General Syndicate of Belgian Medical Doctors (ASGB) by Dr. Marcel DE BRABANTER -> shared management of the system -> shared financial responsibility -> generalized and compulsory system of third party payment >5ZZZZ .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (4)//. fA huge majority of physicians refused the ASGB proposals creating the possibility of rationing of careggf  .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (5)//. February 14, 1961 : prime minister Gaston EYSKENS Law of Union leads to a near-revolution Introduces an Institute for medical control (art. 33) Authorises the King to impose tariffs if no convention is concluded (art. 52, still existing, but somewhat modified in art. 50 11 of the coordinated law on medical care and allowances) End 1963 : creation of the Belgian Association of Medical Trade Unions (BVAS-ABSyM) in opposition to the minister of Social Affairs, E. LEBURTON, by Dr. A. WYNEN0_ZZZ .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (6)//. BVAS-ABSyM regroups the - syndicalist chamber of Lige and Luxemburg (created May 17, 1962) - syndicalist chamber of Walloon Brabant, Hainaut and Namur (created March 22, 1963) - syndicalist chamber of the Brussels metropolitan area (created May 31, 1963) - syndicalist chamber of Antwerp, Limburg and Flemish Brabant (created August 23, 1963) - syndicalist chamber of East and West Flanders (created August 29, 1963) J@( /T   0SHORT HISTORY OF ORGANIZED INTEREST GROUPS (7) 110   !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~    Q !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHILMNOPRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwRoot EntrydO) p !K Current User.PSummaryInformation( PowerPoint Document(DocumentSummaryInformation8d dings 3manF|d0|Wo 0 ` .  @n?" dd@  @@`` 5N'  "Zpppg      !"'c $@Qr ʚ;9ʚ;g4BdBd0pbp@ p<4KdKd 0,G<4dddd 0,G <4BdBd. 0,H___PPT9, a"? %eIFIRST ANNUAL MEETING OF THE INSEAD-EHLP-class 2002 Brussels, May 23, 2003JJI  THE PERSPECTIVE OF THE PROVIDER !!$! Introduction 2. Short history of organized interest groups 2.1. Creation of Sickness Funds and Medical Trade Unions 2.2. Physicians resistance and strike 3. Elements of the law of August 9, 1963 on Sickness and Invalidity Insurance 3.1. The system of conventions 3.2. Representativity of Medical Trade Unions 4. Representation of medical organizations in official organs 5. Our principles and objectives 6. Conclusion(" 2 .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (1)//. The 19th century proletarianism led to the creation of societies of mutual assistance for the working class Legal basis April 4, 1851 Allowing the formation of alliances by the law of June 23, 1894 Governmental support since March 19, 1898 Remained unchanged until December 31, 1990 .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (2)//. BLaw of December 18, 1944 : creation of a mandatory sickness and invalidity insurance system for employees Implementation by Decree of the Regent of March 21, 1945 creating a national committee of directors including : - 8 employees representatives - 8 employers representatives - 5 representatives of the sickness funds - 3 government commissioners : ministry of health care, social security and finance No representation of health care providers Publication of a provisional tariff list by Ministerial Order of April 19, 1945*{"! .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (3)//. Till +/- 1950 : lots of small professional societies July 15, 1954 : creation of the Grouping of Belgian Professional Societies of Medical Specialists (VBS-GBS) and futile attempts reach an agreement with sickness funds October 10, 1954 : creation of the General Syndicate of Belgian Medical Doctors (ASGB) by Dr. Marcel DE BRABANTER -> shared management of the system -> shared financial responsibility -> generalized and compulsory system of third party payment >5ZZZZ .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (4)//. fA huge majority of physicians refused the ASGB proposals creating the possibility of rationing of careggf  .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (5)//. February 14, 1961 : prime minister Gaston EYSKENS Law of Union leads to a near-revolution Introduces an Institute for medical control (art. 33) Authorises the King to impose tariffs if no convention is concluded (art. 52, still existing, but somewhat modified in art. 50 11 of the coordinated law on medical care and allowances) End 1963 : creation of the Belgian Association of Medical Trade Unions (BVAS-ABSyM) in opposition to the minister of Social Affairs, E. LEBURTON, by Dr. A. WYNEN0_ZZZ .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (6)//. BVAS-ABSyM regroups the - syndicalist chamber of Lige and Luxemburg (created May 17, 1962) - syndicalist chamber of Walloon Brabant, Hainaut and Namur (created March 22, 1963) - syndicalist chamber of the Brussels metropolitan area (created May 31, 1963) - syndicalist chamber of Antwerp, Limburg and Flemish Brabant (created August 23, 1963) - syndicalist chamber of East and West Flanders (created August 29, 1963) J@( /T   0SHORT HISTORY OF ORGANIZED INTEREST GROUPS (7) 110 Stiff resistance from physicians against the LEBURTONS Law with refusal of - a state-controlled medical care - financial responsibility for the medical care being offered - imposed tariffs - and demand for a social security system for physicians, leading to a general medical strike from April 1 to April 18, 1964,*LD`` .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (8)//. Jfollowed by the St. John s agreement of June 25, 1964 between - the government - representatives of the Medical Trade Unions, mainly BVAS-ABSyM - representatives of sickness funds - employers - employees trade unions The St. Johns agreement remains the basis of the current system X>F NA%$   S3. Elements of the law of August 9, 1963 on Sickness and Invalidity Insurance TT(S  3.1. The system of agreements 3.1.1. Basic principles The law of February 15, 1993 - strengthens the role of the government social partners - employers - employees trade unions - maintains the impact of the sickness funds - diminishes the influence of the providers For example : the convention physicians- sickness funds needs the approval by : - the general NSIII council - the Insurance Committee - the Budgetary Control Commission$    3.1.2. The Medical Technical Council elaborates the nomenclature of medical services 27 M.D.-members + 1 president 9 sickness funds 7 university 11 medical unions tX4  +3.1.3. Erosion of free choice in the course of the years Same reimbursement for patients treated by physicians in/out the convention still remains but the legislation is curtailing the therapeutic freedom more and more introducing for example reference prices for some hospitalised patients :,+  TAPR-DRG s SURGERY : number and description++ * #73 Lens procedures w or w/o vitrectomy Tonsillectomy & adenoidectomy procedures 179 Vein ligation & stripping 225 Appendectomy 228 Inguinal & femoral hernia procedures 263 Laparoscopic cholecystectomy 302 Major joint & limb reattach proc of lower extrem exc for trauma 313 Knee & lower leg procedures except foot 318 Removal of internal fixation device 482 Transurethral prostatectomy 513 Uterine & adnexa procedures for ca in situ & nonmalignancy 516 Laparoscopy & tubal interruption 540 Cesarean delivery 560 Vaginal delivery z(Z " ZZ''' ''''''')''!''D'',''('' ''?''%''''''             )   /     , (                     hAPR-DRG s internal medicine : number and description55 4 p045 Cva w infarct 046 Nonspecific cva & precerebral occlusion w/o infarct 047 Transient ischemia 134 Pulmonary embolism 136 Respiratory malignancy 139 Simple pneumonia 190 Circulatory disorders w AMI 202 Angina pectoris 204 Syncope & collapse 244 Diverticulitis & diverticulosis 464 Urinary stones w esw lithotripsy 465 Urinary stones w/o esw lithotripsy qZ''9'''''''''' ''''''$''%'''''n                      ?3.1.4. From fee for service to agreed lump sum payments (1)@@$?  Fee for service remains for most medical acts Slowly introduction (since 1988) of agreed lump sum payments - laboratory medicine : 75 % - radiology : +/- 31 %*n6  ?3.1.4. From fee for service to agreed lump sum payments (2)@@$? 4More lump sum payments for - accreditation system (all physicians) - global medical record (G.P. s) - disposability (G.P. s) - medical record software programmes (G.P. s) - local G.P. s circles organizing grand duties (- subsidizing general medical pratices) BZgZ0ZZ J3.1.5. Acceptance of convention between physicians and sickness fundsKK$J  A convention is not accepted if > 40 % of the physicians refuse or if > 50 % medical specialists refuse or if > 50 % G.P. refuse Counting is elaborated by each legal district.#--%---/-   4Refusals to join the convention of December 12, 200255 4  XPercentage of refusals to acceed the convention between physicians and sickness funds (YV##B  5   Refusals to join the convention physicians  sickness funds of December 19, 2002 (in %) ZZ# (W  "33.2. Representativity of medical associations (1)44$3 To be legally representative, a medical association must : Have both medical specialists and G.P.'s Have members in at least 2 of the 3 regions Exist at least 12 months Count at least 1.500 affiliated individual members, registered with the NSIII < #33.2. Representativity of medical associations (2)44$3 Only 2 organizations fulfil the 4 Criteria : BVAS-ABSyM (D + F; G.P.'s + M.S.) Cartel * Confederation of Belgian Doctors - Belgian Gouping of G.P.'s (F, G.P. s) - Belgian Syndicate of Medical Specialists - General Syndicate of Belgian Medical Professions (D; G.P.'s + M.S.) * Syndicate of Flemish General Practitioners (D)D.Z)ZRZ0Zhg $33.2. Representativity of medical associations (3)44$3 ^counting of members failed since 1964 elections at four years intervals were incorporated in the law in 1996 and carried into effect since 1998 the results determine the number of seats in the NSIII councils, committees, commissions & for example in the National Commission Physicians-Sickness FundsZ&ZZjZZ[ZCZ0/ :Composition National Commission Physicians-Sickness Funds ;;# 9  #Participation in medical elections &$"# !" QResults of the medical elections June 30, 1998 and June 25, 2002 (in percentage) RR#p%33.2. Representativity of medical associations (4)44$3 Numerous other medical associations are not representative Medical specialists - Grouping of Belgian Professional Societies of Medical Specialists (G.B.S.-V.B.S.) - numerous scientific societies General Practitioners : strongly dispersed and regionalized - Flemish and Francophone local circles of G.P.'s grouped in UHAK and FAG - a Flemish and a Francophone scientific society (WWVH and SSMG) - a Parliament of Flemish G.P.'s v=ZZ_0Z"Z<Z0ZZ ' B4. Representation of medical associations in official bodies (1)CC B H4.1. At the NSIII Service of Medical Care - Insurance Committee - Budgetary Control Commission - National Commission Physicians-Sickness Funds - National Council for the Promotion of Quality - Accreditation system including - Accreditation Management Group - Joint Committee by Speciality - Working Group on Ethics and Economy - Technical Council for Accreditation - Appeal Commission - Commission of Profiles - Evaluation Committee on Medical Practice relating to Medication Service of Medical Assessment and Control - Service Unit - Committee - Appeal BoardZ0Z0ZiZG0Z*0Z-0Z+,H (!B4. Representation of medical associations in official bodies (2)CC B 4.2. At the Federal Public Service, Public Health, Safety of the Food- chain and Environment Certification of M.D.'s Legislation on hospitals Others on - nursing care paramedical professions clinical biology & rbJ + - `J+ )".5. Principles-objectives (1) Ten basic rules ://$. The patient has a central position The physician respects the Code of Medical Ethics and in particular Article 36 "The physician is free as to his/her diagnosis and therapy. He/She will refrain from prescribing useless examinations or expensive therapies or to perform superfluous acts" The patient is free to choose his medical doctor The physician is free to decide between diagnostic and therapeutic alternatives The protection of medical confidentiality is crucial  " 7""O""0"O"4"n"  0 O 4 *#.5. Principles-objectives (2) Ten basic rules ://$. 6. Physicians ensure the continuity of quality care 7. There is an equivalence between general practitioners and medical specialists 8. There is an equivalence between medical specialists as such 9. An identical pathology gives rise to identical fees, irrespective of the place * Academic or non academic institution * Region * Hospital care or out-patient care 10. In other words, the implementation of a just and objective legislation on the entire territory.  23"P">""c"n3 P >  c +$5. Principles-objectives (3)$ For the new government to be appointed, we reiterate our vision Stop the creation of costly and overlapping structures Give support to the co-operation agreements existing on a small scale between health care providers belonging to the same profession and between providers pertaining to several professions (general practitioners - medical specialists - physicians - nursing staff - paramedics - physiotherapists& ) Restrict the interference of the State in health care Stop excessive standards and bureaucracy AA6"("5"("fA 6 ( 5 ( ,% 6. CONCLUSION$  Continuing the concertation model between health care providers and sickness funds, under supervision of the State, is the best option to maintain and promote the high reputation and international level of the Belgian health care system  -& GWords to remember : "Pas de mdecine sans mdecins" Dr. Andr WYNEN)HHG E  (  r  S (}DP   r  S }D    0PW 4Marc MOENS, M.D. INSEAD-EHLP Brussels May 23, 2003 04 24 $3   08` : 2   0 O4 2  H  0޽h ? ̙33r"OoS-tl( / 0  !"#$%&'()*+,-/՜.+,04     Affichage l'cranffi$ )Times New RomanArial Courier New Wingdings 3Modle par dfautJFIRST ANNUAL MEETING OF THE INSEAD-EHLP-class 2002 Brussels, May 23, 2003Introduction 2. Short history of organized interest groups 2.1. Creation of Sickness Funds and Medical Trade Unions 2.2. Physicians resistance and strike 3. Elements of the law of August 9, 1963 on Sickness and Invalidity Insurance 3.1. The system of conventions 3.2. Representativity of Medical Trade Unions 4. Representation of medical organizations in official organs 5. Our principles and objectives 6. Conclusion/SHORT HISTORY OF ORGANIZED INTEREST GROUPS (1)/SHORT HISTORY OF ORGANIZED INTEREST GROUPS (2)/SHORT HISTORY OF ORGANIZED INTEREST GROUPS (3)/SHORT HISTORY OF ORGANIZED INTEREST GROUPS (4)/SHORT HISTORY OF ORGANIZED INTEREST GROUPS (5)/SHORT HISTORY OF ORGANIZED INTEREST GROUPS (6)1SHORT HISTORY OF ORGANIZED INTEREST GROUPS (7) /SHORT HISTORY OF ORGANIZED INTEREST GROUPS (8)Prsentation PowerPointPrsentation PowerPointPrsentation PowerPointPrsentation PowerPoint+APR-DRGs SURGERY : number and description5APR-DRGs internal medicine : number and description@3.1.4. From fee for service to agreed lump sum payments (1)@3.1.4. From fee for service to agreed lump sum payments (2)K3.1.5. Acceptance of convention between physicians and sickness funds5Refusals to join the convention of December 12, 2002YPercentage of refusals to acceed the convention between physicians and sickness funds ZRefusals to join the convention physicians sickness funds of December 19, 2002 (in %) 43.2. Representativity of medical associations (1)43.2. Representativity of medical associations (2)43.2. Representativity of medical associations (3);Composition National Commission Physicians-Sickness Funds $Participation in medical elections RResults of the medical elections June 30, 1998 and June 25, 2002 (in percentage) 43.2. Representativity of medical associations (4)C4. Representation of medical associations in official bodies (1)C4. Representation of medical associations in official bodies (2)/5. Principles-objectives (1) Ten basic rules :/5. Principles-objectives (2) Ten basic rules :5. Principles-objectives (3)6. CONCLUSIONPrsentation PowerPoint Polices utilisesModle de conceptionTitres des diapositives$(_Josiane BULTREYSJosiane BULTREYSStiff resistance from physicians against the LEBURTONS Law with refusal of - a state-controlled medical care - financial responsibility for the medical care being offered - imposed tariffs - and demand for a social security system for physicians, leading to a general medical strike from April 1 to April 18, 1964,*LD`` .SHORT HISTORY OF ORGANIZED INTEREST GROUPS (8)//. Jfollowed by the St. John s agreement of June 25, 1964 between - the government - representatives of the Medical Trade Unions, mainly BVAS-ABSyM - representatives of sickness funds - employers - employees trade unions The St. Johns agreement remains the basis of the current system X>F NA%$   S3. Elements of the law of August 9, 1963 on Sickness and Invalidity Insurance TT(S  3.1. The system of agreements 3.1.1. Basic principles The law of February 15, 1993 - strengthens the role of the government social partners - employers - employees trade unions - maintains the impact of the sickness funds - diminishes the influence of the providers For example : the convention physicians- sickness funds needs the approval by : - the general NSIII council - the Insurance Committee - the Budgetary Control Commission$    3.1.2. The Medical Technical Council elaborates the nomenclature of medical services 27 M.D.-members + 1 president 9 sickness funds 7 university 11 medical unions tX4  +3.1.3. Erosion of free choice in the course of the years Same reimbursement for patients treated by physicians in/out the convention still remains but the legislation is curtailing the therapeutic freedom more and more introducing for example reference prices for some hospitalised patients :,+  TAPR-DRG s SURGERY : number and description++ * #73 Lens procedures w or w/o vitrectomy Tonsillectomy & adenoidectomy procedures 179 Vein ligation & stripping 225 Appendectomy 228 Inguinal & femoral hernia procedures 263 Laparoscopic cholecystectomy 302 Major joint & limb reattach proc of lower extrem exc for trauma 313 Knee & lower leg procedures except foot 318 Removal of internal fixation device 482 Transurethral prostatectomy 513 Uterine & adnexa procedures for ca in situ & nonmalignancy 516 Laparoscopy & tubal interruption 540 Cesarean delivery 560 Vaginal delivery z(Z " ZZ''' ''''''')''!''D'',''('' ''?''%''''''0             )   /     , (                     hAPR-DRG s internal medicine : number and description55 4 p045 Cva w infarct 046 Nonspecific cva & precerebral occlusion w/o infarct 047 Transient ischemia 134 Pulmonary embolism 136 Respiratory malignancy 139 Simple pneumonia 190 Circulatory disorders w AMI 202 Angina pectoris 204 Syncope & collapse 244 Diverticulitis & diverticulosis 464 Urinary stones w esw lithotripsy 465 Urinary stones w/o esw lithotripsy qZ''9'''''''''' ''''''$''%'''''                      ?3.1.4. From fee for service to agreed lump sum payments (1)@@$?  Fee for service remains for most medical acts Slowly introduction (since 1988) of agreed lump sum payments - laboratory medicine : 75 % - radiology : +/- 31 %*n6  ?3.1.4. From fee for service to agreed lump sum payments (2)@@$? 4More lump sum payments for - accreditation system (all physicians) - global medical record (G.P. s) - disposability (G.P. s) - medical record software programmes (G.P. s) - local G.P. s circles organizing grand duties (- subsidizing general medical pratices) BZgZ0ZZ J3.1.5. Acceptance of convention between physicians and sickness fundsKK$J  A convention is not accepted if > 40 % of the physicians refuse or if > 50 % medical specialists refuse or if > 50 % G.P. refuse Counting is elaborated by each legal district.#--%---/-   4Refusals to join the convention of December 12, 200255 4  XPercentage of refusals to acceed the convention between physicians and sickness funds (YV##H  5   Refusals to join the convention physicians  sickness funds of December 19, 2002 (in %) ZZ# ,W  "33.2. Representativity of medical associations (1)44$3 To be legally representative, a medical association must : Have both medical specialists and G.P.'s Have members in at least 2 of the 3 regions Exist at least 12 months Count at least 1.500 affiliated individual members, registered with the NSIII < #33.2. Representativity of medical associations (2)44$3 Only 2 organizations fulfil the 4 Criteria : BVAS-ABSyM (D + F; G.P.'s + M.S.) Cartel * Confederation of Belgian Doctors - Belgian Gouping of G.P.'s (F, G.P. s) - Belgian Syndicate of Medical Specialists - General Syndicate of Belgian Medical Professions (D; G.P.'s + M.S.) * Syndicate of Flemish General Practitioners (D)D.Z)ZRZ0Zhg $33.2. Representativity of medical associations (3)44$3 ^counting of members failed since 1964 elections at four years intervals were incorporated in the law in 1996 and carried into effect since 1998 the results determine the number of seats in the NSIII councils, committees, commissions & for example in the National Commission Physicians-Sickness FundsZ&ZZjZZ[ZCZ0/ :Composition National Commission Physicians-Sickness Funds ;;# 9  #Participation in medical elections &$"# !" QResults of the medical elections June 30, 1998 and June 25, 2002 (in percentage) RR#x%33.2. Representativity of medical associations (4)44$3 Numerous other medical associations are not representative Medical specialists - Grouping of Belgian Professional Societies of Medical Specialists (G.B.S.-V.B.S.) - numerous scientific societies General Practitioners : strongly dispersed and regionalized - Flemish and Francophone local circles of G.P.'s grouped in UHAK and FAG - a Flemish and a Francophone scientific society (WWVH and SSMG) - a Parliament of Flemish G.P.'s v=ZZ_0Z"Z<Z0ZZ ' B4. Representation of medical associations in official bodies (1)CC B H4.1. At the NSIII Service of Medical Care - Insurance Committee - Budgetary Control Commission - National Commission Physicians-Sickness Funds - National Council for the Promotion of Quality - Accreditation system including - Accreditation Management Group - Joint Committee by Speciality - Working Group on Ethics and Economy - Technical Council for Accreditation - Appeal Commission - Commission of Profiles - Evaluation Committee on Medical Practice relating to Medication Service of Medical Assessment and Control - Service Unit - Committee - Appeal BoardZ0Z0ZiZG0Z*0Z-0Z+,H (!B4. Representation of medical associations in official bodies (2)CC B 4.2. At the Federal Public Service, Public Health, Safety of the Food- chain and Environment Certification of M.D.'s Legislation on hospitals Others on - nursing care paramedical professions clinical biology & rbJ + - `J+ )".5. Principles-objectives (1) Ten basic rules ://$. The patient has a central position The physician respects the Code of Medical Ethics and in particular Article 36 "The physician is free as to his/her diagnosis and therapy. He/She will refrain from prescribing useless examinations or expensive therapies or to perform superfluous acts" The patient is free to choose his medical doctor The physician is free to decide between diagnostic and therapeutic alternatives The protection of medical confidentiality is crucial  " 7""O""0"O"4"n"  0 O 4 *#.5. Principles-objectives (2) Ten basic rules ://$. 6. Physicians ensure the continuity of quality care 7. There is an equivalence between general practitioners and medical specialists 8. There is an equivalence between medical specialists as such 9. An identical pathology gives rise to identical fees, irrespective of the place * Academic or non academic institution * Region * Hospital care or out-patient care 10. In other words, the implementation of a just and objective legislation on the entire territory.  23"P">""c"n3 P >  c +$5. Principles-objectives (3)$ For the new government to be appointed, we reiterate our vision Stop the creation of costly and overlapping structures Give support to the co-operation agreements existing on a small scale between health care providers belonging to the same profession and between providers pertaining to several professions (general practitioners - medical specialists - physicians - nursing staff - paramedics - physiotherapists& ) Restrict the interference of the State in health care Stop excessive standards and bureaucracy AA6"("5"("fA 6 ( 5 ( ,% 6. CONCLUSION$  Continuing the concertation model between health care providers and sickness funds, under supervision of the State, is the best option to maintain and promote the high reputation and international level of the Belgian health care system  -& GWords to remember : "Pas de mdecine sans mdecins" Dr. Andr WYNEN)HHG rSS}-t