Schokkaert Erik, Van de Voorde Carine
Centre for Economic Studies, Naamsestraat 69, Leuven, Belgium.
Health Econ. 2005 Sep;14(Suppl 1):S25-39. doi: 10.1002/hec.1027.
Curbing the growth of public sector health expenditures has been the proclaimed government objective in Belgium since the 1980s. However, the respect for freedom of choice for patients and for therapeutic freedom for providers has blocked the introduction of microeconomic incentives and quality control. Therefore--with some exceptions, particularly in the hospital sector--policy has consisted mainly of tariff and supply restrictions and increases in co-payments. These measures have not been successful in curbing the growth of expenditures. Moreover, there remains a large variation in medical practices. While the structure of health financing is relatively progressive from an international perspective, socioeconomic and regional inequalities in health persist. The most important challenge is the restructuring of the basic decision-making processes; i.e. a simplification of the bureaucratic procedures and a re-examination of the role of regional authorities and sickness funds.
自20世纪80年代以来，抑制公共部门医疗支出的增长一直是比利时政府宣称的目标。然而，对患者选择自由和医疗服务提供者治疗自由的尊重阻碍了微观经济激励措施和质量控制的引入。因此，除了一些例外情况，特别是在医院部门，政策主要包括费率和供应限制以及增加共同支付。这些措施在抑制支出增长方面并未取得成功。此外，医疗实践仍存在很大差异。从国际角度来看，虽然卫生筹资结构相对累进，但健康方面的社会经济和地区不平等仍然存在。最重要的挑战是基本决策过程的重组；即简化官僚程序并重新审视地区当局和疾病基金的作用。
