La performance du système de santé Belge. Rapport 2012 · 1. Donner une vue d’ensemble de la...

2013 www.kce.fgov.be

KCE REPORT 196 B

LA PERFORMANCE DU SYSTÈME DE SANTÉ BELGE RAPPORT 2012

Le Centre Fédéral d’Expertise des Soins de Santé Le Centre Fédéral d’Expertise des Soins de Santé est un parastatal, créé par la loi-programme (1) du

24 décembre 2002 (articles 259 à 281), sous tutelle du Ministre de la Santé publique et des Affaires sociales. Il est chargé de réaliser des études éclairant la décision politique dans le domaine des soins de santé et de l’assurance maladie.

Conseil d’Administration Membres effectifs Membres suppléants

Président Pierre Gillet Fonctionnaire dirigeant de l'INAMI (vice président) Jo De Cock Benoît Collin Président du SPF Santé publique (vice président) Dirk Cuypers Chris Decoster Président du SPF Sécurité sociale (vice président) Frank Van Massenhove Jan Bertels Administrateur général de l'AFMPS Xavier De Cuyper Greet Musch Représentants du ministre de la Santé publique Bernard Lange François Perl Marco Schetgen Annick Poncé Représentants du ministre des Affaires sociales Olivier de Stexhe Karel Vermeyen Ri De Ridder Lambert Stamatakis Représentants du Conseil des ministres Jean-Noël Godin Frédéric Lernoux Daniel Devos Bart Ooghe Agence intermutualiste Michiel Callens Frank De Smet Patrick Verertbruggen Yolande Husden Xavier Brenez Geert Messiaen

Organisations professionnelles représentatives des médecins

Marc Moens Jean-Pierre Baeyens

Roland Lemye Rita Cuypers

Organisations professionnelles représentatives des infirmiers

Michel Foulon Myriam Hubinon

Ludo Meyers Olivier Thonon

Fédérations hospitalières Johan Pauwels Katrien Kesteloot Jean-Claude Praet Pierre Smiets Partenaires sociaux Rita Thys Leo Neels Paul Palsterman Celien Van Moerkerke Chambre des Représentants Lieve Wierinck

Contrôle Commissaire du Gouvernement Yves Roger Direction Directeur Général

Raf Mertens

Directeurs du programme d'études Christian Léonard Kristel De Gauquier

Contact Centre Fédéral d’Expertise des Soins de Santé (KCE) Doorbuilding (10e étage) Boulevard du Jardin Botanique, 55 B-1000 Bruxelles Belgique 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 196B HEALTH SERVICES RESEARCH

LA PERFORMANCE DU SYSTÈME DE SANTÉ BELGE 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

COLOPHON Titre : La performance du système de santé Belge. 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)

Experts externes : 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)

Remerciements : 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)

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

Stakeholders: Les administrations et organismes suivants ont été consultés tout au long du projet lors de réunions inter-administrations : au niveau fédéral (SPF Santé Publique, SPF Affaires Sociales, INAMI, ISP), et au niveau des entitées fédérées: Communauté et Région Flamande (Vlaams Agentschap Zorg en Gezondheid), Fédération Wallonie-Bruxelles (Direction générale de la Santé), Communauté Germanophone (DGOV Ministerium der Deutschsprachigen Gemeinschaft), Région Wallonne (Direction générale opérationnelle des Pouvoirs locaux, de l'Action sociale et de la Santé et observatoire wallon de la santé), Région Bruxelloise (Observatoire de la Santé)

Conflits d’intérêt : Toute relation directe ou indirecte avec un producteur, un distributeur ou une institution de soins qui pourrait entrainer un conflit d’intérêt : 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 : • Les experts externes ont été consultés sur une version (préliminaire) du rapport scientifique. Leurs remarques ont été discutées au cours des réunions. Ils ne sont pas co-auteurs du rapport scientifique et n’étaient pas nécessairement d’accord avec son contenu.

• Une version (finale) a ensuite été soumise aux validateurs. La validation du rapport résulte d’un consensus ou d’un vote majoritaire entre les validateurs. Les validateurs ne sont pas co-auteurs du rapport scientifique et ils n’étaient pas nécessairement tous les trois d’accord avec son contenu.

• Finalement, ce rapport a été approuvé à l'unanimité par le Conseil d’administration. • Le KCE reste seul responsable des erreurs ou omissions qui pourraient subsister de même que des

recommandations faites aux autorités publiques. Date de publication : 25 janvier 2013 Domaine : 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 Classification NLM : W84 Langue : français, anglais Format : Adobe® PDF™ (A4) Dépôt légal : D/2012/10.273/111 Copyright : Les rapports KCE sont publiés sous Licence Creative Commons « by/nc/nd »

http://kce.fgov.be/fr/content/a-propos-du-copyright-des-rapports-kce

Comment citer ce rapport ? 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. La performance du système de santé Belge Rapport 2012. Health Services Research (HSR). Bruxelles: Centre Fédéral d’Expertise des Soins de Santé (KCE). 2012. KCE Report 196B. D/2012/10.273/111.

Ce document est disponible en téléchargement sur le site Web du Centre Fédéral d’Expertise des Soins de Santé.

KCE Report 196B Performance du système de santé i

PRÉFACE

Notre époque est souvent associée de manière péjorative au culte de la performance, toutefois, dans le domaine de la santé et des soins de santé, la recherche de la performance revêt un caractère quasiment indiscutable et même rassurant. Qui pourrait en effet se plaindre d’un système de soins de qualité, efficace, efficient, accessible et équitable ? Que pourrait-on reprocher à un système de promotion de la santé qui réduirait efficacement les inégalités de santé et permettrait aussi que ce niveau de santé s’améliore constamment ?

Le présent rapport vous propose une photographie de cette performance au travers de 74 indicateurs établis de manière rigoureuse par les chercheurs du KCE, de l’Institut Scientifique de Santé Publique et de l’INAMI. Leur travail a été facilité et enrichi par l’implication de dizaines d’experts du monde académique et de la société civile. Les membres de l’administration et du monde politique ont suivi activement toutes les étapes de l’élaboration de ce rapport. Nous remercions vivement chacune et chacun pour cette participation qui renforce la crédibilité du résultat et va en améliorer l’appropriation par toutes les parties concernées.

Nous vous laissons découvrir le détail des points forts de notre système, tels que l’état de santé perçu par nos concitoyens ou la couverture vaccinale des enfants, qui sont autant de raisons d’être satisfaits d’efforts qui ne peuvent toutefois être relâchés. Il faut aussi être conscient que des domaines tels que le dépistage insuffisant de certains cancers ou le report de soins pour raisons financières exigent une attention soutenue et accrue. Il nous faudra également veiller aux multiples manifestations des inégalités entre catégories socioéconomiques ou régionales.

Toutefois, malgré tout le soin et la rigueur dont chaque indicateur a fait l’objet, ce rapport doit être interprété avec une certaine prudence. En effet, les dernières données disponibles remontent parfois à quelques années, notamment celles fournies par les enquêtes. Il faut également tenir compte du temps nécessaire pour que les effets d’interventions de santé publique se traduisent dans les chiffres. En effet, l’administration et le monde politique ont pris des mesures susceptibles d’améliorer la situation dans les domaines de l’offre médicale, de l’adéquation des soins ou de l’équité. Il faudra donc remettre régulièrement l’ouvrage sur le métier afin d’évaluer si le rythme auquel nous progressons sur le chemin de la performance est suffisant. Très probablement, de nouvelles données devront être enregistrées, certains indicateurs devront être modifiés ou remplacés. En matière de santé et de soins de santé, comme dans d’autres domaines de l’activité humaine, il existe très peu d’acquis, l’efficience et l’équité seront toujours en devenir.

Raf MERTENS Directeur Général

ii Performance du système de santé KCE Report 196B

RÉSUMÉ INTRODUCTION L’évaluation de la performance du système de santé (Health System Performance Assessment - HSPA) est un processus qui permet d’offrir un bilan global, une évaluation holistique du système de santé. En se basant sur des indicateurs mesurables, cet outil établit un lien entre les résultats relatifs à la santé et les stratégies et fonctions du système de santé. L’HSPA est explicitement mentionnée dans la Charte de Tallinn, signée par tous les pays européens de l’Organisation Mondiale de la Santé (OMS) mais chaque HSPA est développée selon un cadre stratégique spécifique au pays. Une première évaluation de la performance du système belge de la santé a été publiée en juin 2010. Deux ans plus tard, le rapport HSPA 2012 vise à examiner l’accessibilité, la qualité, l’efficience, la durabilité et l’équité du système de santé belge. Il a également pour objectif d’être une source d’informations pour les décideurs compétents en matière de santé en Belgique.

KCE Report 196B Performance du système de santé iii

OBJECTIFS Objectifs stratégiques du processus d'évaluation de la performance 1. Donner une vue d’ensemble de la performance du système de santé

afin de faciliter la planification des politiques de santé ; 2. Rendre compte de la performance du système du système de santé

belge, conformément à l’engagement de transparence pris dans la Charte de Tallinn ;

3. À long terme, suivre les progrès de la performance du système de santé au fil du temps.

Objectif général du rapport 2012 Proposer et mesurer un ensemble d’indicateurs couvrant tous les domaines et certaines dimensions choisies du système de santé belge, tout en conservant un nombre d’indicateurs qui soit gérable (74 dans ce rapport).

Objectifs opérationnels du rapport 2012 1. Revoir et éventuellement adapter les 55 indicateurs du rapport

précédent, en se focalisant sur les 11 indicateurs qui n’avaient pas pu être mesurés en 2010 ;

2. Enrichir l’outil avec de nouveaux indicateurs relatifs aux domaines suivants : médecine générale, santé mentale, soins de longue durée, soins aux personnes en fin de vie, promotion de la santé ; ajouter des indicateurs relatifs à la continuité des soins et à l’approche centrée sur le patients (deux sous-dimensions de la qualité) ; enfin, proposer des indicateurs relatifs à l’équité dans le système de santé ;

3. Mesurer les indicateurs sélectionnés lorsque c'est possible, ou identifier les lacunes dans la disponibilité des données ;

4. Interpréter les résultats afin de fournir une évaluation globale de la performance du système belge de santé, au moyen de plusieurs critères, y compris une comparaison au niveau international.

MÉTHODES Un examen approfondi de la littérature indexée et de la littérature grise a été effectué pour trouver de nouveaux indicateurs dans les domaines et dimensions susmentionnés. Les indicateurs les plus pertinents ont été sélectionnés, en collaboration avec des experts externes dans chaque domaine. Au total, 74 indicateurs ont été sélectionnés et mesurés. Pour chaque indicateur, des analyses ont été menées au niveau national et régional (quand les données étaient disponibles à ce niveau), par statut sociodémographique (si possible). Les résultats ont aussi été comparés à ceux des 15 pays de l’Union Européenne (UE). Enfin, une évaluation globale a été effectuée.

Source des données L’étude a exploité au maximum les données disponibles en routine (p.ex. bases de données administratives, registres nationaux ou enquêtes récurrentes) : les données administratives de sortie des hôpitaux (RHM), l’échantillon permanent, les bases de données de l’INAMI (doc N, Pharmanet), le Registre Belge du Cancer, les données de surveillance des infections nosocomiales, l’enquête de santé par interview, les études de vaccination et la base de données de la “Direction générale Statistique et Information économique” (DGSIE).

iv Performance du système de santé KCE Report 196B

RÉSULTATS Etat de santé (4 indicateurs) Les quatre indicateurs relatifs à l’état de santé évoluent positivement au cours du temps. L’espérance de vie est légèrement inférieure à la moyenne des pays de l’UE-15, tandis que l’espérance de vie en bonne santé (c’est-à-dire le nombre d’années restant à vivre sans limitation des activités) et la mortalité infantile occupent des positions moyennes dans le classement. Le taux de personnes percevant leur santé comme (au moins) bonne est supérieur à la moyenne des pays de l'UE-15.

Accessibilité des soins (13 indicateurs) En ce qui concerne l’accessibilité financière, malgré la couverture universelle par l’assurance-maladie et l’existence de filets de sécurité sociaux (MAF, OMNIO, Fonds spécial de solidarité), certaines observations sont préoccupantes telles qu’un niveau élevé de dépenses à charge du patient, et un certain niveau de report des contacts avec les services des soins de santé pour des raisons financières. L’accessibilité des mesures de prévention montre des résultats divergents, avec un taux assez moyen de dépistage du cancer (avec des disparités sociales et parfois régionales), un taux de vaccination moyen contre la grippe chez les personnes âgées, mais un bon taux de vaccination chez les enfants. Un autre aspect de l'accessibilité concerne l’adéquation entre les forces de travail en soins de santé (médecins, infirmières) et les besoins de la population. Même si d’importants efforts ont été entrepris pour rendre disponibles les données relatives aux forces de travail, nous manquons toujours d'informations sur le nombre de professionnels de la santé nécessaires pour répondre aux besoins.

Qualité des soins : efficacité (7 indicateurs), adéquation (8), sécurité (6), continuité (7), approche centrée sur le patient (3) La qualité a été subdivisée en 5 sous-dimensions. Concernant l’efficacité, les résultats sont mitigés. Ils sont très bons quant au taux de survie après cancer, mais préoccupants dans le domaine de la santé mentale ; la Belgique présente en effet le second taux de suicide le plus élevé d'Europe (avec de très fortes disparités régionales) ainsi qu’un nombre de colocations en hôpital psychiatrique en augmentation. Pour décrire l’efficacité des soins dans le domaine de la santé mentale davantage d’indicateurs et de données sont nécessaires. L’adéquation des soins est assez décevante, avec des taux élevés et en augmentation de dépistage du cancer du sein en dehors des groupes cibles, un suivi modéré des recommandations (antibiotiques, patients diabétiques) et une augmentation des taux de césarienne, avec une grande variabilité entre les hôpitaux. La sécurité des soins présente des résultats encourageants, avec une tendance à la baisse concernant l‘exposition aux rayons ionisants médicaux, les infections nosocomiales et la mortalité hospitalière après une fracture de la hanche. Par ailleurs, l’incidence de la septicémie post-opératoire et la prescription d’antidépresseurs anticholinergiques aux personnes âgées présentent des niveaux stables. Cependant, l’incidence d'escarres est en hausse. La continuité et la coordination des soins présentent des résultats mitigés, avec une bonne continuité relationnelle avec le même praticien, un taux moyen et en augmentation de consultation multidisciplinaire pour les cas de cancer, mais un faible taux de couverture du dossier médical global et un taux élevé de réadmission dans les hôpitaux psychiatriques. L’approche centrée sur le patient n’a pu être évaluée que très partiellement. Le taux de satisfaction envers les services de santé est élevé, et on observe aussi une tendance à la hausse des décès au domicile. Mais il faut collecter davantage de données dans ce domaine.

KCE Report 196B Performance du système de santé v

Efficience du système de santé (3 indicateurs) L’efficience du système de santé présente des résultats moyens à bons, avec une augmentation de la prescription de médicaments « bon marché », de l’usage de la chirurgie de jour et une diminution de la durée du séjour pour un accouchement normal. Toutefois, ce message positif doit être tempéré par l’inadéquation, et donc le gaspillage de ressources, que montrent certains indicateurs, comme les mammographies en dehors du groupe cible évoquées ci-dessus.

Durabilité du système de santé (6 indicateurs) La durabilité du système de santé présente certains résultats interpellants concernant le manque de remplacement de la cohorte actuelle de médecins généralistes. Il faudrait aussi des données sur le besoin en personnel infirmier associées à des données sur l’évolution du nombre d’infirmiers.

Équité (analyses de tous les indicateurs en fonction du statut socioéconomique et de 2 indicateurs contextuels) La dimension de l’équité a été abordée de deux manières complémentaires. Tout d’abord, les inégalités ont été analysées en fonction du statut socioéconomique pour l’état de santé, les modes de vie et l’utilisation des soins de santé. De grandes inégalités ont été observées dans les indicateurs relatifs à la santé et au mode de vie. Des inégalités ont aussi été observées concernant le dépistage du cancer et le suivi des patients atteints de maladies chroniques. Toutefois, comme la plupart des indicateurs basés sur les hôpitaux n’ont pas pu être étudiés en fonction du statut social dans le cadre de ce projet, les conclusions concernant les inégalités en qualité des soins sont encore largement incomplètes. L’équité a également été abordée par le biais de deux indicateurs mettant en évidence ce problème au niveau macro. Le premier est la progressivité du financement des soins de santé. Il est en diminution, ce qui constitue une évolution vers moins d’équité. Le second est l’index Gini qui correspond au niveau d’inégalité dans la répartition globale des revenus, et qui est lié à un état de santé général moins bon. Cet indice est relativement peu élevé en Belgique, mais il augmente au fil du temps, ce qui indique une répartition moins égale des revenus dans notre pays.

Promotion de la santé (15 indicateurs) Enfin, la promotion de la santé a été principalement abordée au moyen d’indicateurs classiques sur la santé et le mode de vie, complétés par des indicateurs relatifs aux politiques de santé, aux milieux sains et aux aptitudes individuelles. En raison de la disponibilité très limitée d’indicateurs adéquats et de données en dehors des indicateurs classiques de la santé et du mode de vie, seul un aperçu fragmentaire a pu être fourni. La plupart des indicateurs de la santé et du mode de vie présentent un taux national intermédiaire par rapport aux 15 pays de l’UE, mais d’importantes disparités régionales et sociales ont été observées. Nous mettons en évidence le problème de l’obésité et du surpoids qui présente un niveau élevé et une tendance à la hausse, avec d’importantes disparités. La consommation de tabac diminue, mais avec de fortes disparités sociales et régionales. La consommation de fruits et de légumes est largement inférieure aux besoins quotidiens, mais est en hausse. Le manque de support social présente aussi d’importantes disparités sociales et régionales et est particulièrement préoccupant chez les personnes âgées. La Belgique se classe à un rang intermédiaire dans le classement international du Tobacco Control Scale. En outre, certains indices complexes visent à mesurer l’importance des politiques locales de promotion de la santé dans divers environnements (écoles, communes, entreprises) mais ne sont disponibles qu’en Flandre et sont difficiles à interpréter sans une analyse en profondeur.

vi Performance du système de santé KCE Report 196B

CONCLUSION ET DISCUSSION Au moyen de 74 indicateurs, ce rapport fournit une vue d’ensemble de la performance du système de santé belge, donne des signaux aux autorités de santé et pose des questions en vue du suivi ou de recherches ultérieures. Par rapport à la première évaluation du système de santé en Belgique, qui constituait principalement une étude de faisabilité, le rapport 2012 apporte une amélioration substantielle : il est plus complet et met à jour l'outil précédent des 55 indicateurs en intégrant des indicateurs plus pertinents. Il permet aussi de mesurer l’évolution de certains indicateurs. Certaines lacunes dans les données de routine ont été comblées, comme les taux de mortalité infantile, ou le taux de survie après cancer. Cependant, il ne couvre pas de la même manière tous les domaines des soins de santé ni tous les groupes de patients. Les indicateurs donnent des avertissements concernant l’état du système de santé en termes d'accessibilité, de qualité, d’efficience, de durabilité et d’équité. Dans certains cas, les décideurs politiques connaissent déjà les problèmes et ont déjà commandé des analyses supplémentaires pour savoir quelle action entreprendre. Dans d’autres cas, il s’agit de nouveaux signaux adressés aux décideurs politiques, ce qui nécessitera donc une analyse approfondie. La présentation des indicateurs de manière complète et structurée vise à faciliter la priorisation des actions nécessaires et/ou des études à mener. La Belgique n’est pas le premier pays à relever ce défi. Avec la signature en 2008 de la Charte de Tallinn, les États membres se sont officiellement engagés à suivre et à évaluer la performance de leur système de santé. Plusieurs pays voisins ayant des années d’expérience dans la mesure de la performance de leur système de santé ont servi d’exemple pour élaborer ce rapport, notamment les Pays-Bas. La faible disponibilité de données récentes est une des faiblesses entravant la mesure de la performance (comme l’indiquent aussi les rapports précédents sur la performance aux Pays-Bas). La mise à jour régulière des données administratives et la publication dynamique des résultats sur un site Internet seraient l’une des modalités à investiguer.

Avec la Directive européenne sur l’application des droits des patients dans les soins de santé transfrontaliers, cet engagement devient une question intéressant tous les États members.a Dès la transposition de la Directive dans la législation nationale en octobre 2013, les États membres devront faire en sorte que les patients issus d’un autre État membre puissent obtenir des informations pertinentes sur les normes de sécurité et de qualité, afin de choisir en connaissance de cause leurs soins de santé transfrontaliers. Dans ce contexte, le présent rapport établit non seulement la base d’une future évaluation systématique de la performance, mais il peut aussi être considéré comme une première étape dans l’engagement de la Belgique à assurer des soins de santé sûrs, de haute qualité, accessibles et efficients, tant pour les patients belges que pour les patients étrangers.

a Directive 2011/24/UE du Parlement européen et du conseil du 9 mars 2011

relative à l’application des droits des patients en matière de soins de santé transfrontaliers, JO L 88/45, 4 avril 2011

KCE Report 196B Performance du système de santé vii

RECOMMANDATIONSb

Recommandation d’ordre général aux responsables politiques Le concept de performance est implicitement lié à l’atteinte d’objectifs. Si le rapport actuel pose un «constat de la situation», sa principale utilité devrait s’orienter vers une fonction «d’amélioration de la situation». Dans ce but, il est recommandé que les décideurs politiques explicitent des objectifs mesurables et fixent des délais pour les réaliser en tenant compte des recommandations qui suivent.

Constats positifs (situation à maintenir) et constats négatifs (signaux d’attention) De manière générale, il est recommandé que les institutions et instances concernées s’appuient sur les constats qui suivent afin, soit de maintenir le cap dans les domaines pour lesquels des constats positifs ont pu être établis, soit d’améliorer la situation dans les domaines où des points d’attention sont signalés

Maintenir les constats positifs : • Etat de santé : l’état de santé ‘rapporté’ ou ‘perçu’ mesuré par les enquêtes santé (Institut

Scientifique de Santé publique) est meilleur que le niveau moyen européen. • Couverture de mesures préventives : le taux de vaccination des enfants est meilleur que le

niveau moyen européen. • Qualité des soins :

o Efficacité des soins curatifs : très bon résultats pour la survie à 5 ans après cancer du sein ou après cancer colorectal en comparaison des autres pays européens.

o Bonne continuité relationnelle avec le médecin généraliste et très grande satisfaction (au-dessus de 90%) des Belges lors de leurs contacts avec le système de santé.

• Efficience : l'augmentation des taux d’hospitalisation de jour et du taux d'utilisation des médicaments moins chers témoignent d'une amélioration de l'efficience.

Considérer les points d’attention pour orienter les futures politiques de santé : • État de santé :

o Les très hauts taux de suicide par rapport à la moyenne européenne sont interpellants.

b Le KCE reste seul responsable des recommandations adressées aux autorités publiques.

viii Performance du système de santé KCE Report 196B

o On observe une proportion croissante de personnes en surpoids ou obèses et par ailleurs un taux d’activité physique relativement bas, toujours par rapport à la moyenne européenne.

• Couverture de mesures préventives : Les taux de couverture de dépistage du cancer du sein et du col de l’utérus sont bas dans les groupes cibles en comparaison du niveau moyen européen. La couverture du dépistage organisé du cancer du sein est insuffisante pour être efficiente. Autre point d’attention, le dépistage en dehors des groupes cibles du dépistage organisé pour le cancer du sein est important et en augmentation pour les 40-49 et pour les 70-79 ans, ce qui est contreproductif en termes de santé publique et d’utilisation des ressources collectives.

• Équité/inégalités sociales : Les personnes avec un statut socioéconomique plus bas (mesuré par le niveau d’instruction ou par l’accès au remboursement préférentiel des soins de santé) présentent par rapport à la classe la plus élevée : un plus mauvais état de santé (espérance de vie, espérance de vie en bonne santé, mortalité infantile, obésité), des habitudes de vie moins saines (nutrition, tabac, activité physique), une moins bonne couverture de dépistage du cancer, un suivi moins bon pour les patients diabétiques, un support social moins présent et décèdent plus souvent à l’hôpital qu'à leur lieu de résidence habituel.

• Qualité des soins : o Soins (in)appropriés : plusieurs indicateurs montrent que la pratique médicale n'est

pas toujours appropriée. Ainsi : Le choix des antibiotiques prescrits en première intention ne correspond pas

suffisamment aux recommandations et ne montre pas d'amélioration à travers le temps (sauf chez les enfants).

Le pourcentage de patients diabétiques correctement suivis selon les recommandations est insuffisant.

Bien que le niveau soit un peu inférieur à la moyenne des autres pays européens, le taux de césarienne est élevé (20%) et on constate une grande variabilité des taux de césarienne entre hôpitaux pour des grossesses non compliquées.

o Sécurité des soins : le niveau d’irradiation d’origine médicale, bien qu'en légère diminution en 2011, reste très élevé par rapport à la moyenne européenne.

KCE Report 196B Performance du système de santé ix

o Continuité des soins : certains indicateurs montrent une faiblesse dans ce domaine. Ainsi :

Malgré une augmentation constante, le pourcentage de patients disposant d'un dossier médical global (DMG) reste encore trop faible.

Les taux de réadmission dans les hôpitaux psychiatriques sont relativement élevés par rapport à la moyenne européenne.

• Pérennité du système : Le système de santé s'appuie sur une première ligne de soins dont la médecine générale est un élément important. Or l'âge moyen des généralistes ne cesse d'augmenter, tandis que les quotas prévus par la commission de planification ne sont pas remplis depuis quelques années. A pratique constante, ceci pourrait poser des problèmes rapidement quant au fonctionnement de la première ligne de soins.

Recommandation d’amélioration des systèmes d’information de santé La qualité des données et la rapidité avec laquelle elles sont rendues disponibles sont des critères essentiels afin que les indicateurs qui en dépendent soient pertinents. • Délais de mise à disposition des données :

o Poursuivre les efforts afin de transmettre des mises à jour récentes aux organisations internationales (OECD, Eurostat, OMS) ;

o Accélérer la mise à disposition des bases de données administratives (Résumé Hospitalier Minimum).

• Données par domaine de soins : o Soins de santé mentale : réformer le Résumé Psychiatrique Minimum afin de l’adapter

aux standards internationaux (identifiant patient unique) et aux évolutions dans le secteur. Ceci demande une révision qui permette de suivre l’ensemble du trajet des soins des patients, y compris en dehors de l’hôpital.

o Soins de longue durée : s’assurer que les données collectées dans le cadre du projet BelRai seront bien disponibles à un niveau national pour permettre la mesure des différents indicateurs sélectionnés.

o Santé bucco-dentaire : sur-échantillonner le groupe des enfants de 12 ans dans l’enquête sur la santé bucco-dentaire afin de pouvoir calculer correctement les indicateurs internationaux.

o Soins aux personnes en fin de vie : améliorer l'exploitation des données existantes (Registre du Cancer et réseau des Médecins Vigies).

x Performance du système de santé KCE Report 196B

o Santé publique : compléter la banque de données de consommation des médicaments afin de disposer de données concernant l’ensemble des médicaments consommés, y compris ceux qui ne sont pas remboursés mais qui sont essentiels à étudier pour la santé publique ou la sécurité du patient ( benzodiazépines, certains anti-inflammatoires)

Recommandations sur la récolte de nouvelles données ou de nouvelle recherches Certaines données nécessaires à l’établissement des indicateurs sélectionnés doivent encore faire l’objet de récolte. • Inégalités socio-économiques : les bases de données administratives ne peuvent fournir

qu’une réponse partielle. Certaines données manquent complétement (par exemple, le statut socio-économique dans les données des Résumés hospitaliers ou l’origine ethnique), d’autres sont peu précises ou peu discriminantes (par exemple le statut BIM).

• Accessibilité financière : améliorer l'enquête sur le budget des ménages afin d'enregistrer toutes les charges financières des patients liées à leurs soins de santé et afin de permettre une analyse par niveau socio-économique.

• Expérience du patient : des données seront disponibles grâce à la prochaine enquête santé de l’ISP (elles concerneront les médecins généralistes et l’ensemble des spécialistes sans distinction). Il faudrait toutefois collecter des données par type de spécialité).

• Promotion de la santé : o Il n’y a pas de données sur la « litéracie de santé » (health litteracy) en Belgique. En

particulier, il est recommandé que la Belgique participe aux recherches européennes sur le développement d’outils pour mesurer la litéracie de santé et pour qu’elle s’inscrive dans une perspective de collecte de ces données.

o Promotion de la santé dans les milieux de vie : il existe des initiatives dans les différentes régions du pays, toutefois, toutes ces initiatives ne font pas l’objet d’un relevé statistique. En Flandre les données relatives à la promotion de la santé dans certains milieux de vie (écoles, communes, entreprises) sont collectées au moyen des enquêtes VIGeZ. Il est donc recommandé que les autres régions collectent plus systématiquement les données sur la promotion de la santé dans les milieux de vie en fonction de leurs besoins en information pour documenter et soutenir leurs politiques.

o Finalement, il est recommandé de vérifier la possibilité d’inclure des indicateurs de promotion de la santé spécifiquement dans le domaine des soins de santé dans le prochain rapport.

KCE Report 196B Performance du système de santé xi

Recommandations pour le prochain rapport performance (prévu pour décembre 2015) • A l’attention du SPF Santé Publique, de l’INAMI et de l’ISP

o Calculer les indicateurs pour lesquels les données ne sont pas encore disponibles, mais qui le seront d’ici le prochain rapport (projet sur les trajets de soins en ambulatoire, projet BelRAI, expérience des patients dans l’enquête santé, prévalence des infections nosocomiales, délai d’enregistrement des médicaments).

o A l’avenir à des fins de monitoring, il est souhaitable d’inclure les résultats les plus récents. Ces indicateurs devront de préférence être mesurés en routine par les institutions/ administrations, gestionnaires respectifs des banques de données administratives. Les résultats seront transmis aux équipes chargées de l'actualisation du rapport, selon un échéancier et un canevas à préciser.

o Suivre les évolutions internationales (OECD, OMS, Eurostat) afin d’adapter le set d’indicateurs en Belgique si nécessaire.

• A l’attention des équipes de recherche o Identifier de nouveaux indicateurs pour les thématiques peu documentées (question

des forces de travail en soins infirmiers, par exemple). o Actualiser l’évaluation de la performance sur base des données les plus récentes. o Analyser la cohérence globale (en particulier pour renforcer les dimensions relatives à

l’efficience et à la pérennité) et actualiser le set d’indicateurs, à la lumière de nouvelles preuves ou de nouvelles thématiques prioritaires.

KCE Report 196

TABL

6

LE OF COONTENTLISTLISTLIST

11.11.2

1.3

22.12.22.32.4

2.52.62.72.8

Belgian

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

SYNTHÈSECONTEXTECONTEXTE .CADRE CONBELGE .........LES OBJECT1.3.1 Les o

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n Health System

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

.........................ATIONS ............ ........................

E, CADRE CONC............................

NCEPTUEL D'ÉVA............................

TIFS DE CE RAPPobjectifs stratégiqé ..........................objectifs générauxT FAIBLESSESNTERPRÉTER LENTÉ .....................ITÉ ......................

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E DU SYSTÈME D............................

N DE LA SANTÉ ..ÉGALITÉ ..............alités socio-écono

Performance

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

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

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

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ES TABLEAUX S................................................................................................................................................................................................................................

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

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

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

.........................OBJECTIFS .......

............................A PERFORMANC........................................................s d'évaluation de ............................s du rapport 2012DE SANTÉ EN YNOPTIQUES PR............................................................................................................................................................................................................................................................................................................................................................................

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

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

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

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

.....................................................E DU SYSTÈME ........................................................la performance du.......................................................BELGIQUE .....

RÉSENTANT LES............................................................................................................................................................................................................................................................................................................................................................................

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

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

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

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1

. 5

. 7

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13 15

15 15 16 16 18 19 22 22 24 26 27 29 30 31 32 36 36

2

2.93

3.1

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4

11.1

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1.41.522.12.22.333.13.2

Belgian

CONCLUSIOLE RAPPORLIMITATIONQUELLE ESTSANTÉ ? ......QUELLE ESTQUELLES SO3.3.1 La p3.3.2 Pren3.3.3 Une CONCLUSIOSCIENTIFICBACKGROUCONTEXT ....1.1.1 Inter1.1.2 NatioTHE BELGIAOBJECTIVES1.3.1 Strat1.3.2 OverMETHODS TTHE 2012 SEOVERALL HHOW DID WEFACTS AND KEY FINDINGACCESSIBIHOW DID WEFACTS AND

n Health System

ONS SUR LES FORT 2012 SUR LANS.....................T L'UTILITÉ D’UN............................

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ndre des décisionsvision plus globa

ON GÉNÉRALEC REPORT ........UND AND APPR............................

rnational context ..onal context .........N PERFORMANC

S OF THE PERFOtegic objectives ofrall and operationO REACH OPER

ET OF PERFORMHEALTH STATUE DESCRIBE THEFIGURES ...........

GS .......................ILITY OF CAREE EVALUATE THFIGURES ...........

Performance

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ALTH STATUS OF.................................................................................

TY OF HEALTHCA............................

............................VALEUR AJOU.........................NCE DU SYSTÈM............................ARÉE AU PRÉCÉ........................................................? ..........................ent ......................................................................................................................................................................................ONS ....................................................................................................................................

CTURE OF THIS R.........................

F THE POPULATI.................................................................................

ARE? ...............................................

KCE Report

.......................... 4UTÉE ET ........................ 4ME DE .......................... 4

ÉDENT? ............ 4.......................... 4.......................... 4.......................... 4.......................... 4........................ 4........................ 4........................ 4.......................... 4.......................... 4.......................... 4.......................... 4.......................... 5.......................... 5.......................... 5.......................... 5REPORT ........... 5........................ 5ION? ................. 5.......................... 5.......................... 6........................ 6.......................... 6.......................... 6

t 196

40

42

42 43 44 44 44 44 46 48 48 48 48 49 49 53 53 53 54 55 56 56 56 60 60 60 61

KCE Report 196

6

3.344.1

4.2

4.3

4.4

4.5

55.15.25.366.16.2

Belgian

KEY FINDINGQUALITY OEFFECTIVEN4.1.1 How4.1.2 Fact4.1.3 Key APPROPRIAT4.2.1 How4.2.2 Fact4.2.3 Key SAFETY OF C4.3.1 How4.3.2 Fact4.3.3 Key CONTINUITY4.4.1 How4.4.2 Fact4.4.3 Key PATIENT CE4.5.1 How4.5.2 Fact4.5.3 Key EFFICIENCYHOW DID WEFACTS AND KEY FINDINGSUSTAINABHOW DID WEFACTS AND

n Health System

GS .......................OF HEALTHCARNESS OF CARE ..w did we evaluate tts and figures .......findings ...............TENESS .............

w did we evaluate tts and figures .......findings ...............CARE ..................

w did we evaluate tts and figures .......findings ...............

Y OF CARE ..........w did we evaluate tts and figures .......findings ...............NTEREDNESS ...

w did we evaluate ts and figures .......findings ...............Y IN HEALTHCAE EVALUATE THFIGURES ...........

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Performance

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

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

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TEM ..................TY OF THE HEA............................

..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................? ..........................................................................................................

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

.......................... 7........................ 7.......................... 7.......................... 7.......................... 7.......................... 7.......................... 7.......................... 7.......................... 7.......................... 8.......................... 8.......................... 8.......................... 8.......................... 8.......................... 8.......................... 8.......................... 9.......................... 9.......................... 9.......................... 9.......................... 9.......................... 9........................ 9.......................... 9.......................... 9.......................... 9...................... 10........................ 10........................ 10

3

70 71 71 71 72 77 78 78 78 84 84 84 85 89 89 89 90 93 93 93 94 95 96 96 96 99 00 00 00

4

6.377.17.2

7.388.18.2

8.3

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10

APP

APPAPP

Belgian

KEY FINDINGPERFORMAHOW DID WEFACTS AND 7.2.1 Heal7.2.2 Inter7.2.3 HealKEY FINDINGEQUITY ANINTRODUCTSOCIO-ECON8.2.1 How8.2.2 Fact8.2.3 Key EQUITY OF T8.3.1 How8.3.2 Fact8.3.3 Key TOWARDS ASSESSMEGENERAL CAPPENDICE

ENDIX 1. LIST TIER OF TH

ENDIX 2. LISTENDIX 3. LIST

REFERENC

n Health System

GS .......................ANCE OF HEALE EVALUATE THFIGURES ...........lth outcomes .......rmediate health oulth Promotion outcGS .......................D EQUALITY ..ION .....................NOMIC INEQUAL

w did we evaluate sts and figures .......findings ...............

THE HEALTH SYw did we evaluate tts and figures .......findings ...............A MORE COMP

ENT: ADDRESSCONCLUSION .ES ....................T OF INDICATOHE HEALTH SYT OF CHANGEST OF INDICATO

CES ...................

Performance

............................LTH PROMOTIOE PERFORMANC........................................................utcomes ..............comes ..................................................................................................LITIES .................socio-economic in........................................................STEM AT A GLOthe equity of the h........................................................PREHENSIVE H

SING CURRENT..................................................

ORS MEASUREYSTEM, DOMAINS TO INDICATOORS MEASURA.........................

............................ON .....................CE OF HEALTH P.............................................................................................................................................................................................................................nequalities? .................................................................

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

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

ED IN THE 2012 N OF CARE AN

ORS COMPAREABLE IN A NEAR

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

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

PROMOTION? .................................................................................................................................................................................................................................................................................................................................................a global level? .............................................................EM PERFORMANGS ....................................................................REPORT, CLA

ND DIMENSIONED TO THE 2010R FUTURE ................................

KCE Report

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

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

ASSIFIED BY ..................... 130 REPORT ... 14...................... 14...................... 15

t 196

07 07 07 10 10 15 19 22 23 23 23 23 25 30 30 30 31 33

33 37 38

38 42 47 50

KCE Report 196

LIST OF F

6

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n Health System

ceptuel d'évaluatiode l'équité: coeffic............................

ptual framework toancy at birth: interality rate: internatipractising physiciaket expenditures (............................ of women (aged ast two years, by cer and cervical cae of children cove

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s per 1000 live birtaily dosage of antnational compariserapy near end-of-n to medical radiaton ........................dence of Healthcae of population we of hospitalisatio

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on de la performanient de Gini après............................o 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) ................

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rformance 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 –

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de santé belge .....ferts, en Belgique............................Belgian 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 c

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Belgian

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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

ek after dischargesatisfaction 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............................e of the adult pop

nd 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

, by region (2003-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 18 omparison (2000-egion, for all casesosis per 100 000 inon (a) smoking daruits and 200 vegegion (1997/2001-on the Tobacco Coafter taxation and ............................

-2009) .................es, by type of servin ambulatory set

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

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

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

m of Health Accouarison ...................e performance of h............................th obesity (BMI ≥............................an cases only (b)ational compariso

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

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

KCE Report

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

.......................... 900-2010) ............. 9 .......................... 9.......................... 9........................ 10

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st ........................ 11........................ 12

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t 196

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32

KCE Report 196

LIST OF T

6

TABLES TableTableTableTableTableTableTableTableTableTableTableTableTableTable(/100TableTablepopuTableTableTableTableTableTablefollowTableTableTableTableTable

Belgian

eau 1 – Indicateureau 2 – Indicateureau 3 – Indicateureau 4 – Indicateureau 5 – Indicateure 6 – Indicateurs éeau 7 – Indicateureau 8 – Indicateureau 9 – Indicateureau 10 – Indicateueau 11 – Synthèseeau 12 – Indicateue 13 – Life expecte 14 – Number of 0 population) (20

e 15 – Out-of-pocke 16 – Number of lation 65 years an

e 17 – 5-year relate 18 – Exposition e 19 – Percentagee 20 – Evolution oe 21 – Mean age oe 22 – Progressionwing graduation ace 23 – Percentagee 24 – Total healthe 25 – Alcohol cone 26 – Offer of phye 27 – Life expect

n Health System

rs généraux de l'érs évaluant l'accesrs évaluant l'efficars de l'adéquationrs évaluant la sécuévaluant la continurs évaluant de la crs de l'efficience drs de la pérennité urs de la promotioe des inégalités sur de l'équité: progancy at birth (201practising physici10) .......................ket expenditures (accredited beds i

nd older, per regiotive survival by stato medical radiati

e of cancer patienof place of death oof practising GPs n between 1996 according to type oe of GPs using rech expenditures acnsumption habits fysical activity in seancy at 25 years

Performance

état de santé ........ssibilité aux soinsacité des soins ..... des soins ...........urité des soins ....uité et de la coordcentralité du patiedes soins .............

du système de saon de la santé ......ocio-économiquegressivité du finan0), and Healthy Lians, estimation o............................(2003-2010) ........n homes for the e

on, 2010 ..............age, period 2004-on per inhabitant ts who had a MO

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

and 2008 of graduof specialisation ...commended softwccording to the Syfor the populationecondary schoolsby sex and educa

............................ de santé .................................................................................................

dination des soinsnt dans le systèm............................anté .................................................s ..........................ncement public duLife 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 ........ational level, abso

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

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

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

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

............................s ...........................me de santé .........................................................................................................................u système de soin25 (2008), by sex alent, and density........................................................g homes per 100 ........................................................mSv): Belgium (2

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

olute difference to

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

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

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

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

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

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

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

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

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

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

.......................... 3ns de santé ........ 3

and region ........ 5y .......................... 6.......................... 6 .......................... 6.......................... 7

2004-2011) ........ 8 ......................... 9.......................... 9........................ 10

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

7

18 21 23 25 26 28 29 30 31 34 37 39 57

61 64

69 73 85 92 95 01

01 04 05 15 19

8

higheTablehigheTableTable

Belgian

est educational leve 28 – Health expeest educational leve 29 – Inequalitiese 30 – Progressivi

n Health System

vel and concentraectancy at 25 yeavel and concentras expressed with aity indicators of th

Performance

ation inequality indars by sex and eduation inequality indabsolute difference financing of the

dices (CII) (Belgiuucational level, abdices (Belgium 20ce, relative differen public healthcare

m 2001) ..............bsolute difference 04) ......................nce, and summare system (2005-20

KCE Report

........................ 12 to ........................ 12

ry measures ..... 12011) ................. 13

t 196

25

26 28 32

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

n Health System

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

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

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

PSI PYLL RAI RHM – MZG RIZIV – INAMI

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

n Health System

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

Performance

Safety Indicator 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

SYNTTHÈSE

Belgiann Health System

1

1LSjupdDsc

Q(LbscHq

ÀHudpgpppsLp

Performance

1 CONTEXOBJECT

1.1 ContexteLa première « ÉvaSystem Performanuin 2010.1 Ce prpremière définissad'approches adopDans la seconde sse sont révélés êcours du temps et

Qu'est-ce qu'uneHSPA) ?

L’HSPA est un probilan global, une ésur des indicateurscontribuer à la plaHSPA est élaboré question.2

À l'issue de la pubHSPA belge ont sune évaluation sysdemandé d’étoffeportant sur les dogénérale, la santpersonnes en fin dpatient et sur la coproposer des indisanté. Le présent Rappprésente le fruit de

XTE, CADRTIFS

aluation de la Pernce Assessment remier rapport coait un cadre conptées par d'autresection, 55 indicaêtre mesurables. points d’action en

e Évaluation de la

ocessus, spécifiquévaluation holistiqus chiffrés qui envonification stratégiqen fonction d'un c

blication de ce prouhaité la poursustématique du sys

er ce jeu d'indicamaines suivants :é mentale, les sde vie ; ajouter deontinuité des soinscateurs permetta

port sur la Perfoe ce travail.

RE CONCE

rformance des So- HSPA) en Belg

omportait deux seceptuel pour le

es pays, adaptéeateurs avaient été

Les forces, faibnvisagés ont été d

a Performance d

ue à chaque paysue du système deoient des « signauque du système dcadre stratégique

remier rapport, lesuite du projet, danstème de santé beateurs en y inté: la promotion de soins de longue es indicateurs ports (deux sous-dim

ant de mesurer l'

ormance du Syst

KCE Report

EPTUEL ET

ins de Santé » (Hgique a été publiéections principaleHSPA belge sur

es au contexte bé sélectionnés, doblesses, évolutiondiscutés.

u Système de Sa

, qui permet d’offre santé. En se basux », cet outil visede santé. Chaque e spécifique au pa

s commanditairesns le but de procéelge. Ils ont égale

égrant des indicala santé, la méddurée, les soins

tant sur la centralensions de la quaéquité du systèm

tème de Santé

t 196

T

Health ée en

es. La base

belge. ont 40 ns au

anté

rir un sant

e à

ys en

s de l' éder à ement ateurs ecine

s aux ité du alité) ; me de

2012

KCE Report 196

La Charte de Tmesurer la per

En juin 2008, le'Europe' de l'Or« 'Charte de Taprospérité ». Ceengagement posignataires s'encomptes au sujpublication de r

1.2 Cadre systèm

Le cadre conce

6

Tallinn (2008), unrformance des sy

es Ministres de la rganisation Mondiallinn sur les systèette Charte contieorte sur la performngagent à promouet de la performarésultats mesurab

conceptuel d'éme de santé beleptuel est présenté

n engagement intystèmes de sant

Santé des 53 payale de la Santé (O

èmes de santé poent sept engagemmance des systèmuvoir la transparennce des systèmes

bles ».3

évaluation de lalge é en Figure 1.

Belgian

ternational visanté en Europe

ys composant la rOMS) ont signé laur la santé et la ents. Le troisième

mes de santé : « lence et à rendre des de santé grâce l

a performance

n Health System

nt à

égion a

e es États es la

du

Performance 13

14

Figure 1 – Cad

Remarque : Ce ravie sont présenté

dre conceptuel d

rapport ne contient aés dans le chapitre c

'évaluation de la

aucun chapitre spécconsacré à la promo

Belgian

a performance du

cifiquement consacrotion de la santé.

n Health System

u système de san

ré aux indicateurs s

Performance

nté belge

sur les déterminantss non médicaux de lla santé. Les indica

KCE Report

teurs relatifs au mo

t 196

de de

KCE Report 196

1.3 Les objL'évaluation syun processus éobjectifs stratéterme de ce proobjectifs spécifrapport. 1.3.1 Les ob

perforLe processus H1. Informer le

pour les aid2. Rendre co

système dsignant la C

3. Suivre les temps.

1.3.2 Les obProposer et medes dimensionsque le nombre dQuatre objectifs1. Revoir les

attention pn'était disp

a Le nombr

maladie cguides dedents carcardiovascsurvie à 5l'utérus);

6

jectifs de ce raystématique de laévolutif, jalonné pgiques peuvent ocessus évolutif. fiques et des sou

bjectifs stratégiqrmance du systèHSPA poursuit troies autorités de la der à planifier les omptes, de manide santé belge, Charte de Tallinn.progrès de la pe

bjectifs générauesurer un jeu d'ins choisies du systd'indicateurs restes opérationnels ons 55 indicateurs articulière aux 11onible en 2010a.

re d'infirmières en chez les patients e bonne pratique criées, manquantes culaire chez les pe

5 ans après un diagla mortalité prém

apport performance de

par la publication être définis comCes derniers doiv

us-objectifs opéra

ques du processème de santé is objectifs stratégsanté quant à la politiques de sanère transparenteconformément à

. erformance du sy

ux et opérationnendicateurs couvraème de santé en e gérable (74 indint été fixés :

du rapport pré indicateurs pour

exercice; les coûtschroniques; les pr

clinique; le dépistagou obturées à l'âgersonnes âgées degnostic de cancer (dmaturée; l’incidence

Belgian

s systèmes de sdes rapports HS

mme les objectifsvent être différenctionnels de ce de

sus d'évaluation

giques : performance du s

nté. e, de la performaà l'engagement

ystème de santé a

els du rapport 20ant tous les domBelgique, en veillcateurs dans ce r

écédent, en portar lesquels aucune

s supplémentaires lrescriptions conforge du cancer colorge de 12 ans; le de 45 à 75 ans; ledu sein, du côlon, de des escarres d

n Health System

anté est SPA. Les s à long ciés des euxième

de la

système,

ance du pris en

au fil du

012 aines et lant à ce rapport).

ant une donnée

iées à la mes aux ectal; les dépistage e taux de du col de dans les

2

3

4

Lradsl'sp

Performance

2. Étoffer ce jeules domainesgénérale, la spersonnes encentralité du dimensions dmesurer l'équ

3. Mesurer les identifier les la

4. Interpréter lesde la performcritères, notam

Le rapport sur la apport de monitor

d'autres pays. A trsystème de santé efficacité, la pére

se veut une sourcepolitiques compéte

établissemenrisque.

u d'indicateurs en s suivants : la psanté mentale, lesn fin de vie ; a

patient et sur de la qualité) ; prité du système deindicateurs chois

acunes en terme ds résultats dans lance du systèmemment une compa

performance during national. La Bravers 74 indicatebelge s'efforce dennité/durabilité et e d'informations gents en matière de

nts de soins de lon

y intégrant des ipromotion de las soins de longue

ajouter des indicla continuité de

roposer des indice santé. sis, ou quand cde disponibilité dee but de fournir u de santé belge aaraison internatio

u système de sanBelgique y est noturs, le rapport sure mesurer l'accesl'équité du systèm

globale pour les die santé et de prom

ngue durée et au

indicateurs portana santé, la méde durée, les soinsateurs portant s

es soins (deux cateurs permetta

e n’est pas poses données. une évaluation glau moyen de diffénale.

nté belge est un amment comparér la performance dsibilité, la qualité,me de santé belgeifférents décideursmotion de la santé

sein de la popula

15

nt sur ecine s aux

sur la sous-nt de

ssible,

obale érents

ée à du e. Il s é.

tion à

16

2 FORCDE SA

2.1 Commeprésen

Les résultats synoptiques ci-est consacré à Ces tableaux sy• Un pictogr

indicateur. niveau natinternationasocio-éconpossible qu

• Dans la Belgique(benchmarcouleur.

• La colonnerésultats sdécideurs sur la baséchéant la

• L'évolutionprésentée l'importanc

• Les dernièrésultats p

b EU-15 fait

décembreEspagne, Portugal,

ES ET FAIANTÉ EN B

ent interpréter tant les résultades 74 indicatedessous, par domla promotion de laynoptiques contieamme illustre l'év

Cette évaluatiotional, par rappoaux ; l’évolution d

nomiques. Notonue pour certains incolonne « Belgiquest comparée

rking international

e suivante contienont disponibles. politiques, notam

se de données ocollecte d'informa générale au couensuite (augmen

ce es changementères colonnes par sous-groupes

t référence aux 15

e 2003, à savoir: Finlande, France,

Royaume-Uni et Su

BLESSESBELGIQUE

les tableaux syats ? eurs sont présemaine et/ou dimena santé.

ennent les informavaluation globale n résume diversort à d’éventuelsdans le temps ; lesns que cette éndicateurs. ue », la valeur

aux résultats l) et représentée

nt l'année la plus Cette informationment pour éviter bsolètes, ainsi qations plus récentrs des 5 dernière

ntation, diminutionts n'est pas illustréprésentent, quan: sexe, statut soc

États membres deAllemagne, Autri

Grèce, Irlande, Itauède.

Belgian

DU SYSTÈ

ynoptiques

ntés dans les tnsion. Un chapitre

ations suivantes : des résultats de

s critères : la vas objectifs nations disparités région

évaluation global

de l'indicateur des pays de au moyen d'un

récente pour laqn est importante de prendre des due pour favorisees.

es années disponn ou stabilité). Toée.

nd c’est possiblecio-économique (f

e l'Union européeniche, Belgique, Da

alie, Luxembourg, P

n Health System

ÈME

tableaux e distinct

chaque aleur au naux ou nales ou le n’est

pour la l'EU15b

code de

uelle les pour les

décisions r le cas

ibles est outefois,

e, des faible ou

ne au 31 anemark,

Pays-Bas,

•

SC(tol'PinS“

c

Performance

élevé)c et régpar sous-groul'ampleur desrégionale, il cRégion de Brud'une granderégions du paet ruraux.

Enfin, les dodoivent être m

Source des donnCe rapport utilise atelles que les bas

ou les enquêtes réÉchantillon perma

Pharmanet), le Renfections nosocomSurvey - HIS), les Direction générale

Selon la sou

par le niveadépenses de

gion (Wallonie, Flaupes, des couleurss différences. Poconvient de teniruxelles-Capitale. Ce agglomération ays se composen

omaines dans lemenées sont indiq

nées autant que possib

ses de données adécurrentes) : le Réanent (EPS), les b

egistre belge du Cmiales, l'enquête détudes de vaccine Statistique et In

rce des données, au d'études, soit p santé.

andre et Bruxelless aident le lecteurour ce qui concr compte du contCette région se courbaine, tandis t d'environnemen

esquels des étuués au moyen du

ble les données didministratives, lesésumé hospitalier bases de données

Cancer, les donnéede santé par interation et la base dformation économ

le statut socio-éconpar le droit au rem

KCE Report

s). Dans ces anar à mieux appréhecerne la compartexte spécifique ompose exclusiveque les deux a

nts urbains, subur

udes complémenu symbole .

sponibles en routs registres nationar minimal (RHM), s de l'INAMI (doc es de surveillancerview (Health Intere données de la

mique” (DGSIE).

nomique est mesurmboursement major

t 196

alyses ender raison de la

ement autres rbains

taires

tine aux

N, e des rview

ré soit ré des

KCE Report 196

Légende des t

Évaluation glob

Résumau

Résu

Résu

Bons

Très(tousrenc

Des comnéce

§ Les quintiles so£ Groupe de réféobtenu les meillegroupe socio-écodans le groupe so

6

ableaux synopti

bale

ultats trèvais

ultats mauvais

ultats moyens

s résultats

s bons résultats les critères son

contrés)

données/étudeplémentaires son

essaires

ont calculés sur la bérence : le statut soceurs résultats. Exemonomique élevé OUocio-économique él

ques

Comparaiso(EU-15) La Belgiqueles pays ob

s Les moins b

Des résultamoyenne

Des résulta

Des résultamoyenne

s nt

Les meilleu

s nt

base des résultats dcio-économique le p

mples fictifs : Deux foU moitié moins bons

levé.

Belgian

on internationale

e se situe§ parmibtenant :

bons résultats

ats inférieurs à la

ats moyens

ats supérieurs à la

urs résultats

de tous les pays. plus élevé, le genre ois plus mauvais : 2: 13% d'alimentatio

n Health System

i

Risques rela

Très grandemauvais ouréférence£

a Grandes diffmoins bons

Différences ou moins bo

a Différences bons de 20%

Paramètre n

Données no

(femmes/hommes)20% de fumeurs danon équilibrée dans le

Performance

atifs en fonction d

es différences entru moitié moins b

férences entre les

moyennes entre ons

ténues ou nulles % au maximum

non pertinent pour

on disponibles

) affichant les meillens le groupe socio-ée groupe socio-écon

u genre, du statut

re les groupes : leons dans le gro

s groupes : les ré

les groupes : les

entre les groupes

r cet indicateur

eurs résultats, la régéconomique faible pnomique faible par r

t socio-économiqu

es résultats sont aupe comparé qu

ésultats sont au m

résultats sont de

s : les résultats so

gion (Wallonie, Flanpar rapport à 10% drapport à 26% d'alim

ue et de la région

au moins deux foisue dans le group

moins 50% meilleu

e 20% à 50% mei

ont meilleurs ou m

ndre, Bruxelles) ayande fumeurs dans le mentation équilibrée

17

s plus pe de

urs ou

lleurs

moins

nt

e

18

2.2 État deQuatre indicaterésultats globala promotion dsanté. Pour ces quatrtemps (Tableamoyenne EU-1santé (définie fonctionnelle à

Tableau 1 – Ind

Indicateur

Espérance de v

Espérance de sannées)

Etat de santé p(% en bonne ou

Taux de mortal(nombre de dnés vivants) i L'espérance de ii La comparaisoniii Le code couleuautres indicateurs

e santé eurs généraux de aux et très distauxe la santé, à cô

re indicateurs, onu 1). L’espéranc5 (de 0,7 années

comme le nopartir d'un âge

dicateurs généra

vie (en années)

santé (à 25 ans, e

erçu u très bonne santé

ité infantile écès/1000 enfan

vie par statut socion internationale est bur utilisé pour les diffrs), mais sur l'ample

l'état de santé onx de l'efficacité duté de tous les a

n observe une éce de vie et légès). La mortalité inmbre d'années donné) se situen

aux de l'état de s

Global B

80

en 4

é) 76

nts 3.

o-économique est pbasée sur l'espéran

fférences sociodémoeur des différences a

Belgian

nt été choisis comu système de sanutres déterminan

volution positive èrement inférieurnfantile et l'espérde vie sans l

nt dans la moyen

santé

Belgique Dernièannée dispon

0.0 2010

1.0 ii 2008

6.8 2008

.5 2010

présentée ici à l’âgence de santé à la naographiques en termabsolues : jaune = 1

n Health System

mme des nté et de nts de la

dans le re à la rance de imitation nne des

résEOl’vamsm

ère

nible

Évolution

augmentat

augmentat

augmentat

diminution

e 25 ans. aissance. mes d'espérance de1 à 2 ans de différen

Performance

ésultats de l’EU-santé comme assEU-15. On observe de graespérance de vie

vivent plus longteavec des limitationmoins bonne. Tosocio-économiquemeilleurs en Fland

M F

tion 77.4 82.6

tion 41.3 41.2

tion 79.5 74.3

n 4.2 3.4

e vie et d'espérancence, orange = 2 à 6

15. Le pourcentasez bonne (ou trè

andes différencese, mais pas pomps que les homns fonctionnelles,us les paramètre

es plus faibles. Edre, hormis pour la

Socio faible

Socioélevé

M: 47.6i F: 54.0

M: 55F: 59

M: 27.7 F: 28.9

M: 46F: 47

57.4 85.7

e de santé n'est pas6 ans de différence,

age de personneès bonne) est su

s entre les femmeur l'espérance de

mmes, mais viven et elles considères sont moins bon termes de régioa mortalité infantil

o é

Flandre

5.0 .9

80.9

6.3 .1

M: 43.7 F: 42.3

78.6

4.0

s basé sur le risque rouge = plus de 6 a

KCE Report

s qui considèrenupérieur à la moy

es et les hommese santé : Les femnt davantage d'anrent leur santé coons pour les groons, les résultatse.

Wallonie Brux

78.5 80.0

M:37.4 F:39.1

M:38F:40

73.7 74.3

3.1 4.6

relatif (comme pourans de différence.

t 196

t leur yenne

s pour mmes nnées omme oupes s sont

xelles

8.5 .6

r les

KCE Report 196

2.3 AccessL'accessibilité peuvent avoir physique (répadisponibilité depréalable à la qTreize des sepde santé. Ils saccessibilité finaux soins de lode vie.

Disponibilité dDes efforts conpersonnel soignpreuve l'ajout dpas de résultaindicateurs ne est suffisant po

Accessibilité fMalgré la couvmultiples filets Spécial de Solidifférer certainsmédicaments, lfinancières. Ce 90. Par ailleurssanté en Belgmoyenne EU-15

6

sibilité est définie commrecours aux pr

artition géographie personnel qua

qualité et à l'efficietante-quatre indicsont regroupés p

nancière, couvertuongue durée et m

des soignants : mnsidérables ont étnant en Belgique de ces deux indicats complets dansuffisent pas à ur répondre aux b

financière verture par l'assude sécurité socidarité), 14% des s soins de santé lunettes/lentilles, pourcentage est , la contribution d

gique se monte 5, qui est de 15%

me la facilité avrestations de saique), de coût, dalifié.4 L'accessib

ence d'un systèmecateurs évaluent lpar thèmes : disure des mesures

moment de début

médecins et infirmté consentis pour (médecins et infi

cateurs, pour lesqns le précédent déterminer si l'ef

besoins de la pop

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des patients à l'enà 19%, soit se

%.

Belgian

vec laquelle les nté, en termes de temps d’accèbilité est une ce de santé. l'accessibilité du ponibilité des sopréventives, accedes soins palliati

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rmières en activitquels nous ne disrapport. Cependaffectif soignant disulation.

verselle et l'existeà facturer, Omnioent avoir été contr intervention chiru

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Performance

Couverture des mLa Belgique peut mesures préventivLa couverture du deçà de la moyenans, malgré l’existdu sein. D’autre paqui peut susciter dépistage. La couprésente peu de moyenne EU-15, communément acnotable de cette coLa couverture duprésentée, car le que très récemmeEn termes de vacde l'OMS (75%) nentement. La Belgique obtienenfants.

mesures préventcertainement fai

ves. dépistage du ca

ne EU-15 (68.3%tence d'un prograart, les différencedes questions q

verture du dépistdisparités régionmais restent médcepté en Europe.ouverture.

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amme organisé des entre les régionquant à l'efficientage du cancer duales. Les résultadiocres par rappo. On n’observe pa

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a grippe des perscette couverture

e bons résultats p

me de couverture

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ns sont marquantece du programmu col de l'utérus (

ats sont proches ort à l'objectif de as non plus d’évo

ne peut encorerançaise n'a été

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pour la vaccinatio

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20

Accessibilité dLe nombre de évolué au coursâgées de 65 anélevé en WallonLes soignants les personnes (ACVQ) pendamaillon importapopulation âgéinformels varie 12,1% est lég(11,7%). Ce rémode de vie, spécifiques d'enAucune donnédisponible, cel'accessibilité de

Moment de déLe début des sretrouve en phproblèmes de tardive d'y avodans la semainleur mutuelle, cutile d’obtenir ptemps, différenc

des soins de longlits dans les éta

s de la dernière dns ou plus. Dans nie et à Bruxelles informels, qui sonâgées dans leurs

ant au moins unant des soins deée de 50 ans et

de 8% en Suèdèrement supérie

ésultat doit toutedes valeurs so

ncouragement à re relative aux b

es deux indicatees soins à long te

but des soins paoins palliatifs est ase terminale. Cdisponibilité des

oir recours. Dans ne de la demandece qui semble inplus de données ces régionales).

gue durée blissements de s

décennie, avec 70l'ensemble, ce noqu'en Flandre.

nt définis commes activités couranne heure par see longue durée.5

plus et faisant de à 16,2% en Itur à la moyennfois être contextociétales et de rester à la maisonesoins des patieeurs restent ins

erme.

alliatifs parfois différé jus

Ce délai peut êtresoins palliatifs, 20% des cas, le

e du forfait pour ndiquer une décis

sur cet indicateu

Belgian

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'les personnes antes de la vie quoemaine', représen

5 Le pourcentagpartie de ces so

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KCE Report 196

Tableau 2 – Ind

Indicateu

Forc

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épenses totales dee contacts avec leons financières (%e du cancer des femmes âgéeutérus (% des fem

re vaccinale infanHib (3)

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ant l'accessibilité

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ère (2

n Health System

anté

el-ique

Dernièreannée disponible

9 2010

9i 2009 9.0 2010

9.4 2010

4 2008

0.1 2010

1.8 2010

7.9 2009

4.5 2009

5.0ii 2009

0.3 iii 2011

2.1 2007

20.0) iv 2006

Performance

e

b

Évolution

M

stable

stable

stable

augmen-tation

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stable

augmen-tation

augmen-tation

augmen-tation

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M F Socio faible

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27.0 4.

48.6 62

48.9 64

63.5 46

ocio evé

Flandre

0 11.0

2.9 64.9

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98.3

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Wallonie Br

14.0 26

55.3

51

64.6 63

96.9

98

92.4 91

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21

ruxelles

6.0

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01

22

i Les données deii Valeurs nationaiii Valeurs et compiv Données natioDTP-Hib (3) DiphROR (1) Rougeo

2.4 QualitéLa qualité est daux individus eeffets souhaitéconnaissances.dimensions : l'ela centralité du 2.4.1 EfficaL'efficacité est souhaités sont mais à l'exclusindicateurs d'effSept indicateursanté : le tauxcolorectal, le taindicateurs de habitants (ce qpopulation), le tmentale par rahandicaps (telsd'hospitalisationà l'ensemble de

e l'OCDE relatives aales basées sur la Hparaison internation

onales indisponibleshtérie-Tétanos-Coquole-Oreillons-Rubéol

é des soins définie comme 'laet aux populationés sur la sant.'6 La qualité deefficacité, l'adéquapatient. cité

définie comme atteints, pour toutsion de celles qfficacité sont doncrs ont été chois

x de survie aprèsaux d'hospitalisati

santé mentale qui est égalementaux d'emploi de apport au taux ds que musculo-sns psychiatriqueses hospitalisations

aux effectifs des infiHIS, disparités socionale basées sur dess. Valeur basée sur ueluche-Haemophille (première dose).

a capacité des ses d’augmenter laté, conformémenes soins est suation, la sécurité,

'la mesure selotes les personnesqui n'en tireraienc des indicateurs dis pour évaluer s cancer du seinon pour asthme, : le nombre de

nt un indicateur personnes souffr

d'emploi de perssquelettiques), ais non volontaires s psychiatriques.

Belgian

irmières ne sont paso-économiques basés données de 2010.une seule étude delus Influenzae B (tau

ervices de santé da probabilité d’obnt à l'état actu

ubdivisée en cinla continuité des

on laquelle les rs qui pourraient ennt aucun avantagde résultats. l'efficacité des sn, du col de l'utainsi que trois no

e suicides par de l'état de sant

rant d'un trouble donnes souffrant insi que le pour(colocations) par

n Health System

s comparables entreées sur l'EPS. s Mutualités Chrétieux de couverture po

destinés tenir les uel des q sous-soins et

résultats n profiter ge'. Les

soins de térus ou ouveaux 100.000 té de la de santé d'autres

rcentage r rapport

LaeLpePtaepl’inspplaqpimcré

Performance

e pays.

ennes. our la troisième dos

La survie après unaux autres pays encore disponible Les taux hospitaliprestations ambulaen terme d’efficaciPour les indicateuaux de suicide européens. Toutepersonnels et socefficacité des sondiquent qu'une suicide en Belgipersonnes souffrapersonnes atteintea nécessité de réqu’au cours des psychiatriques nomportant constatéces disparités poégional).

e) ;

n cancer du sein européens. L’évà ce jour. isations pour cauatoires – sont légité) que la moyen

urs d'efficacité en extrêmement é

fois, le taux de ciétaux, et n’est doins de santé me

action concertéeque. Le deuxièm

ant de troubles mes d'autres handicécolter d’autres d

dernières annéon volontaires (cé à Bruxelles doitourraient être lié

et du colon est bvolution des taux

use d'asthme – rgèrement plus élene EU-15. soins de santé m

élevé par rapposuicide dépend é

donc qu’un qu'unentale. Quoi qu'il e est requise pome indicateur, l

mentaux comparé caps, est difficile données. Le dernées, le pourcentcolocations) a at s’interpréter aveées à un phéno

KCE Report

bonne, en comparx de survie n’est

eflétant un échecevés (donc moins

mentale, on observort aux autres également de fac

n indicateur indireen soit, les rés

ur réduire le taue taux d’emploiaux taux d’empl

à interpréter et mnier indicateur mtage d'hospitalisaugmenté. Le % ec prudence (en omène urbain et

t 196

raison t pas

c des bons

ve un pays

cteurs ect de sultats ux de des loi de

montre montre ations

plus effet,

t non

KCE Report 196

Tableau 3 – Ind

Indicateur

Soin

s cu

ratif

s

Taux de su- Cancer du

- Cancer du

- Cancer du

Hospitalisa(/100 000 s

Sant

é m

enta

le

Taux de su(nombre/10

Taux d'esouffrant d

Hospitalisa(colocationhospitalisat

i Résultats pour leii Dernières donnéiii Le résultat tiré div Dernières donnv Rapport entre levi Résultats tirés d

6

dicateurs évalua

r

urvie relative à 5 au sein

u col de l'utérus

u côlon

ations pour asthmesujets 15+)

uicide 00 000 personnes

mploi des pate troubles mentau

ations forns) (en % de toutetions psychiatriqu

e cancer colorectal ées disponibles poudes Données de Sa

nées disponibles poe taux d'emploi des de la dernière éditio

ant l'efficacité de

Global Bq

ans 8

6

MF

e 4

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tients uxv

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rcées es les ues)

8

dans les Données ur la Belgique dans anté de l'OCDE, aveur la Belgique danspersonnes souffran

on de l'Enquête sur

Belgian

s soins

Belgi-que

Dernièannéedispoble

88.0 2008 i

69.8 2008 i

M: 62.3 iF: 64.6

2008 i

48.4iii 2009 i

18.6 2008iv

0.7 2002vi

8 2009

de Santé de l'OCDEles Données de Sa

ec ajustement en fos les Données de Sant de troubles mentales Forces de Trava

n Health System

ère e ni-

Évolution

i

i i

i stable

v stable

Augmen-tation

E pour la Belgique ;anté de l'OCDE: 200nction de l'âge. Le tanté de l'OCDE : 20aux et celui de persail de l'Union Europ

Performance

n M F

62.3 64.6

28 52

28 10

; 04 (cette année a setaux belge non ajus005 (cette année a ssonnes atteintes d'apéenne.

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Socioélevé

ervi de base à la costé est de 40/100 00servi de base à la cutres handicaps.

o Flandre W

87.6 8

70.6 6

M: 62.5 F: 64.5

MF

17 2

8 7

omparaison internati00 ; omparaison interna

Wallonie Brux

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24 14

7 14

ionale) ;

ationale) ;

23

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9.9 .3

24

2.4.2 AdéquL'adéquation pesoins de santé des meilleures La relation entrles résultats et Huit indicateursgénéral, leurs rqui concerne lepopulation cibleles antibiotiquesLa proportion caractérise par Deux indicateud'antipsychotiquque cette consaugmentation.Enfin, un indicaa été utilisé (l’cancéreux), maréférence, com

uation eut être définie cdispensés sont apreuves disponibre l'efficacité et l'ales processus de s ont été choisis résultats sont plute dépistage non e) ou le respect des ou le suivi des pde naissances pune grande varia

urs portent sur ues par l'ensembsommation, déjà

ateur de l’agressivutilisation des ch

ais ses résultats sparaison à d’autre

comme étant 'la mdaptés aux besoiles'. adéquation est le soins. pour mesurer l'a

tôt mauvais, plusapproprié du ca

es guides de bonpatients diabétiqupar césarienne eabilité entre hôpita

la consommatioble de la populatsupérieure à la

vité des soins auxhimiothérapies ensont difficiles à ines pays, ou évolut

Belgian

mesure selon laquns cliniques, com

reflet de la relatio

adéquation des so particulièrement ncer du sein (hone pratique cliniqes).

est en progressioaux. on d'antidépresstion. Tous deux moyenne EU-15

x personnes en fin fin de vie des nterpréter sans notion au cours du t

n Health System

uelle les pte tenu

on entre

oins. En pour ce

ors de la ue (pour

on et se

seurs et révèlent , est en

n de vie patients

orme de temps.

Performance KCE Reportt 196

KCE Report 196

Tableau 4 – Ind

Indicateur

Mammographiegroupe cible (%- Femmes âgée

- Femmes âgée

Antibiotiques comparée à l‘aou associéeclavulanique.)

Suivi correct diabétiques (%)

Césariennes (naissances viva

Prescription journalière personnes)

- Antidépr

- Antipsyc

Patients souffrbénéficiant dedurant les 14 dleur vie (%) i Des patients déc*Patients diabétiq

6

dicateurs de l'ad

es en dehors du %) es de 40-49 ans

es de 71-79 ans

(% amoxicilline moxicilline seule

es à l‘acide

des patients )*

(par millier de antes)

de (quantité moyenne/1 000

resseurs

chotiques

rant du cancer chimiothérapie

derniers jours de

cédés à leur domiciques adultes se sou

déquation des so

Global Belgiq

35.5

20.8

44.9

54

193

68.4

10.5

(12%/23%)i

ile/à l'hôpital. Absenumettant régulièrem

Belgian

oins

que Dernière année disponible

2010

2010

2008

2008

2009

2010

2010

/ 2005

nce de données natment à des examens

n Health System

e

Évolution

stable

augmentation

stable

stable

augmentation

augmentation

augmentation

tionales. Valeurs tirés rétiniens et sangui

Performance

M F Sofa

28

16

46.4 51.1 44

54 55 48

43.1

92.8

10.8 10.3

ées d'une seule étuins (%)

ocio aible

Socio élevé

Fl

8.6 36.6 28

6.2 23.2 16

4.4 49.4 46

8 58 57

60

9.

de des Mutualités C

andre Wallonie

8.6 46.4

6.4 27.7

6.0 42.8

7 52

0.6 85.8

6 11.9

Chrétiennes.

e Bruxelles

47.7

31.2

47.1

48

57.1

11.7

25

26

2.4.3 SécurLa sécurité desystème ne porSix indicateursmoyens : l’expoavec un débu

Tableau 5 – Ind

Indicateur

Exposition de lradiations (MSv/capita)

Incidence du Mmillier d'admiss

Incidence dpostopératoire

Incidence despatients hospita

Mortalité intra-fracture de la ha

Prescription anticholinergiquprenant des antI OR Odds Ratio

rité s soins est définrte pas préjudice as évaluent la séosition aux radia

ut de diminution

dicateurs évalua

la population belgd’origine m

MRSA nosocomisions)

de la sept(/100 000 sorties)

s escarres chealisés (%)

-hospitalière aprèanche (%)

d’antidépreues (% des patientidépresseurs)

nie comme « la mau patient ». écurité des soinations médicales

en 2011), régr

ant la sécurité de

Global

ge aux édicale

al (par

ticémie )

ez les

ès une

esseurs nts 65+

Belgian

mesure selon laq

ns. Leurs résultareste trop élevé

ression importan

es soins

Belgique Deranndis

2.2 201

1.5 201

1224 200

16.8 200

6.3 200

14 201

n Health System

quelle le

ats sont ée (mais tes des

inmdpSa

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0 diminut

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07 augme

07 diminut

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Performance

nfections nosocomméticilline) ; diminde la hanche ; et iprescription d’antiSeule l'incidence augmentation.

tion M F

te tion en

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entation

tion 1.84i

13 1

miales au MRSAution de la mortaincidence stable ddépresseurs antides escarres c

F Socio faible

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A (Staphylococcusalité intra-hospitalide la septicémie pcholinergiques auchez les patients

cio vé

Flandre

1.2

17

KCE Report

s aureus résistanère après une frapostopératoire et ux patients plus s hospitalisés es

Wallonie Brux

2.2 1

11 10

t 196

t à la acture de la âgés. st en

xelles

KCE Report 196

2.4.5 ContinLe concept de que la continuicontacts, l'aspecoordination enindicateurs pedimensions, cerapport précédeContrairement asur l'efficacité d’autres pays indicateurs sondossier médiconcologie (COMscientifique, teProvider of Carle mesurer. Un seul résultasupposer d’unehabituel. Des « contact avechospitalisation »observés en réadmissions efaire l'objet dspécifiquement

d L'indice U

proportionhabituel. Lmédecin gl'indice UPtrois quarhabituel.

6

nuité des soins continuité des soté de l'informatio

ect relationnel desntre les soignantsrmet de tirer d

e qui représente ent sur la performaux indicateurs codes soins, on peen matière de ct spécifiques à nocal global ou M). D'autres indicals que l'indice Ure)d, mais rares s

at, l'indice UPC, pee bonne qualité résultats moyen

c le médecin g» et « 'tenue d’utermes d'utilisat

en hôpital psychiad'une collecte dt la santé mentale

UPC (prestataire de n des contacts d'un Lorsque l'indice estgénéraliste. L'indicaPC est égal ou surts des contacts s

oins recouvre diffén entre les soigns contacts patients et les organisatdes conclusions une avancée sig

mance. ommunément utilieut difficilement coordination des otre système de s

la consultatioateurs sont bien

UPC (prestataire ont les pays disp

eut être considérérelationnelle ave

s sont enregistrgénéraliste endéaune COM ». Destion du dossier atrique. Ce derniede données par.

soins habituel – Uspatient qui a lieu avt de '1', le patient aateur exprime le popérieur à 0,75, c'ese sont faits avec

Belgian

érentes dimensionnants, la planificat/généraliste, ainstions. Le set actupour chacune

gnificative par rap

isés sur l'état de scomparer la Besoins. En effet,

soins de santé, teln multidisciplinadécrits dans la litde soins habituosant des donné

é comme positif, ec son médecinés dans les indans les 7 jourss résultats négat

médical globaler indicateur est lr l'OCDE ; il c

sual Provider of Cavec son médecin géa toujours consulté ourcentage de patieest-à-dire dont au mc leur médecin gé

n Health System

ns, telles ation des si que la uel de 7 de ces

pport au

santé ou lgique à certains ls que le aire en ttérature el-Usual

ées pour

et laisse traitant

dicateurs s après tifs sont et de e seul à

concerne

are) est la énéraliste le même

ents dont moins les énéraliste

Performance 27

28

Table 6 – Indic

Indicateur

Patients dispmédical global

Patients diagcancer et consultation multidisciplinair

Contact avec ldans la semal’hôpital (% des

Proportion demédecin géné(Indice UPC iii)

Réadmission dpsychiatrique, dsortie (%) - diagnostic de

- diagnostic de

Patients ayancontact avec ledurant leur der(%) i: Données belgesii 72% des persontirés d'une seule iii L'indice UPC (Ucontact avec le m3 contacts sur 4 a

cateurs évaluant

osant d'un do(%)

gnostiqués avecbénéficiant

oncolore (COM) (%)

e médecin généraine de la sortis sujets 65+)

e contacts avéraliste habituel

dans le même hdans les 30 jours

schizophrénie

trouble bipolaire

t eu au moinur médecin générrnière semaine d

s les plus récentes.nnes décédées à leétude des Mutualité

Usual Provider of Camême médecin généavec leur médecin g

la continuité et d

Global

ossier

c un d’une

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vec le (%)

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Les données de l'Our domicile ont eu ués Chrétiennes) ; are) est la proportioéraliste. L'indicateurgénéraliste habituel)

Belgian

de la coordinatio

Belgique Dernannédisp

47 2010

68.8 2008

58.4 2009

71.4 2010

20.2

2009

15.6 2009

(72%) ii 2005

OCDE les plus réceun contact avec leur

on des contacts avecr utilisé présente le l).

n Health System

on des soins

nière ée onible

Évolutio

0 augmen

8 augmen

9 stable

0 stable

9i

augmen

9 i stable

5

entes pour la Belgiqur médecin généralis

c le médecin générapourcentage de pa

Performance

on M F

tation 42 50

tation

55.4 60

72.1 71

tation

ue datent de 2007 ;ste durant leur derni

raliste habituel d'un ptients dont l'indice U

Socio faible

Soéle

0 54 44

0.8 64.2 54.

.2 76.7 70.

; ière semaine de vie

patient. L'indice '1' iUPC est au moins d

cio evé

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58

73.8

6 60.6

5 70.8

25.2

19.7

e (données nationale

indique que le patiede 0,75 (ce qui signi

KCE Report

Wallonie Brux

32 29

62.7 55.7

57.8 42.5

74.4 65.9

17.2

10.2

13.4 7.1

es indisponibles, ch

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t 196

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KCE Report 196

2.4.6 CentraLa centralité duprestation de sodu patient ». Lcentralité du paa été entreprisprésentés. Ce données. En odes information

Tableau 7 – Ind

Indicateur

Satisfaction qusoins de san'satisfaits' ou 'tr

Douleur toujol'hospitalisation

Personnes déchabituel (% de i Données nationii Le degré de satsatisfaction n'est iii Résultats tirés div Fondé sur une

6

ralité du patient u patient est défioins respecte les

Le rapport précédatient. Une rechercse, à l'issue defaible nombre d'

outre, les rares inns parcellaires sur

dicateurs évalua

uant aux servicenté (% de parès satisfaits')

urs maîtrisée d (% de patients)

cédant à leur dopersonnes décéd

ales pas encore distisfaction est supérielégèrement inférieu

d'une seule étude, détude des Mutualité

inie comme « la besoins, valeurs e

dent ne contenaiche approfondie d

e laquelle trois i'indicateurs reflètndicateurs mesurar un sujet complex

ant de la centralit

Global

es de atients

durant

omicile ées)

sponibles. Les résuleur à 90% pour les ur (87%) que pour ledans le cadre du proés Chrétiennes et su

Belgian

mesure selon laqet préférences indt aucun indicateude données et indindicateurs peuvete une réelle careables ne fournissxe.

té du patient dan

Belgique Dad

>90% ii 2

(41.0) iii 2

(45.1)i 2

ltats pour la Flandrecontacts avec les mes hôpitaux, rojet RN4cast ; ur d'autres publicati

n Health System

quelle la dividuels ur de la dicateurs ent être ence en sent que

LdUqpdLnsé

ns le système de

Dernière année disponible

Évo

2008

2009

2007 augm

e et Bruxelles sont gmédecins généralist

ions.

Performance

Les résultats attesdifférents servicesUne seule étude question centrale performances de d'autres pays. L'indicateur relatifnombre de paties'assortit toutefois économique.

santé

olution M

Aucudiffér

mentation

groupés ; tes, les dentistes, le

stent d'une satisfas de soins de sant

a été en mesuqu'est la maîtrisela Belgique so

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F Socio faible

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ne rence

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iv

es spécialistes et les

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45.1i

s services de soins

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es informations sétude dans laquelfaibles par rapp

évolution positivst en diminution)onction du statut s

Wallonie Brux

Plus faible

La faible

45.1

à domicile. Le degr

29

nt aux

sur la le les

port à

ve (le ), qui socio-

xelles

plus e

i

ré de

30

2.5 EfficienL'efficience est correcte de rl’ « input ») est que ces ressobénéfice ou lesTrois indicateursanté. À l'instarune utilisation confirmée par prescription deinterventions chséjour en hôpit

Tableau 8 – Ind

Indicateur

Proportion de c

Durée d'hospitun accoucheme

Prescription dmarché » (% dtotal, en ambula

Autres indicatesection « Adéqu

DDD = dose quo

nce du systèmedéfinie comme é

ressources (budginvestie dans le urces sont utilisé meilleurs résultatrs ont été retenur des autres pays plus efficiente del'évolution des tr

e médicaments «hirurgicales de jotal après un acc

dicateurs de l'eff

chirurgie de jour (%

talisation moyennent normal (en jou

de médicamentsde DDD par rapatoire)

eurs analysés uation des soins »

tidienne déterminée

e de santé étant 'la mesure sgets, temps et système (au niveées de manière ts possibles (l’«ous pour évaluer l'eeuropéens, la ten

es services de sorois indicateurs :« bon marché »,

our, ainsi que la rcouchement norm

ficience des soin

Globa

%) ne après urs)

s « bon pport au

dans la »

e (Defined Daily Dos

Belgian

selon laquelle la personnel, nota

eau macro), en s’aà en tirer le plu

utput»).'4, 7 efficience du systndance en Belgiqoins. Cette tendaune augmentatioune augmentat

réduction de la dmal (qui est un in

ns

al Belgique Dad

46.2 2

4.3 2

46.0 2

se)

n Health System

quantité amment, assurant

us grand

tème de que est à ance est on de la tion des durée du ndicateur

pdDinnnrélapvsl'c

Dernière année disponible

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2008 aug

2008 dim

2010 aug

Performance

plus comparable dernière reste touD'autres indicateundications quant nombre de patiennature à réduire évèlent toutefois a moitié des déprogramme nationvariabilité inexpliqsigne de manquefficience. C'est l

césariennes.

olution M

mentation

inution

mentation

entre pays que lutefois supérieure urs analysés dans

à l'efficience dnts disposant d'ule nombre d'examdes tendances mpistages du cannal suscite des qquée des prestatiue d'adéquation, le cas par exemp

F Socio faible

Soél

la durée d'hospità la moyenne EU

s ce rapport fourndu système. Ainn dossier médicamens redondants

moins positives. Lencer du sein s'efquestions quant ions de soins pe

une dimensionple pour la grande

ocio evé

Flandre

46.2

KCE Report

alisation totale). U-15. nissent égalemensi, l'augmentatioal global peut êtrs. D'autres indicae fait par exempleffectue en dehorà son efficience.

eut également êtrn directement liée variabilité du tau

Wallonie Brux

45.9 45.3

t 196

Cette

nt des on du re de ateurs e que rs du Une re un ée à ux de

xelles

KCE Report 196

2.6 PérennLa pérennité (système à: • Offrir et m

exemple pl'équipeme

• Être innova• Répondre a• Rester finaDes indicateuréléments de ladépenses totalfinancière.

Tableau 9 – Ind

Indicateur

% de diplôgénéralistes Âge moyen desInfirmières diplô% des médecinmédical électroNombre de jouraigus (par habitProportion desproduit intérieuri Pour cette sérieii Cet indicateur diii Cet indicateur dPIB : produit intér

6

nité (ou durabilité) e

maintenir des inpar la formation ent ; ant ; aux besoins émer

ancé durablement rs spécifiques ona définition. Le des de santé) est

dicateurs de la p

més en méde

s médecins générômées (par 1 000ns généralistes utnique rnées d'hospitalistant)iii s dépenses de r brut (% du PIB)

e d'indicateurs, les ddoit être interprété cdoit être interprété crieur brut

st définie comm

frastructures comet l'enseignemen

rgents ; par des recettes

nt été choisis pdernier indicateurt un indicateur gé

pérennité du syst

ecine devenant

ralistes habitants)ii tilisant un dossier

ation en hôpitaux

santé dans le

données ne sont pasconjointement avec conjointement avec

Belgian

me étant la capa

mme du personnnt), des structure

collectives. pour chacun desr (% du PNB alloénérique de la p

tème de santé

Global Be

t 30.

51.41.

r 74.

x 1.2

e 10.

s disponibles par rél'indicateur de la de

c l'indicateur relatif a

n Health System

acité du

nel (par es et de

s quatre oué aux

pérennité

LladhminreEre2

lgique Deandis

1 20

4 207 200 20

2 20

5 20

égion, mais par langensité en infirmièresau pourcentage de c

Performance

Les résultats sont a cohorte de médde la retraite) et phôpitaux aigus pmédical électronndicateurs ne peelatives aux beso

En termes de poueprésentaient 10.

27,6 milliards en 2

ernière nnée sponible

Évolu

09 diminu

09 augme10 stable10 augme

09 stable

10 augme

gue (francophones os diplômées (dans lechirurgies de jour (d

parfois négatifs (decins généralisteparfois moyens (nar habitant ; utiliique par les

euvent pas être oins (infirmières dircentage du PIB, .5% en 2010. En

2003 et € 37.3 mill

ution Néerlai

ution 29.2

entation 51 e entation 83.7

e

entation

ou néerlandophonese chapitre consacrédans le chapitre con

(faible capacité dues qui vieillit et qunombre de journéisation encore inmédecins générinterprétés sans plômées). les dépenses totatermes absolus,

liards en 2010.

ndophones Fra

31

52 62

s) ; é à l'accessibilité) ;nsacré à l'efficience)

u système à rempui arrive bientôt à ées d'hospitalisationsuffisante du doralistes). Les adisposer de don

ales en soins de ce montant était

ancophonesi

.0

.5

).

31

placer l’âge

on en ossier autres nnées

santé t de €

32

2.7 PromotPour différentesdu présent rappromotion de la1. La promoti

conférer d'améliorerstratégiqueresponsabsoins de snombre dspécifique

2. La plupart promotion un travail adaptés au

3. Les donnée4. Les indicat

comportemvision rédudistaux, qud'autres favaleurs et politiques d

e Les cinq a - élaborer

santé d'int - créer des - développ - renforce - réoriente Les valeu

suivantes:multisecto

tion de la santés raisons, il n'a pa

pport un aperçu ca santé : on de la santé, daux patients dav

r leur santé', ees (définis dansilités situées ess

santé, et même a'indicateurs strucseraient nécessades indicateurs

de la santé ne sode développeme

u contexte belge/res disponibles soteurs convention

ments de santé, uctrice de la promui sont influencés acteurs. De nomb

d’un certain bede santé.

axes de la Charte d'r de politques publtégrer la santé danss environnements pper les aptitudes indr l'action communauer les services de sars et dimensions p: participation, auto

orialité.

é as été possible decomplet de la pe

définie comme 'le vantage de maîtest un concept s la Charte d'Osentiellement en au-delà du systèmcturés au sein ires. qui seraient néc

ont pas opérationent complémentairégional. nt rares. nnels de résultatsaisés à mesurer

motion de la santétant par la promo

breux autres indicnchmarking, son

'Ottawa sont les suiiques saines (il aps toutes les politiquepropices (cadres dedividuelles utaire anté rincipales de la pro

onomisation, équité,

Belgian

e présenter dans erformance en ter

processus qui cotrise sur leur sa

très large. SeOttawa) portent s

dehors du système de santée. U

d'un cadre con

cessaires pour évnnels. Certains reire, d'autres doiv

s liés à la santér mais représenté. Ce sont des rotion de la santé cateurs, assortis t requis pour pil

ivants: ppartient aux autorites) vie)

omotion de la santé, pérennité, multistr

n Health System

le cadre rmes de

onsiste à anté afin es axes sur des

ème des Un grand nceptuel

valuer la equièrent vent être

ou aux tent une résultats que par de leurs loter les

tés de la

é sont les ratégie et

EpfrPvrépeRinptandecstoaré«pLanpminpB

Performance

En conséquence, présentée dans leragmentaire, comPour la plupart devie, les chiffres naégionales et socia

propices à la santet au sein des catéRares sont les nternationale. Onprésente, en progabagisme reste néanmoins en régdisparités socialesest largement inféconsommation hesemble être en aoutefois être interau biais de désiraégionale pour l

« consommation pplus de « binge drLe taux de diagaugmentation depnette augmentatioprésentons pas demesure où les rénclure une propopertinent pour l'éBelgique.

la performance e présent rapport

mme illustré dans ls indicateurs clasationaux ont des ales sont observéé en Flandre (à l'égories socio-éco

indicateurs à n soulignera la pgression et caracttrop élevé (20%ression. Il se cara

s et régionales. Laérieure aux besoiebdomadaire d'alaugmentation. Le rprété avec prudeabilité sociale. Onl’indicateur, à l'problématique » (inking » chez les j

gnostic de l’infecpuis quelques anon parmi la populae comparaison inésultats obtenus ortion importantevaluation des po

en termes de pau moyen de 15

e Tableau 10. ssiques de statut d

valeurs intermédées, sous la formeexception de la c

onomiques plus élavoir fait l'objetroblématique de térisée par d'impo

% de fumeurs auactérise égalemena consommation dns quotidiens, mcool n'est pas tdegré de conso

ence, car il est pan observe peu deexception d'un tendance à l'assujeunes en Flandrection HIV en Bnées. Ce pource

ation homosexuelternationale pour pour la populatio

e de cas 'importéolitiques de prom

KCE Report

promotion de la 5 indicateurs n'es

de santé et de stydiaires Des dispe de modes de vieconsommation d'aevées. t d'une comparl'obésité, qui es

ortantes disparitéu quotidien) maint par de substantde fruits et de légais elle s'améliorrès élevée, mais

ommation d'alcoorticulièrement sene disparité sociataux plus élevé

uétude) à Bruxellee. elgique est en

entage est de plule masculine. Nocet indicateur, da

on non belge peés', ce qui n’est

motion de la sant

t 196

santé st que

yle de arités e plus alcool)

raison t très

és. Le s est tielles umes re. La s elle ol doit nsible ale ou é de es, et

lente us en us ne ans la uvent t pas té en

KCE Report 196

On observe audisparités sociaélevé parmi la pLa Belgique seScale (échelle les politiques consommation Les autres indpolitiques localede vie. Ils ne soCes données stendances obseamélioration détablissements bonne), et l'offdes politiques dœuvre dans de

6

ssi que le manquales et régionalespopulation âgée. e positionne dandes Politiques de

publiques de de tabac.

dicateurs sont dees de promotion dont disponibles qusont difficiles à inervées au gré d'éde la culture d

scolaires (la cfre d'activités phyde promotion de nombreuses com

ue de support socs. Ce niveau est

ns la moyenne de Lutte contre le T

différents pays

es indices visant de la santé menéeue pour la Flandrnterpréter sans aétudes successivede promotion dculture de particysiques est en ala santé ne sont

mmunes.

Belgian

cial montre d'impen outre nettem

dans la Tobacco Tabagisme), qui cs visant à réd

à mesurer l'impes dans différentsre (via les études analyse approfones semblent indiqde la santé dacipation est relatugmentation. Parpas idéalement m

n Health System

portantes ent plus

Control compare duire la

pact des s milieux VIGeZ). die. Les

quer une ans les tivement r contre, mises en

Performance 33

34

Tableau 10 – In

Indicateur

Adultes en surp

Adultes obèses

Dents cariées, l’âge de 12-14 a

Taux de diagpopulation belg

Fumeurs quotid

Consommation- Problématique

- Surconsomma

- Consommatio

Consommation200 g. de légum

Au moins 30 mpar jour (%)

Support social i

Échelle d’évalumesures anti-tScale)

Volume d'activit

ndicateurs de la

poids ou obèses (

s (%)

manquantes, obtans (moyenne)

nostic du VIH de (/100 000 hab)

diens (% 15+)

d'alcool (% 15+) ei

ationii

on ponctuelle imm

quotidienne minimes et 2 fruits (%)

inutes d'activité p

insuffisant (%)

uation de l’efficactabac (Tobacco

té physique à l'éc

promotion de la

Global

%)

turées à

dans la

odéréeiii

male de )

physique

cité des Control

cole

Belgian

santé

l Belgi- que

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46.9 200

13.8 200

1.3 iv 201

3.9 201

20.5 200

10.2

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7.9 200

8.1 200

26.0 200

38.1 200

15.5 200

50/100 201

200

n Health System

rnie née

spoble

Évolution

08 augmenta-tion

08 augmenta-tion

10

10 augmenta-tion

08 diminution

08 augmenta-tion

08 stable

08

08 augmenta-tion

08 stable

08

10

09 augmenta-

Performance

M F

53.7 40.4

13.1 14.4

6.9 0.7

23.6 17.7

13.1

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10.1 5.9

12.8 3.7

23.4 28.5

48.7 28.3

15.1 16

Socio faible

Socioélevé

57.8 40

19.1 9.1

22.1 13.1

11.5

11

5.9 8.4

8.3 7.6

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o

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47.1

13.6

3.8

18.6

9.5

7.9

8.9

30.0

45.1

12.4

5.5/10

KCE Report

Wallonie Brux

48.9 39.8

14.6 11.9

2.40 8.9

24 22.3

10.7

14.4

8.4 6.7

7 6.2

19.2 25.3

28.4 24.7

20.0 22.9

t 196

xelles

8

9

3

4

3

7

9

KCE Report 196

Politiques de dans les comm

% des établissd'une 'équipe sai: Calculé sur la b ii Femmes 15+ ; iii Consommation iv Certaines donnv Pour la Wallonievi Indicateurs tirés

6

promotion de launesVII

sements scolaireantéVII

base de la populatioHommes 22+ ; ponctuelle de nomb

nées sont disponiblee et Bruxelles ; s de VIGeZ, respec

a santé

es dotés

on des personnes co

breuses boissons aes, mais pour un nom

ctivement pour la pré

Belgian

200

200

onsommant de l'alco

alcoolisées (≥6 boismbre trop restreint d

évention du tabagis

n Health System

tion

09

09 augmenta-tion

ool (non abstinents)

ssons) au moins unede pays ;

sme, l'alimentation é

Performance

) et du cut-off CAGE

e fois par semaine ;

équilibrée et l'activité

E, 2+ ;

;

é physique (scores

37/36/50vi

42/64/54 vi

importés de VIGeZ)

40%v 40%

Z) ;

35

% v

36

2.8 Équité L'équité est unsystème de sajugement normd'approches etlittérature. Ellesintitulée « L'équsanté » (disponEn tenant compl'équité de dedocumenté les et de recours asocio-économiqEnsuite, nous donner un éclasanté (les résulL'équité en md'inégalités sysgroupes sociausociale ». En exclusivement (par exemple tableaux synopfiche détaillée drestreint la situniveau d'étuderemboursemenbases de donsociale, telles qn'ont pas été ét

et égalité n paramètre clé danté.1 C’est aussatif et et à une prt de définitions s sont présentéeuité dans l'évalua

nible sur notre sitepte de ce contexeux manières cinégalités en term

aux soins de sanque (les résultatavons proposé d

airage contextuel tats sont contenu

matière de santé tématiques dans

ux qui occupent dconséquence,

sur les inégalités en fonction du sptiques de chaqude chaque indicateuation socio-écones (pour les indt majoré (bénéficnées administrat

que le statut profetudiées dans ce ra

dans l'évaluation si une question rise de position pode l'équité ont

es dans l'Annexeation de la perfore Internet). xte, nous avons acomplémentaires.mes de santé, de té en Belgique ets sont contenusdes indicateurs gaux questions d'

us dans le Tableauest parfois déf

la santé/les déterdes positions diffé

le présent csocio-économiqu

sexe ou de la rue dimension, et eur (voir Annexe Snomique à une sdicateurs provenciaires de l’intervetives. D'autres dssionnel, les reveapport.

Belgian

de la performancontroversée, lié

olitique. Un large été formulées

e S2 au présent rmance des systè

approché la dimen D'abord, nousdéterminants de n fonction de la ss dans le Tableglobaux d’équité équité dans les su 12 et la Figure 2finie comme « l'arminants de la sanérentes dans la hichapitre se coues. Les autres inrégion) figurent d

sont évoquées S1). Nous avons seule caractéristi

nant de la HIS)ention majorée)

dimensions de l'enus ou l'origine e

n Health System

nce d'un ée à un éventail dans la rapport,

èmes de

nsion de s avons la santé situation

eau 11). afin de

soins de 2). absence nté entre iérarchie oncentre négalités dans les dans la en outre ique : le ) ou le pour les inégalité

ethnique,

2Dinécospdinnm

Performance

2.8.1 InégalitéD’importantes ndicateurs de saétat de santé perçchaîne des détermobservées dans dsanté » (tabagismphysique et suppodimension « accendicateurs des an’étaient pas dismesurées.

és socio-économinégalités socionté globaux (esp

çu). Ces résultats minants de la sade nombreux indime, surpoids, aort social). Des inéessibilité ». Malhautres dimensionsponibles, de so

miques -économiques s

pérance de vie etrévèlent l'existen

anté. Des inégaliticateurs du chapalimentation peuégalités ont aussi heureusement, pns, les donnéeorte que les iné

KCE Report

s’observent danst espérance de s

nce d'inégalités datés ont égalemenitre « Promotion u équilibrée, acété observées da

pour la plupart es socio-économégalités n'ont pu

t 196

s les santé, ans la nt été de la ctivité ans la

des iques être

KCE Report 196

Tableau 11 – S

État de santé gEspérance de v

Espérance de v

Espérance en s

Espérance en s

% de la popula'très bonne'iii

Accessibilité dReport du conraisons financiè

Dépistage du ca

Dépistage du c64 ans) v

Adéquation % des patientsappropriés (exréguliers) v

Promotion de % de la populat

% de la populinsuffisant iii

% de la populat

6

Synthèse des iné

général vie à 25 ans, hom

vie à 25 ans, femm

santé à 25 ans, ho

santé à 25 ans, fe

ation 15+ qui qual

des soins ntact avec les seères (% des ména

ancer du sein (%

cancer du col de l

s diabétiques adamens de la ré

la santé tion 15+ qui décla

lation 15+ qui fa

tion adulte consid

égalités socio-éc

mes, 2001 i; ii

mes, 2001 i; ii

ommes, 2001 i; ii

emmes, 2001 i; ii

lifie sa santé de '

ervices de santé ages) iv

des femmes 50-6

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ultes bénéficiant tine et analyses

are fumer tous les

ait état d'un supp

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Belgian

onomiques

Valeglob

51.38

57.09

40.47

40.42

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de soins de sang

54.0%

jours iii 20.5%

port social 15.5%

èse (IMC ≥ 13.8%

n Health System

ur bale (f)

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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%

Performance

dans roupe

le as (f)

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55.03

59.9

46.33

47.1

85.7%

4.0%

62.9%

64.2%

58.0%

13.1%

10.1%

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dans oupe plus

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ce

bas vs le vé)

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n.a.

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37

re de hèse u PAF)

%

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38

30) iii

% de la populaou obèse (IMC

% de la populaet 200 gramme

% de la populatpendant au moi en années ; ii 5 nles taux ne sont p(Fraction attribuaSource : Health IIndicateurs conte

Nous avons retde la progressindicateur de laratios calculés financement réles taxes indirecitoyens acquconsommation proportion plus des taxes indireà mesure que lel'interprétation prévisionnels etEnsuite, commedes revenus aude Gini depuistraduit un surccroissante en Bque dans les au

ation adulte consi≥ 25) iii

ation affirmant cons de légumes par

tion affirmant pratins 30 minutes paniveaux d'études ; iipas ajustés en fonc

able à la Population)Interview Survey et extuels de l'équité

tenu deux indicatsivité du financea répartition du redans le Tableau gressif (taxes in

ectes sont régresittent le mêmeet services, deélevée de leurs

ectes (le montant e revenu augmende la des donnét pas de comptes e l'état de santé pu sein d'un pays, 1988 en Belgiqucroît d'inégalité

Belgique, ainsi qu'utres régions.

idérée comme en

nsommer au moir jour iii

tiquer une activitéar jour iii ii 4 niveaux d'étudestion de l'âge ; mesu) pour tous les autreEPS (calculs du KC

teurs contextuels ement public desevenu national. P12 indiquent que

ndirectes) a augmssives parce que taux d'imposit

e sorte que les revenus. En consdes taxes divisé

nte. Il convient touées 2010-2011, définitifs.

peut être influencénous présentons

ue. L’augmentatiodes revenus, on'un degré d'inégal

Belgian

n surpoids 46.9%

ns 2 fruits 26.0%

é physique 38.1%

s ; iv 5 catégories deures de synthèse = Ies indicateurs. CE et de l’ISP (instit

de l'équité: un ins soins de santéPremière observae la part des sou

menté. En règle gtoutes les catég

tion sur les binantis conserve

séquence, le taux par les revenus) tefois d'être prudecar il s’agit de

é par le niveau d's l'évolution du coon du coefficient n observe une lité plus élevé à B

n Health System

% 57.8%

% 21.7%

% 24.0%

e revenus ; v 2 catégICI (Indice de Conc

tut de santé publiqu

ndicateur é et un

ation, les urces de générale, ories de ens de ent une x moyen diminue

ent dans budgets

inégalité oefficient

de Gini inégalité

Bruxelles

Performance

40.0%

29.4%

42.8%

gories de rembourscentration des Inéga

ue)

17.8%

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ement ; alités) portant sur l'e

1.45

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espérance de vie et

KCE Report

-14.7%

13.1%

12.3%

de bonne santé, FA

t 196

%

%

%

AP

KCE Report 196

Tableau 12 – In

Indicateurs de

Ratio rentréetotales

Ratio rentrtotales

Ratio rentrées

Total

Source : Vade m

6

ndicateur de l'éq

e progressivité

es proportionn

rées progress

régressives/ren

ecum de la sécurité

quité: progressiv

nelles/rentrées

sives/rentrées

ntrées totales

é sociale, INAMI, ca

Belgian

vité du financeme

2005 (comptes définitifs)

20(cdé

71.1% 71

18.9% 19

10.0% 10

100.0% 10

alculs du KCE

n Health System

ent public du sys

006 comptes éfinitifs)

200(codéf

1.0% 72.0

9.0% 18.0

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stème de soins d

07 mptes

finitifs)

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mptes

isoires)

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ovisoires)

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0.0% 100

10 udget)

2011 (budg

.8% 61.4%

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.8% 20.2%

0.0% 100.0%

39

get)

%

%

%

%

40

Figure 2 – Inditransferts, en B

Source : DGSIE Note : le coefficiepopulation. Lorsqrevenus), le coeffpossède tous lesfaible, plus la distégale.

cateur de l'équitBelgique et dans

(Belgique) ent de Gini exprime que l'égalité est parffficient est '0'. Lorsqs revenus), le coeffictribution des revenu

té: coefficient des les régions

l'inégalité entre les faite (toutes les persue l'inégalité est totcient est '1'. Plus le us au sein de la pop

Belgian

e Gini après taxat

revenus au sein d'usonnes ont les mêmtale (une seule perscoefficient de Gini e

pulation en question

n Health System

tion et

une mes sonne est n est

2ÉLcmsacbAEusocsLadcvUtrpdtonQaLlecBdc

Performance

2.9 ConclusioÉtat de santé Les quatre indicatcours du temps. moyenne des paysanté (c’est-à-direactivités) et la morclassement. Le taubonne est supérieAccessibilité desEn ce qui concuniverselle par l’asociaux (MAF, observations sont charge du patientservices des soinsL’accessibilité desavec un taux redisparités socialescontre la grippe vaccination chez leUn autre aspect deravail en soins dpopulation. Mêmedisponibles les dooujours d'informanécessaires pour rQualité des soapproche centréeLa qualité a été ses résultats sont cancer, mais préBelgique présented'Europe (avec decolocations en h

ons sur les forc

teurs relatifs à l’éL’espérance de

ys de l’UE-15, tae le nombre d’annrtalité infantile occux de personnes ur à la moyenne d

s soins cerne l’accessibiassurance-maladOmnio, Fonds préoccupantes te

t, et un certain ns de santé pour des mesures de prévelativement bas s et parfois régio

chez les persoes enfants. e l'accessibilité code santé (médece si d’importants onnées relatives ations sur le norépondre aux besins : efficacitée sur le patient ubdivisée en 5 somitigés. Ils sont toccupants dans e en effet le see très fortes dispahôpital psychiatri

ces et faiblesse

état de santé évoe vie est légèrendis que l’espéranées restant à vivcupent des positiopercevant leur sades pays de l'UE-

lité financière, mie et l’existence

Spécial de elles qu’un niveauniveau de report des raisons financièvention montre de

de dépistage donales), un taux onnes âgées, m

oncerne l’adéquatcins, infirmières)

efforts ont été aux forces de tra

ombre de professoins. é, adéquation,

ous-dimensions. Crès bons quant ale domaine de

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KCE Report

es

oluent positivemeement inférieure ance de vie en bvre sans limitationons moyennes da

anté comme (au m15.

malgré la couvede filets de sé

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mais un bon tau

tion entre les forcet les besoins entrepris pour reavail, nous manqsionnels de la

sécurité, contin

Concernant l’efficu taux de survie ala santé mentalesuicide le plus ainsi qu’un nombntation. Pour dé

t 196

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KCE Report 196

l’efficacité des d’indicateurs etL’adéquation deaugmentation dcibles, un suivdiabétiques) etgrande variabiliLa sécurité detendance à lamédicaux, les une fracture depost-opératoirepersonnes âgéd'escarres est eLa continuité etavec une bonnmoyen et en ade cancer, maiun taux élevé dL’approche cepartiellement. Lélevé, et on odomicile. Mais i

Efficience du s

L’efficience du avec une augmarché », de l’du séjour pourdoit être tempéque montrent cdu groupe cible

6

soins dans le dt de données sontes soins est assedu dépistage du vi modéré des rt une augmentatté entre les hôpita

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système de santé

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domaine de la st nécessaires. ez décevante, av

cancer du sein recommandationstion des taux deaux. e des résultats ernant l‘expositionomiales et la moilleurs, l’incidencen d’antidépresseues niveaux stables

des soins présenttionnelle avec le consultation multide couverture du ans les hôpitaux ppatient n’a pu faction envers le

ne tendance à laavantage de donné

é

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anté mentale da

ec des taux élevéen dehors des

s (antibiotiques, e césarienne, av

encourageants, avn aux rayons iortalité hospitalière de la septicémieurs anticholinergiqs. Cependant, l’in

tent des résultats même praticien, disciplinaire pourdossier médical gsychiatriques. être évaluée q

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n Health System

avantage

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vec une

vec une onisants re après e ques aux ncidence

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Performance

Pérennité du sysLa pérennité du syconcernant le remédecins généralpersonnel infirmied’infirmiers.

Équité (analysessocioéconomiqueLa dimension complémentaires. décrivant l’état desanté en fonction été observées danDes inégalités ontet le suivi des pata plupart des indien fonction du staconcernant les inncomplètes. L’équité a égalemen évidence ce prdu financement deune évolution vecorrespond au nivet qui est lié à elativement peu é

qui indique une ré

tème de santé ystème de santé

enouvellement inslistes. Il faudrait

er associées à de

s de tous les e et 2 indicateursde l’équité a

Tout d’abord, e santé, les mod

du statut socioéns les indicateurst aussi été observients atteints de mcateurs basés suatut social dans négalités en qua

ent été abordée problème au niveaues soins de santéers moins d’équveau d’inégalité dun état de santélevé en Belgiquepartition plus inég

présente certainssuffisant de laaussi des données données sur

indicateurs en s contextuels)

été abordée les inégalités o

des de vie et l’utéconomique. De gs relatifs à la sanvées concernant lmaladies chroniquur les hôpitaux n’o

le cadre de ce plité des soins so

par le biais de deu macro. Le premé. Il est en dimin

uité. Le second dans la répartitionté général moinse, mais il augmengale des revenus d

s résultats interpe cohorte actuelles sur les besoinl’évolution du no

fonction du s

de deux mannt été analyséetilisation des soingrandes inégalité

nté et au mode dee dépistage du caues. Toutefois, coont pas pu être étprojet, les concluont encore large

eux indicateurs memier est la progres

ution, ce qui conest l’index Gin

n globale des revs bon. Cet indicente au fil du tempdans notre pays.

41

ellants e de ns en ombre

statut

nières es en ns de és ont e vie. ancer omme tudiés usions ement

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42

Promotion de Enfin, la promod’indicateurs claindicateurs relaaptitudes indivd’indicateurs aclassiques de lpu être fourni. La plupart des taux national d’importantes dmettons en évidun niveau éledisparités. La disparités sociaest largement imanque de supet régionales âgées. La Belgique sinternational dcomplexes vispromotion de lentreprises) mainterpréter sans

De plus amplePour chacun depeut être consuSupplement S1informations tecalcul, présentinternationales interprétations,

la santé otion de la santéassiques sur la saatifs aux politiquviduelles. En raadéquats et dea santé et du mo

indicateurs de laintermédiaire pa

disparités régionadence le problèm

evé et une tendconsommation d

ales et régionalesinférieure aux bepport social préseet est particulièr

se classe à un du Tobacco Consent à mesurer a santé dans divais ne sont disps une analyse en

es informations ses indicateurs décultée sur le site In1. Cette fiche motechniques sur leste les résultats

et analyses ainsi que les réfé

a été principaleanté et le mode d

ues de santé, auaison de la d données en

ode de vie, seul u

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ente aussi d’imporrement préoccup

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l’importance devers environnemeonibles qu’en Flaprofondeur.

sont disponibles crits ci-dessus, unnternet du KCE, dtive le choix de l'is sources de do

chiffrés, y compar sous-grou

érences bibliograp

Belgian

ment abordée aude vie, complétés ux milieux sains

disponibilité très dehors des indun aperçu fragme

ode de vie présen15 pays de l’UEont été observéedu surpoids qui psse, avec d’impe, mais avec d

on de fruits et de l mais est en hau

rtantes disparités ant chez les pe

aire dans le clasoutre, certains

s politiques locents (écoles, comandre et sont dif

sur notre site Inne fiche de documdans le documenindicateur et cont

onnées et les mompris les compaupes, les limitephiques.

n Health System

u moyen par des et aux limitée

dicateurs entaire a

ntent un E, mais

es. Nous présente portantes e fortes légumes usse. Le sociales

ersonnes

ssement indices

ales de mmunes, fficiles à

nternet! mentation nt intitulé tient des odes de araisons es des

3

3

LpsincéddecCddladcàdQp

Performance

3 LE RAPPERFORAJOUTÉ

3.1 Quelle essystème d

La finalité du syspossible, afin de csanté des persnformations présecas échéant, la également aider lde santé publiqud’objectifs est un en effet, les futcomparaison entreCe rapport esquissde santé à traversde signaux d'avera pérennité et l'décideurs politiqucommandité des aà prendre. Dans décideurs politiqueQuoiqu’il en soit, lpour ambition d’or

PORT 201RMANCE :ÉE ET LIMIst l'utilité d’un rade santé ? stème de santé contribuer au mieonnes vivant eentées dans ce rperformance du

es décideurs poliue aux niveauxmaillon importantures évaluationse résultats observse un tour d’horizs le prisme de 74rtissement quant équité du systèmes étaient déjà c

analyses complémd'autres cas, c

es et requièrent da présentation ex

rienter le choix de

2 SUR LA UTILITÉ, VITATIONSapport sur la pe

belge est d'être eux au maintien een Belgique. Erapport devraientu système de sitiques à formulefédéral et régiot dans l'évaluatios pourront ains

vés et objectifs à aon de la performa

4 indicateurs. Cesà l’'accessibilité, me de santé. Dconscients des p

mentaires visant àces signaux sondès lors une ana

xhaustive et structes priorités d’actio

KCE Report

VALEUR

erformance du

aussi performantt à l'amélioration n conséquence,t servir à optimissanté. Elles devrr des objectifs ch

onaux. La formuon de la performai s’appuyer sur

atteindre. ance du système s indicateurs font la qualité, l’'efficians certains cas

problèmes et ontà identifier les ment nouveaux poualyse plus approfoturée des indicateons et de recherch

t 196

t que de la

, les er, le raient hiffrés lation

ance : une

belge office ence, s, les t déjà sures

ur les ondie. eurs a hes

KCE Report 196

3.2 Quelle précéde

Le rapport préPerformance', éétait que, en Bgrâce notammesecond rappoperformance du

Meilleure dispo

La disponibilité données sont mortalité infantnationales de m

Un éventail d'ipanoramique d

Comme indiquéétoffé pour co(suffisamment) indicateurs ontmentale, des sdans une moindsoins de longueDeux indicateules indicateurs statut socioécosont disponibles

6

est la valeur ajent? écédent, intitulé était avant tout u

Belgique, il est poent à la bonne crt présente la

u système belge d

onibilité des don

des données a édésormais dispo

tile. D'autre partmortalité a été nota

ndicateurs plus du système

é dans les objectiouvrir les domapris en compte

t été ajoutés à soins aux personndre mesure, danse durée, la centrars contextuels deont fait l'objet d'

onomique (lorsqus).

joutée de ce ra

'Un premier Pasune étude pilote. ossible de procédecollaboration entre

première évalude santé. Ses atou

nnées

été améliorée de monibles pour la t, le délai de diablement réduit.

complet, pour u

ifs opérationnels, aines et dimensdans le rapport l'éventail dans lnes âgées, de la

s les soins aux pealité du patient et e l'équité ont été une analyse syst

ue les données p

Belgian

apport comparé

s vers la MesurSa principale coer à une telle évae les administratiuation complète uts sont les suivan

manière significatsurvie au cance

isponibilité des d

ne vision plus

le jeu d'indicateusions qui n'étaieprécédent. De nole domaine de la continuité des sersonnes en fin de

la promotion de lajoutés, tandis q

tématique en fonpermettant cette

n Health System

ée au

re de la nclusion aluation, ons. Ce

de la nts :

ive : des er et la données

urs a été ent pas ouveaux la santé soins et, e vie, les la santé. que tous ction du analyse

SmLSins'Iace'pn

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Performance

Simplification demeilleure lisibilitéLa structure du jeSeuls les indicatendicateurs pour lsont évoqués danIndicateurs en capproche favorisechangements en ten matière de principaux' et 'secne jouait aucun rô

Systématisation L'analyse des donprésentés selon ldans le temps parcomparaison inter

Recours aux info

Une utilisation maque celles qui sones registres et lesHIS), Résumé hopermanente steePharmanet), les denquêtes de vaccdonnées disponibcollecte additionneemps.

Amélioration de lEnfin, des tableauélaborés pour perde leur interprétatdes indicateurs.

la structure de lé de l'analyse eu d'indicateurs aeurs mesurés onlesquels nous n'ans la section 'Doours de dévelop

e la compréhensermes de disponi

données. L'ancondaires' a aussile dans leur interp

de l'analyse des nnées a été systéa même structur

r région, analyse pnationale.

ormations déjà di

aximale a été faitnt contenues danss enquêtes récurrospitalier minimalekproef), bases onnées de survecination, Registreles de manière roel, facilite l'analys

la communicatioux synoptiques armettre une présetion. Ces tableau

l'éventail d'indica

a été simplifiée ànt été gardés daavons pas pu raonnées disponiblppement' (voir susion du jeu d'indbilité des donnéescienne distinctio été supprimée, cprétation.

données matisée et les ind

re : évolution danpar sous-groupes

isponibles

te des données ds les bases de dorentes : l’enquête l (RHM), EPS (é

de données illance des infectie belge du cancoutinière, qui n'indse de l'évolution

on des résultatsagrémentés de coentation claire et x favorisent égale

ateurs, pour une

à de multiples égaans le jeu actuelssembler de dones prochainemenupplément S1).

dicateurs, souligns ainsi que les lacon entre indicacar il s'est avéré q

dicateurs sont touns le temps, évo

socio-économiqu

déjà disponibles, onnées administra

de santé par intechantillon permande l'INAMI (doions nosocomiale

cer. Le recours àduisent aucun code l'indicateur da

odes couleurs onlisible des résultaement la compar

43

e

ards : . Les

nnées nt' ou Cette e les cunes ateurs qu'elle

ujours lution

ues et

telles atives, erview nent -c N, s, les

à des oût de ans le

nt été ats et raison

44

3.3 Quelles3.3.1 La peMalheureusemeau système de existent, la valel'objectif. Dans externes (tels qavec des résulont été comparde positionner pas pour autanCertains résultatout en étant l'interprétation ddébat8, en raisque les variativalidité des com

Plusieurs organd'autres pays dl'OMS dans sonbisannuel 'Panocollaboration enindicateurs ECHConsumer IndeConsumer Pow

3.3.2 PrendCertaines donndatent de 2010administratives internationales,2005! Dans de politiques, de b

s sont les limitarformance, maisent, très peu d’osanté ont été dé

eur de l'indicateules autres cas, l'a

que les objectifs ltats d'autres payrés à la moyenne la Belgique par r

nt à la question « ats peuvent en efmauvais par ra

des comparaisonon des multiples ions méthodolog

mparaisons.

nisations internatio'Europe en matièn Rapport 2000 suorama de la Santéntre l'OCDE et l'UHI supporté par l'Uex13 publié par l'orwerhouse.

dre des décisionées sont manifes. Ce délai est inhéet à des registres nous avons parfonombreux cas, il aser leurs décisio

ations de ce ras en fonction de bjectifs spécifique

éfinis en Belgique.r a été évaluée pappréciation s'estfixés par l'OMS)

ys. Quand c’étaitdes pays EU-15.

rapport à ses voisNos résultats sonffet être meilleurspport aux objects de performancelimitations liées

iques et context

onales comparentre de santé et de ur la Santé dans lé en Europe'10,11 qnion EuropéenneUnion Européennerganisation privée

s sur base de dotement obsolètesérent au recours às. Pour procéder àois dû nous baserserait difficile, pou

ons sur de telles in

Belgian

apport ? quel objectif ? es et mesurables. Lorsque de tels par rapport à la vt fondée sur des ou sur une comppossible, les indCette approche a

sins, mais elle nent-ils bons ou mas que ceux d'autretifs définis. Par e entre pays fait à cette démarch

tuelles, qui nuise

t déjà la Belgique soins de santé. Ce Monde”9, le rapqui est le fruit de l, le site Internet de12, et l'Euro Healsuédoise Health

onnées obsolète et les plus récent

à des données à des comparaisor sur des donnéesur les décideurs nformations. Pour

n Health System

s relatifs objectifs aleur de objectifs paraison dicateurs a permis e répond uvais? » es pays, ailleurs, toujours

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Performance

concerne les indicactuelles devraienperformance, dans

3.3.3 Une visioLes lacunes ont gabsence de donnndicateur ou des i. Statut santé

dans la mortaDans le rappo'années potenutilisée commprématurée pamortalité évitaservices de sa

2. AccessibilitéPour optimiseindispensableambulatoires savoir le pourassurance, à

3. Accessibilitémesurer l'équdes dépensesremboursemeintervention déconomique. disposer de patients.

cateurs dérivés dent être contenues ds la mesure où un

on plus globale, généralement traitnées (actuelles), einformations plus

é général : étudialité prématuréeort précédent, la mntielles de vie perd

me indicateur du star groupe de causable, pourrait ajouanté. é financière : uneer les politiques d'ae d'avoir une visionainsi que des ass

rcentage de persoquel coût, pour qu

é financière et équité du système es privées (contribuents nets par lesdu maximum à

Pour calculer ctoutes les donné

e la HIS, des donndans le prochain r

n nouveau HIS se

mais certaines t à l'absence d'inet à la nécessité détaillées. ier la part de m

e mortalité prématurdues' jusqu’à l'âgetatut santé. L’étudse, et éventuellemter un éclairage in

e vision plus globaccessibilité finann plus globale des

surances hospitalionnes couvertes puelles couverturesquité : une maniè

est de prendre enution individuelle os compagnies d'afacturer) en fonc

cette distribution, ées de revenus

KCE Report

nées parfaitement rapport de ra mené en 2013

lacunes subsistdicateurs pertinende trouver un me

mortalité « évita

rée (exprimée en e de 70 ans) était de de la mortalité ment aussi de la ntéressant sur les

bale est nécessancière, il est s suppléments sation privées (à

par une telle s précisément). ère plus exhaustiv compte la distribofficielle, supplémassurances privéction du statut s

il est nécessairet de dépenses

t 196

.

tent nts, à eilleur

able »

s

aire.

ve de bution ments,

es et socio-re de s des

KCE Report 196

4. Force de disponiblesdemande. envisagée l'offre et desont incoToutefois, besoins. Dseulement d'organisatsoins prima

5. Santé mechangemeplus récenéquilibré aL'objectif pen charge recourant ambulatoirenouveaux i(tels que dossier, ouet le budgepas encordisponibles

6. Continuitérelatives adisponiblesnouveaux chronique dans la pmanque epertinents, coordinatio'santé' du p

6

travail : de mes, mais il manquUne planificationdans le cadre d

es besoins des pontestablement

ce rapport ne cD'autre part, l'ef

des besoins tion du système aires et des soinsentale : les indnts intervenus ré

nte a pour but d'axé sur les 'réseaprincipal de cette de proximité à chplus aux servic

es ne répondentindicateurs ont étle pourcentage d

u encore le rapporet total des soinsre pu être mesus. é et coordinatioux nouveaux tras, mais des lactrajets pour le dsont en cours d'

prochaine éditionencore des don

tels que les reon des soins ou lapatient.

eilleures donnéesue encore des in efficace de l'effed'une politique glpatients. Les donnaméliorées dep

contient aucun inffectif soignant médicaux, maisdes soins de s

hospitaliers. icateurs actuels

écemment dans c'instaurer un moaux de soins' (intréforme est de m

haque fois que la cces hospitaliers t plus aux besoié proposés pour de patients bénért entre les dépens de santé mentaurés en raison d

on des soins :ajets de soins amcunes subsistentiabète de type 2'évaluation. Ces n du rapport pennées relatives etours d'expérien

a disponibilité perm

Belgian

s relatives à l'offormations relativ

ectif soignant devlobale tenant comnées relatives à lpuis quelques ndicateur portant nécessaire dépes aussi des manté, et notamm

s ne reflètent pce secteur. La réfdèle de soins intitulé 'projet Artic

mettre l'accent surchose est possiblque lorsque le

ns du patient. Psuperviser ces év

éficiant d'une gesses en soins de ple). Ces indicateu

des limites des d

de nouvelles dmbulatoires seron. Les résultats

2 ou l’insuffisanceéléments seront

erformance. Toutaux autres ind

nce des patientsmanente des infor

n Health System

ffre sont ves à la vrait être mpte de 'offre se années. sur les

end non modalités ment des

pas les forme la tégré et le 107'). r la prise e, en ne

es soins Plusieurs volutions stion de proximité urs n'ont données

données t bientôt de ces

e rénale intégrés

tefois, il dicateurs s sur la rmations

7

8

9

Performance

7. Centralité dules données intrinsèquemecar elle exprimattentes spécPour nous pprochaine val'expérience d(généralistes internationalel'OCDE.14 Leambulatoires rapport.

8. Soins de lonévaluer la quâgés : la prévâgés soumis l'incidence deindicateurs nmanque de prochainemeninstrument a éâgées bénéfic

9. Soins aux pesont disponibLes quelquesrapport portensur la populatCes deux gpopulation élcarence en dnationale n'a en fin de vie. fin de vie n'edes organisat

u patient : de nomsont rares. La c

ent difficile à mesume la capacité ducifiques du patientpermettre de miegue de la HIS cdu patient en ma

ou spécialistes, ces questions s

es expériences seront donc inté

ngue durée : Plualité des soins devalence de la mà une contentions escarres et la p'ont pas encore données dans

nt des données été mis au point pciant de soins à doersonnes en fin bles en Belgique, s indicateurs relant sur la populatiotion de patients broupes ne couvigible aux soins données. Jusqu’àété publiée sur l'aEn comparaison

st pas ou peu retions international

mbreuses initiativecentralité du patiurer sur base de u système à répot ou à favoriser l'eux appréhendercontiendra une satière de soins d). Pour permettseront fondées sdes patients e

grées dans la pr

sieurs indicateurse longue durée dalnutrition, le pon physique, la pr

problématique de pu être mesuréce domaine. L’pour certains ind

pour évaluer les bomicile ou en instde vie : de nombmais très peu de

atifs à ce paramèon de patients dé

bénéficiant de soinvrent pourtant p

palliatifs, ce quà présent, aucunaccessibilité ou s avec les autres

eprésentée dans les.

es ont été prises, ent est un paramdonnées quantita

ondre efficacemen'implication du par cette dimensioérie de question

de santé ambulatre une comparur le questionnai

en matière de rochaine édition d

s ont été choisis dispensés aux paurcentage de parévalence des chla polymédicationés, ce qui attest’outil BelRAI foudicateurs retenusbesoins des persotitution. breuses études loe données nationètre présents danécédés d'un cancns palliatifs à dom

pas l'ensemble dui atteste d'une ne donnée de psur la qualité des domaines de soiles bases de don

45

mais mètre

atives, nt aux atient. on, la s sur toires

raison re de soins de ce

pour atients atients hutes, n. Ces te du urnira

s. Cet onnes

ocales nales. ns ce cer ou micile. de la réelle

portée soins ns, la nnées

46

10. Promotiondonnées sinformationlittéracie ecomme un comme lesles facteursaux individpromotion 2008-2013l’étude eurpour certai

11. Une plus le prochaine peut indicateurspropose divinputs et intéressant

12. Inégalitésindicateursdonnée somutuelles, brutes et a

n de la santé : nur la littéracie en

ns sont disponiben santé est un

paramètre clé das aptitudes individs qui déterminent dus de faire de

de cette littéraci3 de la stratégie opéenne sur la Hns pays. grande attentionin rapport. Manifêtre valablemen

s contenus dans verses mesures dles outputs.7,15

t potentiel d'étude: les inégalités n

s car, dans certaiocio-économique les informations pproximatives.

nous ne dispososanté (health lite

bles dans d'autconcept relativem

ans la gestion de lduelles requises p

sa propre santé. meilleurs choix eie a été définie de l'Union Europ

Health Literacy son

n devrait être pofestement, l'efficie

nt évaluée sur ce rapport. La

de l'efficience fondCe point recèle

e. n'ont pas pu êtreines sources de n'est disponible.sur le statut socio

Belgian

ns pas, en Belgieracy), alors que dres pays d'Euro

ment nouveau, coa santé. Il peut êt

pour comprendre Ces aptitudes pe

en matière de sacomme action p

péenne. Les résunt disponibles dep

ortée à l'efficiencence des soins dla base des qlittérature intern

dées explicitemene incontestablem

e étudiées pour données (RHM), Dans les donnéo-économique son

n Health System

ique, de de telles ope. La onsidéré tre défini et gérer rmettent anté. La

prioritaire ultats de puis peu

ce dans de santé quelques nationale nt sur les ment un

tous les aucune

ées des nt assez

4CpfacdpreCppteécLempppl'c(édlad

Performance

4 CONCLUCe rapport contieperformance du saisabilité préalabchiffrées, ce rappode la performancepolitiques sur certecherches comp

Ce rapport marquprécédent, grâce pertinents. Dans cemps. Des lacuneété comblées depcause ou le taux dLa Belgique n'est en 2008 la Charmembres se sonperformance de possèdent plusieperformance des élaboration de ce

clés d'une évaluaégalement soulig

données récentesa publication dyndes modalités à in

USION GÉnt les résultats dsystème belge deble. En présentaort a pour ambitioe du système de tains points et delémentaires. e une avancée s à un éventail

certains cas, il pees importantes duis la dernière éd

de survie au cancepas le premier parte de Tallinn st formellement eleur système de

eurs années d'esystèmes de s

e rapport, par exeation efficace de née dans les rapp. La mise à jour réamique des résu

nvestiguer.

ÉNÉRALE 'une première éve santé, faisant snt 74 indicateurs

on de brosser un santé, d'attirer l'ae suggérer des p

ubstantielle en cod'indicateurs pl

rmet de mesurer dans les donnéesdition, telles que leer. ays à avoir relevéur les systèmes

engagés à supere santé. Plusieuexpérience danssanté, ont servi

emple les Pays-Bala performance

ports néerlandaiségulière des donn

ultats sur un site

KCE Report

valuation globale suite à 'une étuds assortis de vatour d’horizon co

attention des décidpistes d’actions o

omparaison au raus complets et des 'évolution da

s de base ont en e taux de mortalit

é ce défi. En paras de santé, les rviser et à évaluurs pays voisinss la mesure d d'exemples loras. Une des conddu système de ) est la disponibilnées administrativInternet seraient

t 196

de la de de aleurs mplet deurs ou de

apport plus

ans le outre

té par

phant États

uer la s, qui de la rs de ditions santé ité de ves et

l’une

KCE Report 196

Avec la directivsoins transfropréoccupation directive aura é2013, les États autre État mepertinentes surpermettre de rapport jette nsystématique dcomme une presponsabilités soins sûrs, de h

f Directive 2

relative àtransfronta

6

ve européenne suontaliers, l’engag

partagée par toété transposée damembres devron

embre sont en r les normes de sprendre une décnon seulement de la performancepremière étape p

et de dispenser haute qualité, acc

2011/24/UE du Parl’application des draliers, JO L 88/45, 4

ur les droits des pgement pris àous les États mans les législation

nt s'assurer que lemesure de rec

sécurité et de quacision informée. les fondements e, mais il peut é

permettant à la tant aux patientsessibles et efficie

rlement européen eroits des patients e4 avril 2011

Belgian

atients dans le ca Tallinn devie

membres.f Lorsquns nationales, en es patients provencevoir des inforalité des soins, pDans cette optid'une future év

également être coBelgique d'assum

s belges qu'étrangnts.

t du conseil du 9 mn matière de soins

n Health System

adre des ent une ue cette

octobre nant d'un rmations pour leur que, ce

valuation onsidéré mer ses gers des

mars 2011 de santé

Performance 47

48

SCIENTIFIC RREPORT

Belgian

T

n Health System

111TInthTopspbrefuhadtoecsfosaTthfi

F

BEhthe

Performance

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.

From values to a

By signing the TEuropean region highest attainable his common valuequitable basis,

ROUND A

ional context ter in 2008 e 53 Ministers of on of the World H

n Health SystemsTallinn Charter is y strengthening t

ents signed, thee member states or health systemnale of that commsystems are esse

eed to demonstratat health systemsn, health promotioconcerns in their

oped by the WHOhe Tallinn Charteand participatin

ent across sectorponsive to peopleealth systems are

ment proved afterwrence the world

ctions, from Tall

Tallinn Charter, areinforced that tstandard of healt

ue a set of goacontribute to so

ND APPRO

Health from the Health Organisatios for Health and

to commit memtheir respective he third is relate

commit) to proms performance to

mitment is given eential to improvingte good performa

s are more than hon and efforts to ir policies, an apprO in its “Health iner include promo

ng, investing in rs that influence e‘s needs, preferee prepared and abwards to be visiowas struck by a

linn to Health 202

all member statesthey share the cth as a fundamen

als were listed: iocial well-being a

KCE Report

OACH

countries belongion (WHO) signedWealth”. The pr

mber states to imhealth systems. Oed to health symote transparencyo achieve measuearlier in the text:g health, and thernce”. The Chartehealthcare and ininfluence other seroach that was alrn All Policies”.17 Ooting shared valu

health systems health, making h

ences and expectable to respond to conary, as no long

global economic

20

s of the WHO incommon value ontal human right. mprove health oand cohesivenes

t 196

ing to “The imary prove

Of the ystem y and urable “well refore r also clude

ectors ready Other es of

and health ations crisis. after c and

n the of the From

on an ss by

KCE Report 196

distributing the and aim at efficinterim report omember statesparallel, the Wpolicy, Health 2policy framewopast decades decreasing 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

6

burden of fundingciency by makingon the implemen

s have made opeWHO European re

2020.19 It aims to ork in light of the

in Europe: chanility), globalisationtechnological iness to informationrities focus on: n health through nstrating the impth promotion,

urope’s major heanon-communicab

DS, antibiotic resising people-centreess for emergencihealthy and supponal context ion of the report

r the signature of stem Performancehe title of this repof the Belgian he authors: healthch broader scope),

ce lie in the amou

g fairly accordingg the best use of ntation of the Talerational these vaegion has launche

provide a coheretrends that have

nges in demogran and migration (inovation (includn for patients and

a life-course apportance for the

alth challenges (able diseases, tobstance),

ed health systemies and ortive environmen

on Belgian Heal

the Tallinn Charte Assessment (Hport “A first step thealthcare systemcare system is me, and it is the first

unt of work neede

Belgian

to people’s abilitavailable resourc

llinn Charter detaarious commitmeed in 2010 a newnt evidence-basebecome salient o

aphy (increasing ncluding health w

ding genetics), d the general pub

pproach and empWHO of the e

among which recobacco, diet and

s, public health

t.19

lth System Perfo

er, the first BelgiaHSPA) was publtowards measurinm” is illustrativeentioned instead ot step only… The ed for this first eva

n Health System

ty to pay ces.3 An ails how

ents.18 In w health ed health over the ageing,

workers), rapidly

blic. The

powering expected

ognising physical

capacity

ormance

an report ished in

ng of the of the of health reasons aluation:

nleTHtasrewAHereswcps(toa

1T(staTwnocdE

Performance

new collaborationevels had to be The report was aHSPA framework ailored to the Beselected, and 40 oesults, strengths,

were discussed. After the publicatiHSPA requested evaluation of theequested to enric

such as mental hwere insufficientlycommunities requepromotion by enlsystem to a full evi.e. continuity of co be insufficientlyassess these dime

1.2 The BelgThe Belgian perfosee Figure 3) inailored to the BelgThe conceptual fwhich do not reprnon-medical deterof 5 domains: heacare and end-of-ldifferent dimensioEquity has been d

s between admiinitiated, and sta

articulated aroundwas constructed

elgian context. Seof them could be weaknesses, ev

on of the first repthe project to b

e Belgian Healtch the set of indicaealthcare, long-te

y covered in this fested new indicatarging the set fvaluation of the hcare, patient cent

y represented, andensions.

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

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.

49

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.

50

Figure 3 – The

e conceptual frammework to evalua

Belgian

ate the performa

n Health System

nce of the Belgia

Performance

an health systemm

KCE Reportt 196

KCE Report 196

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

6

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 p

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 myocardi

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 afte

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

•

•

•

g

Performance

episode) or ttesting, 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

Home nursin

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

to detect health 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 the

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

problems befores, 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.

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

e they occur (reices 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

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

51

egular health

and

o the e who basis

entary g time grated n two cond,

vices:

come of-life

piritual

ties of . Care s (for ursing

s pour oorden living Older need

son de medical

public nt.

52

• Health proenabling pdeterminangoes 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 deg

omotion has beenpeople to incrents, and thereby imeyond 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 pro

n defined by the ase control ovemprove their healaries 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 healthcare

Belgian

WHO as “the proer their healthth". The health prsector: indeed on

developing 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 the

n Health System

ocess of and its

romotion 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

•

•

•

E(ereSinfanthEadpmo

Performance

needs, given tThe link betwbetween outco

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

the current best eween effectivenesomes and proces

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

evidence and the ps and appropriateses.

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 ‘coo institutions 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.

KCE Report

provider’s experieeness reflects the

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

t 196

ence”. e link

e right event

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KCE Report 196

Assessment oOnly a partial amade into the Performance of• Outcomes

Nutbeam’sinto 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

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6

of the Health promassessment of thscope of this wo

f health promotionof the health pro

s framework in Chmes 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.

motion he health promotioork. More detailsn. omotion can be

hapter 7 Performaaction (like health

opting 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

Belgian

on performance cs are given in Ch

categorized (seeance of health proh 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

n Health System

could be hapter 7

e further, omotion) 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

1SpStoo1T1

2

31OTcndpaF1

2

3

Performance

1.3 ObjectiveSystematic evaluprocess, with puStrategic objectiveo be differentiatedoperational sub-ob1.3.1 StrategicThe HSPA proces

. 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

es of the perforation of health

ublication of HSes, defined as the d from the specificbjectives. c objectives of ths pursues three se 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;

mance project system perform

PA reports as objective of the o

c objective of the

he HSPA processtrategic objectiveties 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

ance is an on-important milest

on-going process, present report, a

ss s: 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

53

going ones. have nd its

health

health in the

time.

s and nable ns or nd the rt, we

with a ata in

mains: care, and lly to

gaps

54

4. To interpreperformancincluding a

1.4 MethodOperational objspecial focus onThe update of tbetween the reFederal Public SOperational 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.

et the results in oce of the Belgian

an international be

ds to reach opebjective 1: To revn the 11 indicatorthe former 55 indesearch team anService (FPS) Pujective 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

order to provide ahealth system by

enchmarking when

erational objectview the core setrs for which there icators was made

nd a specialist inblic Health.

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

Belgian

a global evaluatioy mean of severaln appropriate.

tives t of 55 indicatorswere no data in 2e in a consensus health indicators

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

n Health System

on of the l criteria,

s, with a 2010.

meeting s of the

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

TaOoAgwwwlabdFwOeWadrereaTgfo

Performance

The whole set of avoid redundancieOperational objectobjective 2, and toAfter the setting gathered the data were classified intwithin the next twwhom these indicack of relevant dbeing 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

indicators was thes in indicators antive 3: To measur

o identify gaps in tup of an updatedto measure them

to two categorieswo years, and thoscators should be data, these indicaand 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

hen reviewed by nd enhance the core the indicators sthe available datad set of indicato

m. Indicators withos: those for whichse for which it is collected. Nevertators were select

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.

KCE Report

the research teaonsistency of the sselected in opera. rs, the research out (yet) availableh data will be ava

not clear how antheless, in spite oted by the experon “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

t 196

am to set.

ational

team e data ailable nd by of the rts as under

t was

global

rmed: sis by f most These tation

rs are esults

KCE Report 196

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 outda

6

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.

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

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

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

InwinliM•

•

•

Performance

n addition to thesewithin a two-year 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.

e 74 indicators, 1timeframe have

xt edition of the p3.

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

identify 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

1 indicators for whbeen selected.

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

hich data are expProbably, they wrt. 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 /

55

ected will be 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-

56

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

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

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h

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2.2 Facts and

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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).

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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

KCE Report

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

t 196

ented n the

7 Life sharp an be dards, health

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omen rs are stable gions,

ocess

KCE Report 196

For internationBelgium is situ62.6 years versEU-15.

Table 13 – Lifeage 25 (2008),

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

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nal comparisons, ated close to thesus 63.0 years in

e expectancy atby sex and regio

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ts.wiv-SStoredProcess/guth+Expectancy+Sta

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KCE Report

t 196

KCE Report 196

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

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KCE Report 196

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

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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

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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

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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

KCE Report

wever, we still do

lth Data is cures (on the basis ofe).

t 196

o not

rently f their

KCE Report 196

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

6

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.

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

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

63

based tly by

health OOP

tures) s and a very n the

64

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

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

KCE Reportt 196

KCE Report 196

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,

6

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 agedessentially 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

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

65

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.

66

Figure 8 – Per2010)

Note: mammotes

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

KCE Report

ears, by region (2

lation

t 196

2006-

KCE Report 196

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

6

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

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

67

dose-enzae d and e was demic and a

od for global st the

68

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

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

KCE Report

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

t 196

and

care er 100 in the eadily le the

000 to tween r 100 a and home ber of much

9 2010

KCE Report 196

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

6

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

ATpTthcspFsda

n

Performance

mes per 100 pop

Beds i

Wallon

3.4

Accessibility of eThe 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: tof 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:

region, 2010

Brussels

3.8

art palliative careof-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).

69

e tart of hase. either ere is are is for a

kness lump their

ek of

three nd the of the d from

70

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

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

KCE Report

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

t 196

es in %, , 5%). 007

hin %). n

ainst 5% are

KCE Report 196

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

6

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

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

71

duals nd are vided

uity of

omes, to all

rs are

care, to the cators ening ce or

rative ancer,

treat

72

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

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 Survivalries (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.

KCE Report

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

t 196

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

KCE Report 196

Table 17 – 5Belgium

Cancer type

Female breastcancer Cervical cancer Colon cancer:males Colon cancer:females Source: Belgian C

6

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

Performance 73

74

Figure 11 – 5-y

Source: OECD HNote: results for c

Effectiveness Asthma, a chrooutpatient basiProper managexacerbation aasthma commoadmission ratescare coordinatio(healthcare quaAcross OECDadmission rateasthma admiss

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 to

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 avera

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).

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

awraamc

Eph

Performance

or females: intern

also the case in Bwas 52/100 000 inates in the OECD

are slightly abovemight highlight thecare setting.

Effectiveness ofpopulation, invhospitalization an

national compari

Belgium: in 2009,nhabitants and 28D Health data (20e the EU-15 avee need for more

f mental healthvoluntary comnd working statu

ison (2004)

the asthma adm8/100 000 inhabita007) show that 48erage (47.2/100 0

effective and tar

hcare: suicide mmittals withinus of persons wit

KCE Report

ission rate for femants for males. Be8.4/100 000 inhab000 inhabitants). rgeted care in pr

rate in the gen the psychth mental illness

t 196

males elgian bitants

This imary

eneral iatric

s

KCE Report 196

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 (

6

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

75

76

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

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

KCE Report

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

t 196

iatric

ge in

at the to the s well rtugal eased

2009

KCE Report 196

Figure 14 – Ememployment comparison (2

Source: Europea

6

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

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

77

er, d 63% ear

he

04-

an ears). n

% to is

data are

78

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

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

KCE Report


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

t 196

ented n the

-2002 ended r age extent

in the large s are

ussels on of s not nostic

nd for

KCE Report 196

Figure 15 – Ma

Source: IMA-EPS

0%

10%

20%

30%

40%

50%

% fem

ales

40-49

yea

rs s

cree

ned

B

6

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

09 2010

Wallonia

79

80

Application of and prescriptioSeveral 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

guidelines: folloon of antibioticsons 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

KCE Report

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.

t 196

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

KCE Report 196

Figure 16 – C-s

Source: OECD H

Appropriateneantidepressan

Average daily q(DDD) per 1000The prescriptioper 1000 popPrescription of

6

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

ers). It is conside

nks high in terms sheet). We caming better or wxes; between regness of antidepres to be studied

81

erably

ms of annot

worse. gions; essant and

82

Figure 17 – De

Source: Pharman

Average daily per day) The prescriptio1000 populatiobetween regionAggressivenesspatients Receiving (or incancer patients

0102030405060708090

100D

aily

con

sum

ptio

n of

ant

idep

ress

ant

per 1

000

popu

latio

n

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

KCE Report

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)

t 196

010)

eir life kness d that ed for erapy ng in ancer

.7

83.8

90.0

KCE Report 196

Figure 18 – Ch

Source: Results f

Residential ca

Palliative care un

6

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

83

84

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

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

KCE Report

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

t 196

ents are. udy

d the

ends ty.

e right harm

r and

PSI,

, PSI,

cribed

tients ailable ix C).

KCE Report 196

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

6

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

nhabitant (expre

2009 2010 2

2.29 2.29 2

1.6% 0.1% -2

a13v2.pdf)

85

essed

2011

2.22

2.9%

86

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

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

KCE Report

A, making compamicrobial Resisrogram does not

t 196

arison tance focus

KCE Report 196

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

6

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

1,81,5

2010

/1

2010

/2

87

88

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

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

KCE Report

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.

t 196

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

KCE Report 196

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

6

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

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.

89

users, utions

e fact rsonal

events ovider

iders, osses hronic

one or nuous

tween

tinuity

MD –

ounter

sulted

90

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

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

M

LApthrewreckfr

Performance

Figure 21 – PercGMD – DMG), by

Source: RIZIV – INA

Management con

Link 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 p

ncounter 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

KCE Report

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

t 196

ecord

older sed in more

ontact ussels on of

do not ital or

KCE Report 196

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 re

6

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 G

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 specialis

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 dr

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

abph

R

AtocsfolooinIntwo2mthresFTpcre

CMmpisgms

Performance

attention to a reimbetween GPs apercentage found heavy administrati

Relational contin

A 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 treat

bursement measuand specialists.

in the data are ive burden.

nuity

ationship betweencommunication,

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 can

ure aimed at facilPossible 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. Sin

itating the coordinnations 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 introducti

91

nation 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

92

2003, a clear discussions abOverall, 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

increase of its bout how to bette69% 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

use is noticed fer involve GPs

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

for all cancer typare currently con

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

pes and nducted.

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

KCE Report

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

t 196

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

KCE Report 196

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

6

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

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

93

of and , and

fy the

tients’ ivacy; social

their early;

upport skills;

their ions):

ement nning; ion in

to be

n was

home

94

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

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(

PPTcth6dwascmcp

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

KCE Report

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

t 196

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

KCE Report 196

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

6

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

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%).

95

ss.

th be

ent of tal

s ome. e of ients rs

96

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

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

KCE Report

f DDD prescribe7 billion. On the sly increased to r8.9% as original d

t 196

ed in same reach drugs

KCE Report 196

Figure 24 –ambulatory se

Note: DDD DefinSource: RIZIV – I

Utilisation of hospitalisationCarrying out elcircumstances etc.) saves moconsidered as aThe Belgian su2008. The coincreasing trend25).

6

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

Performance 97

98

Figure 25 – Pe

Source: OECD H

Utilisation ofhospitalisationThe 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

teercentage 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)

KCE Report

6%

50%

58%

0% 60% 7

t 196

70%

KCE Report 196

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

s

6

verage 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)

3.54.04.1

4.34.5

4 5stay in days

99

100

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

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

M

Ta2mpin

F

NS

Performance

6.2 Facts and


Maintenance of w

The 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

KCE Report


approaching retireyears 2000, 2004re 27). Another w

age of GPs cur(FTE) was 51.4

009)

heck up (RIZIV – INA

t 196

ented n the

ement 4 and

way of rrently years

AMI)26

KCE Report 196

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

6

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%

pe of specialisat

006 2008

814 941 11014%

704 781 493211

30%

101

ion

160 17%

554 227

29%

102

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

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

KCE Report

es not seem to begh number of nuis 41.7, high abovsary when interprnd those will pro

58.7

60.0 70.0n (2010)

t 196

e from ursing ve the reting

obably

KCE Report 196

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

6

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

1.5 2.0ays (2009)

103

0

104

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.

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%


KCE Report 196

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

6

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 200529.4811 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 200832.2427 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

main function in

s very close to thearing total healthtive the registratie expenditures.

105

n the

e EU-hcare on of

106

Figure 31 – To

Source: OECD H

02468

101214161820

200

Tota

l hea

lth e

xpen

ditu

re a

s %

GDP

Be

Ne

EU

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)

KCE Report

%9%9%10%10%

10%10%11%11%11%11%

12%12%

12%

0% 12% 14%s domestic produ

t 196

%uct

KCE Report 196

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

6

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

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

107

ess of ”. The all the vers a mental em. It t.

ctures ns and

108

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

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,


KCE Report 196

Figure 32 – ThThe Nutbeam’s

Source: adapted “Health promotion

6

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

m framework

ge 12

the municipalities promotion team

ed)

tice: Tobacco Co

109

ontrol

110

7.2 Facts a


7.2.1 HealthFour important described abovexpectancy, heas they are less

Overweight an

Adult 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

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


KCE Report 196

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 and

6

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

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

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 Decay

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),

MmIns(inpyaTM

Performance

besity (BMI ≥30),

Health Data for inte

Missing (M), Fillemaximum mean Dn 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

ed (F) teeth (T). DMFT score belowey 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

WHO goals set w 1.0 for 12-year-o2009-201084, 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

rnational compa

for the year 20olds. 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

111

rison

010 a

e in a result nders ries in 12-14 atified

mited.

112

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

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


KCE Report 196

Figure 34 – Dia

Source:Scientific

6

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)

113

114

Figure 35 – Ra

Source: OECD H

ate of the new HIV

Health Data 2012

V diagnosis per

Belgian

100 000 inhabita

n Health System

ants: Internationa

Performance

al comparison

KCE Report

t 196

KCE Report 196

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

6

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

opulation (aged

2004 200

9% 8%

8% 10%

8%

lic Health (WIV – IS

115

15 or

08

%

SP)

116

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

ilyercentage 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

KCE Report

east 2 fruits and

2008

Wallonia

t 196

d 200

KCE Report 196

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%)

6

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.

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

117

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

118

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.

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

O

PSpth

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 secon

n 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

KCE Report

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

t 196

urvey g the at we . 40%). since

ms of naire. pation , this

ctivity. ge in from

KCE Report 196

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

6

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

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.

119

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

120

7.2.3.3 HeaThe Tobacco C

The 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”.

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


KCE Report 196

Figure 37 – Int

Source: A survey

6

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)

121

122

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

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

KCE Report

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

t 196

kly

ther

han 5

y, ables ver, , 2%). es of r in ther

with iate

KCE Report 196

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 social

6

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 h

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 impor

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

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,

amT••

CTinesSeFethpclawEsascwFgFRp

Performance

and to monitor measurements). 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 SE

if they chang

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 soc

ge over time

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 w

(by repeating

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 with

123

those

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

124

variable, the Bpeople with a lo

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 g

u BIM: Bén

reimburse

BIMu (increased ow income level) a

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 experience

néficiaire à Interv

ement); BO: Bénéfic

reimbursement, and BO (normal re

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 the

vention Majorée

ciaire Ordinaire

Belgian

mostly corresponeimbursement).

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 advantage

(beneficiary of i

n Health System

nding to

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

ncreased

gpoInre

L

TdTSththnFalesrephthWininsa

Performance

group. It is comppopulation and thoverall rate in the n this chapter, welative risk (RR) a

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

puted as the diffehe rate in the mopopulation.

we highlighted thas large as 1.2 (or

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

erence between tore advantaged

e indicators for wr 0.83 when the g

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

KCE Report

the overall rate igroup, divided b

which we observradient was rever

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.

t 196

n the y the

ved a rse).

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

KCE Report 196

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

6

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

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

125

level, ration

the level

vel, in cy are asing

The elative or life men.

ars in This

r than h less

126

Table 28 – Helevel, absoluconcentration

Diploma

Higher

Secondary higher Secondary lower Primary

No diploma

Total

CII absolute

CII relative

Source : Van Oye

The self-perceImportant inequdifference of 2educational levAttributable Frathe whole poputhe rate of subjeInfant mortality Belgium, only p

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 a

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 f

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 instance

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

ainth8Thleinre7Incsreha0Foabthsssba

Performance

association was fncomes 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

found in Brussent 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

ls between the 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.

KCE Report

number of houst 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.

t 196

ehold 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

KCE Report 196

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

6

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).

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

127

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

128

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

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, rela

Overvalue

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 m

n 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

KCE Report

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%

t 196

mary ure (CII F)

% %

%

% %

KCE Report 196

% 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

6

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

-34.1%-14.7%

13.1%

12.3%

ttributable Fraction)

129

% %

for all

130

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

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

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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

KCE Report

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.

t 196

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

KCE Report 196

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

6

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

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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

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

131

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

132

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

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

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parison

same income, the coon of the incomes.

KCE Report

10 udget)

2011 (budg

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.4% 18.4%

.8% 20.2%0.0% 100.0%

oefficient is 0). Whe

t 196

get)

% % %

%

en

KCE Report 196

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

6

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

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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 system

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 lu

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

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 an

133

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

134

maximum billinmechanisms, 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

ng system (MABndividual 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

).134 In addition insurances reimb

e 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

to these publiclyburse 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

y-funded 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

McInthcsminownInc“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 sen 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

KCE Report

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

t 196

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

KCE Report 196

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

6

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 measure

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.

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

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,

•

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The availabilitby all care ppatient electrindicators unpractices withpatients for wis accessible as the “Réseand pilot pro(http://www.viand currently e-Health platfo

Patient centeredn

Patient 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 t

ty of the whole heroviders is a cenronic 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 initia

ess 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

ealth information ontral question, linecord, 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 da

y 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

of a patient at anyked to the one o

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 quantiability to succes

encourage 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

135

y time of the

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

136

approach. Morequality. 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 manage

e detailed analys

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. In

sis should be per

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 p

Belgian

rformed to evalua

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 w

n Health System

ate their

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

thM

LBLnlotoSdinepndinAdTccUs(cdth

w

Performance

he participation oMeasurement of q

Long-term care: BelRAI assessmeLong-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

of patients’ represuality indicators is

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.

sentatives in thes soon expected i

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

KCE Report

ir board of govern this domain.

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

t 196

rnors.

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

KCE Report 196

Efficiency desObviously, efficfew indicators efficiency meascould certainly

End-of-life car

The 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

6

erves more attenciency in healthca

selected in thissures which explbe an interesting

re: many local stu

tors 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 Belgium

this report are bar 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 nation

ased 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

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.

137

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

138

APPEAPPENDTIER OF Health Status

• Life expec• Health exp• Self-perce• Infant mor

Dimension

Accessibility

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

KCE Report

IFIED BY

End-of-Life Ca

• % of pawho died wone week start palliative service

t 196

are

atients within

after of

care

KCE Report 196

Quality - Effec

Quality - Appropriatene

6

tiveness

ess

because of finareasons

Belgian

ancial

• %aged old wmamwithinyears

• % aged old wmamwithinyears

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

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

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

• % of capatients receiving chemotherin the lasdays of life

139

ancer

rapy st 14 e

140

Quality - Safet

Quality - ContiCare

Quality - Patiecenteredness

Equity

y •

inuity of •

•

nt •

•

•

Medical radiexposure of population

Coverage of gmedical record Usual providercare index

Satisfaction health care servic

Indicators of progressivity of phealthcare financGini coefficient band after taxation

Belgian

iation the

global

r of

with ces

the public cing efore n and

n Health System

•

•

•

•

•

•

•

•

Performance

Incidence of 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

hospital 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

of discharges om psychiatric in-tient care admitted to ychiatric in-tient care that curred within 30 ys

chizophrenia, polar disorder)

KCE Report

• Number contacts between patient andGP in the months of

• Patients in their place residence

t 196

of

the d the last 3 life

dying usual

of

KCE Report 196

Efficiency

Sustainability

Health Promot

Type of indica

Health outcom

Intermediate healthy lifesenvironments

Health promot

6

•

•

• • •

•

tion

tor

mes

health outstyles and

tion outcomes

transfers % prescription ofcost 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

f low-

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

% surgical dayAverage lengstay for delivery Acute care be(number per ca

g, filled teeth in ch

indicators) vegetables

y and secondary leunicipalities

dimension in their rt

y-case gth of normal

ed days apita)

hildren at age 12

evel in schools

school project

141

142

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

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

KCE Report

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

t 196

nitial o six lts at or of

ly ill ness s not

post-or of

or all ewer ation dard

KCE Report 196

QA4: Percentguidelines oprocesses

QA6: Hysterec

QC1: Number

QC2: Average

QE03: ColorecNo data availa

QE06: Acute influenza

QE07.3: Salt co

6

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.

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

143

et of ys in

better

es by e the

MD –ation gher

nuity how

re, a cator

n

Since ia is cator ma”,

lgian

144

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)

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

KCE Report

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

t 196

was hs of eave

Gezin nths,

s not

ck of f the

L) is and ems.

rtality care

KCE Report 196

QS1: Incidence

QS2: Incidence

QS4: Incidence

QS5: Incidencindividuals at No data availa

Sustainability

S1.1: Amount

S2: Qualificatio

S4: Yearly amo

6

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

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 s

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 sustaina

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, s

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 syste

145

s, the better as in

or the been ream

nd of ative udes ECD

ance, was

em’s

146

S6.1: Number

of acute care beds (per 1000 pop

Belgian

pulation)

n Health System

capacity tthe SSF (EMA), aThis is thsystem.

RemovedRationaledays, numoccupanc

Performance

to be responsive are usually thos

and are reimbursehus not a very re

d in 2012 e: this is a secondmber per capita”.cy rate and length

to emerging needse waiting for aped by compulsoryelevant indicator

dary indicator link. The latter was p

h of stay.

ds. However, treapproval by Europy health insurancof the sustainab

ked to the indicatopreferred because

KCE Report

tments reimbursepean Medical Agece after this approility of the health

or “S6 acute caree it also account

t 196

ed by ency oval.

hcare

bed s for

KCE Report 196

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 participatio

6

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 –

data: RIZIV – INAare ge of patients reare (diabetes/renr for patients reare (diabetes/renfor chronic care aathways is to impwith chronic di

and other hn in a pathway

in the pathwayson in this public inv

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

is a medical file cintroduced in A

evention and healtpromotion. It is thctors, organize ), and counsel forhelp the GP in

DMG+ is thus

AMI

egistered in an anal failure) and gistered in an a

nal failure) are set up in Belgprove follow-up aisease, general

healthcare profesis voluntary, the

s of care is a ivestment. Accord

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

ambulatory pathfrequency of ph

ambulatory path

gium since 2009. nd collaboration b

practitioner, sssionals. Becau

e percentage of ndicator of the

ding to the RIZIV –

n Health System

tinent to hich data e idea is

e of data

(GMD –on and

d by the ains an

e GP can make a

ventions urs. The

oring the f health

way for hysician way for

The aim between

specialist use the

patients patients’ – INAMI,

•

Performance

there were 20renal 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

0 176 registered on 31 October 2

nown. 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.

pathways for dia011.142 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

abetes and 15 42exact 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

alth related emergecade.151 This stre

in the field of mses. Depending obility of a mental h

be practical. Still, tal health expert52 mation not availabata, this indicator

147

28 for tor is roject

on will

s for

mental as an 9 The with when s are eople

ze the d that crisis

health room

health tment eased

gency esses

mental on the health there ise is

ble in could

148

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

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,

•

•

Performance

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

KCE Report

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).

t 196

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

KCE Report 196

• 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

6

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

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