Medical technology assessment and reimbursement policy of implantable devices in Belgium: possibilities and limitations for the future

Abstract

The Belgian health care system is based on a mixture of public and private initiatives. It is financed by social contributions proportional to income (70%) and by state subsidies (30%) in a Bismarck model of national solidarity and compulsory health insurance covering the whole of the 10 million population. The administration of the system is exclusively assigned to five recognized sickness funds, and its policy-making structure is built on an advisory and consensus mechanism between government officials, health insurers, and interest groups of providers and institutions. In order to coordinate and supervise a uniform application of insurance cover by the sickness funds a National Institute of Health and Disability Insurance (R.I.Z.I.V.) was created in 1963. Health care delivery is paid through the reimbursement of a per diem price for the hospital and of a fee-for-service for the provider. It is obvious that this output-financed health care system in Belgium has led to an increase of services offered and a generalized purchase of the latest and most expensive technology.