The Belgian health care context

1
The Belgian health care context

• Belgium was evaluated the sixth best country in
  the world, according the the UNDP-list
• Health insurance is compulsory for Belgian
  citizens (implies a SIS-card)
• Health care is not free but the health insurance
  covers a large part
• Belgians living in poverty can apply for a
  third-party-payment
• Hospital bills since recently have a
  ceiling-arrangement

2
Right to health care for asylum seekers

• When an asylum seeker arrives in the country an
  asylum centre is appointed to him/her. The person
  can stay there but can also decide to live
  somewhere else.
• The asylum centre is responsible to pay for any
  medical costs, whether the person in inside or
  outside the centre
• Psychological support depends on the asylum
  centre and the doctor inside the centre

3
Right to health care for illegal immigrants

• Belgian law of 1996 gives illegal immigrants the
  right to health care.
• The law is called Aide Médicale Urgente
• Not only urgent but most aspects of health care
  are included
• Health care is for free for illegal immigrants
• Health care suppliers can get payment from the
  local Public Centre for Social Assistance (CPAS)

4
Cases of concern

• Difficult administration different procedures
  for each CPAS
• Lack of communication between CPAS, health care
  suppliers and patients
• Delays in payment by the federal government and
  by the CPAS
• No continuity of care saturation of facilities
• Mental health is neglected

5
Testimonial

• Mohammed, 34 years, Moroccan
• Eye problems in Morocco, looking for treatment in
  Belgium
• Diagnosed with diabetes in Belgium, after arrival
  in 2001
• Delays in treatment, complications
• Now regularised situation, handicapped for life

6
Access to health careby MSF

• General objective
• To assure a systematic and structural access to
  health care for the excluded in the cities of
  Antwerp, Brussels and Liège medical, social and
  psychological

7
Access to health careby MSF

• Specific objective
• To assure before the end of 2005 the acceptation
  of an operational model by the local authorities,
  which would allow a medical, social and
  psychological access to health care for asylum
  seekers and illegal immigrants in the cities of
  Antwerp, Brussels and Liège.
• For non-medical problems refer the patients to
  the most adequate structures.

8
The work of MSF

• Result 1 integrating patients into the existing
  health care structures by
• Offering social, medical and psychological
  consultations for people with a difficult access
  to health care
• Referring to adapted services
• Specific identification and reference to the
  services concerning mental health care

9
The work of MSF

• Result 2 making the intervention of MSF
  unnecessary by
• Lobbying so that services and procedures are
  functioning efficiently
• Simplification of procedures (federal, regional,
  local)
• Promotion of an access to health care model,
• More knowledge between GPs about the specific
  procedures (AMU)
• More visibility for the project

10
Number of patients 2003

• 9947 consultations for 4407 patients in 2003,
  from which
• 4884 in Brussels
• 2967 in Antwerp
• 2096 in Liège

11
Status of the patients2003
12
Nationality of the patients 2003
13
Lobbying strategy

• Focus on all levels involved
• Collaboration with local and regional NGOs and
  institutions
• Federal Ministry of Social Integration
• Regional Flemish, Brussels and Walloon Unions of
  Cities section CPAS
• Local CPAS, city
• Health care suppliers GPs
• Political inform party or opposition members
• Media attention
• (International)

14
Solutions could be simple

• Ensure a number of principles in the procedures
  applied by the CPAS such as a medical card
• Promotion of good practices
• Promotion of follow-up by GP
• Recognize importance of mental health care
• Faster payment
• Information