Concluding forum February 18, 2016
The debate on how solidarity should be maintained in our public health system is very timely. "When citizens are asked for opinions individually, solidarity appears to be coming under pressure” says Ignaas Devisch, bioethicist at the University of Ghent. "But when they are given ample time and the opportunity to discuss this issue among themselves and together with experts and stakeholders, they still value solidarity and the right to health for all very highly."
According to the CitizenLab, people are responsible for their behaviour and thus for their own health, but only to a certain extent because contextual factors play a determining role. The responsibility of citizens should therefore not lead to a failure to reimburse medical treatments for lifestyle-related diseases. The participants therefore support the principle of so-called lifestyle solidarity - solidarity with those who, due to their behaviour, are at greater risk of incurring medical expenses.
Seven points on which views were expressed in the CitizenLab are set out below. Experts have recast these points into an agenda for change.
Both evidence and experience: Civilians want reimbursement decisions to be based less on outdated decisions or on the interests and concerns of all kinds of stakeholders. For citizens, only two points are really important: evidence - scientific evidence - and experience: patients' qualification by experience. This means that patients must also be involved in making decisions.
Mono-disciplinary reimbursement commissions (where only one specialty is present) are no longer appropriate in health insurance. The judgement on whether or not medicines and treatments should be reimbursed, must depend on multidisciplinary committees (such as the Insurance Commission of the RIZIV/INAMI).
Minister De Block agrees with citizens on this. "It is clear that we must move towards a more cross-cutting multi-disciplinary collaboration within our consultation bodies. Patients undoubtedly deserve to have a place at these round table discussions. The needs and expectations of patients and caregivers do not always coincide. Patients focus more on quality of life. When setting up clinical trials, when starting treatments and even during policy making, patients' experience of care deserves much more attention. "
Applications for reimbursement of medicines and treatments can currently only be made by companies - pharmaceutical companies, doctors and hospitals. This is no longer desirable; citizens and patients must be able to submit applications too.
Not a sickness policy but a health policy, with clear objectives (see also 5 and 7), aimed directly at the patient and viewing the patient as a whole, not just on his condition(s).
An emphasis on prevention, health promotion and health education. This also requires: moving from problem-oriented or disease-focused care towards targeted care encompassing the aim of "maintaining health".
Alda Greoli, cabinet secretary to the Walloon Minister of Health and Social Action Maxime Prévot, underlines that the methodology of the CitizenLab ‘shows that solidarity is the best way to soften our selfishness’.
She was careful to point out that prevention and health promotion are very important to citizens. Since the Sixth State Reform, these areas are within the remit of the Regions and Communities. “We are working towards harmonization of these policies” confirms Alda Greoli, “and we will strive to include them in the long term, well beyond this legislature.”
Not life extension in itself as the ultimate goal of healthcare, but the quality of life of the patient and his environment.
Maintaining a high quality of life for as many years as possible should be the mission of our healthcare, according to a participant in the CitizenLab.
Flanders has shown, through the socialization of care and through its disability reform, that quality of life is the key frame of reference for policy making, says Jo Vandeurzen, Flemish Minister of Health, Welfare and Family. Health can be linked at the community level with welfare and family policy. This allows Flanders to play an important role in achieving health goals.
Citizens expect the authorities to regularly re-map health and welfare needs and not just to constantly build on agreements made in the past. We need to move toward a flexible, learning system. Citizens have no objection to making better use of the huge quantity of data available to governments. They even support this, as long as it is well organized.
Jo De Cock, General Administrator of the RIZIV/INAMI is aware that his organization should evolve into a learning organization. He suggested renaming it the Federal Care Institute. Patients need to become more involved in decision-making and the General Council of the RIZIV/INAMI could be the platform where health objectives are developed in consultation with the communities and regions.