82
HiT in Belgium
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Table 3.7: Co-payments for outpatient pharmaceuticals on 1 January 2009 Reimbursement category
Non-preferential treatment
Preferential treatment
A–vital drugs (e.g. insulin for diabetics, cancer drugs, antiretrovirals)
100% reimbursement, no co-payment
100% reimbursement, no co-payment
B–therapeutically significant drugs for nonlife-threatening diseases (e.g. antibiotics, antiasthmatics, antihypertensives)
75% reimbursement, copayment: 25% with a maximum of €10.80 (€16.10 when there are generics/copies)
85% reimbursement, copayment: 15% with a maximum of €7.20 (€10.80 when there are generics/copies)
B large package size– therapeutically significant drugs for non-lifethreatening diseases (e.g. antibiotics, antiasthmatics, antihypertensives)
75% reimbursement, copayment: 25% with a maximum of €13.50 (€24.20 when there are generics/copies)
85% reimbursement, copayment: 15% with a maximum of €8.90 (€16.10 when there are generics/copies)
C–therapeutically less significant drugs for systematic treatment (e.g. antiemetics, spasmolytics)
50% reimbursement, copayment: 50% with a maximum of €13.50 (€24.20 when there are generics/copies)
50% reimbursement, copayment: 50% with a maximum of €8.90 (€16.10 when there are generics/copies)
Cs–drugs used in certain chronic illnesses (e.g. drugs used in coronary heart disease), antihistamines and vaccines
40% reimbursement, copayment: 60% without maximum
40% reimbursement, copayment: 60% without maximum
Cx–contraceptives and antispasmodics
20% reimbursement, copayment: 80% without maximum
20% reimbursement, copayment: 80% without maximum
D–non-reimbursable drugs
0% reimbursement, copayment: 100%
0% reimbursement, copayment: 100%
Source: NIHDI 2009c
3.3.3
Pooling of funds The budget for the health system is determined on an annual basis using a six-step procedure: (1) determining needs; (2) carrying out technical estimates; (3) identifying potential economy measures; (4) suggesting the global budget objective and partial objectives; (5) determining the budget; and (6) negotiating conventions and agreements. These steps are described in turn below. Furthermore, Fig. 3.6 details the process for determining the global budgetary objective and its breakdown into partial budgetary objectives in terms of the structures involved and the missions achieved. (1) Determining needs. The conventions and agreements commissions make an inventory of the changes which are necessary for financing their branch of industry, based upon the expenses level (on the assumption of unchanged legislation) as established by the Health Care Department of the NIHDI. The inventory of needs is centralized by the Health Care Department and submitted to the different management boards (Insurance Committee, General Management Committee). This takes place from April to June of the year preceding the financial year.