Belgian Health Care Knowledge Centre.
European Observatory on Health Systems and Policies.
Health Syst Transit. 2020 Dec;22(5):1-237.
The Belgian health system covers almost the entire population for a large range of services. The main source of financing is social contributions, proportional to income. The provision of care is based on the principles of independent medical practice, free choice of physician and care facility, and predominantly fee-for-service payment. The Belgian population enjoys good health and long life expectancy. This is partly due to the population's good access to many high-quality health services. However, some challenges remain in terms of appropriateness of pharmaceutical care (overuse of antibiotics and psychotropic drugs), reduced accessibility for mental health and dental care due to higher user charges, socioeconomic inequalities in health status and the need for further strengthening of prevention policies. The system must also continue to evolve to cope with an ageing population, an increase of chronic diseases and the development of new technologies. This Belgian HiT profile (2020) presents the evolution of the health system since 2014, including detailed information on new policies. The most important reforms concern the transfer of additional health competences from the Federal State to the Federated entities and the plan to redesign the landscape of hospital care. Policy-makers have also pursued the goals of further improving access to high-quality services, while maintaining the financial sustainability and efficiency of the system, resulting in the implementation of several measures promoting multidisciplinary and integrated care, the concentration of medical expertise, patient care trajectories, patient empowerment, evidence-based medicine, outcome-based care and the so-called one health approach. Cooperation with neighbouring countries on pricing and reimbursement policies to improve access to (very high price) innovative medicines are also underway. Looking ahead, because additional challenges will be highlighted by the COVID-19 crisis, a focus on the resilience of the system is expected.
比利时的卫生系统为广大民众提供了几乎涵盖所有服务的医疗保险。主要的资金来源是与收入成比例的社会缴款。医疗服务的提供基于独立行医、医生和医疗机构自由选择以及主要按服务收费的原则。比利时民众享有良好的健康和较长的预期寿命。这在一定程度上是因为民众能够很好地获得许多高质量的卫生服务。然而，在药物治疗的适当性（抗生素和精神药物的过度使用）、由于较高的用户收费而导致心理健康和牙科保健的可及性降低、健康状况的社会经济不平等以及需要进一步加强预防政策等方面仍然存在一些挑战。该系统还必须继续发展，以应对人口老龄化、慢性病增加和新技术的发展。这份比利时卫生技术评估简介（2020 年）介绍了自 2014 年以来卫生系统的演变，包括新政策的详细信息。最重要的改革涉及将更多的卫生权限从联邦政府转移到联邦实体，以及重新设计医院护理格局的计划。政策制定者还追求进一步改善获得高质量服务的机会，同时保持系统的财务可持续性和效率，因此实施了一些措施，促进多学科和综合护理、集中医疗专业知识、患者护理轨迹、患者赋权、循证医学、基于结果的护理和所谓的“同一健康”方法。还在与邻国就定价和报销政策进行合作，以改善对（价格非常高的）创新药物的获取。展望未来，由于 COVID-19 危机将突出更多的挑战，预计将重点关注系统的弹性。
