The decision is made: as of 1 August 2022, public financing for digital consultations by (general) practitioners will also be introduced in Belgium. So far only a temporary arrangement applied (since covid). Belgium is now taking a step towards telehealth for all Belgians, as is the case all over the world. The next few years will be about learning from real-life experience. Hybrid care, the most optimal combination of physical and digital, is thus coming closer.
Telehealth runners in Europe
Last year, dashplus made this image about post-covid telehealth in Europe:
As you can see, Belgium is still relatively behind in telehealth. Since March 2020 (the start of the lockdowns), the country has only introduced a temporary arrangement for digital consultations with all healthcare professionals.
Neighbours France (2018) and Germany (2019) introduced permanent financing of digital health services for all HC-professionals already before covid. But despite years of experience from Scandinavia and Portugal Belgian decision-makers remained anxious: won’t public healthcare spending skyrocket? Won’t doctors lose contact with their patients? Will they be able to work with digital tools and will this not result in extra administration? Won’t teleconsultation harm the weak and the elderly in society? And finally (despite tons of research and calls to action from ao WHO): is there sufficient scientific evidence that digital consultations are as qualitative as physical consultations?
Fortunately, by mid-summer 2021, the Belgian government had already determined that telehealth should have a permanent place in the health system after COVID, so a decision had to be made anyway.
How is telehealth organised as of 1 August 2022?
This is now in place: Belgian general practitioners (GPs), specialists, psychiatrists, child psychiatrists and neuro-pediatricians are reimbursed by the health administration RIZIV/Inami for teleconsultations (’consultations at a distance’).
They receive a fee of 23,06 euros for a video consultation and 10,38 euros for a telephone consultation. Doctors can have an unlimited number of consultations with their patients in this way. And this also applies within medical guard services. The doctors will therefore use brand new and permanent reimbursement codes for this as of 1 August 2022.
Doctors are free to choose which platform they use to conduct the digital consultation and how they collect payment for it. This is similar to the arrangement in neighbouring countries.
Patients, for their part, will be reimbursed for the consultation and will only have to pay a fee of 4 euro. They can take the initiative for a teleconsultation at any time. But it is up to the doctor to judge whether a remote consultation is the right choice for a specific question. For example, the doctor must be able to consult the patient’s file during the consultation.
But there are a number of conditions for the public reimbursement by RIZIV/Inami of remote consultations. These must be consultations:
- with a doctor with whom the patient already has a ‘treatment relationship’. This is described as follows:
- a GP who manages the patient’s Global Medical Record (GMD) (or another doctor of this practice)
- a GP or specialist with whom a physical consultation has taken place in the current calendar year or in at least 1 of the 2 calendar years prior
- with a specialist on referral from a GP. The specialist must indicate the referring doctor in the consultation report
- within a medical guard service
Healthcare providers can use a platform of their choice. It must comply with these technical provisions in order to be publicly reimbursed:
- communication takes place via end-to-end encryption
- communication is not stored on the platform
- if the platform contains other functions besides the possibility of video or audio communication (including the exchange of documents), these are provided in such a way that the users can comply with the applicable legal provisions, as described on the eHealth website
Belgium makes a leap forward to hybrid care
From 1 August 2022 onwards, Belgium will therefore make a leap forward: it will now be possible for all doctors and all patients to have a physical OR a digital consultation together.
Of course, GPs will have to learn how to do this and will need support.
But we also know from other countries that most digital consultations are actually done by GPs. And that it is not only younger GPs, but also more experienced professionals. They are pushed by the patients, who are always extremely satisfied with this closer contact with a doctor.
Another important point is accessibility of healthcare. Telehealth supports accessibility of the health system, since it’s easier for people with reduced mobility, small social networks, low SES. And it reduces no-shows. But the current financing is not helpful on this point.
So, there are still important challenges to be tackled. And Belgium still needs a regulation for tele-expertise and mobile health apps.
Do you want to explore and understand the healthcare system in Belgium? We organise a stakeholder webinar on 9 December 2022. You’re welcome to join!
What will the future bring?
- In the coming years, there will be a lot to learn about the real-life application of remote consultations in Belgium. No doubt, the current framework will continue to evolve. It’s crucial to make the health system sustainable for the future.
- Also an arrangement for tele-expertise is being worked out. This should be in place by end of 2022. Doctors and care providers will then be able as well to consult each other digitally.
- And what about mobile health apps? Belgium has brilliant companies for the monitoring and therapy of a range of conditions. But only two (2!) of them are currently reimbursed- under a nominative arrangement. About 20 other mobile health companies are still waiting for a generic arrangement. In the meantime, private health insurances like Helan, CM, and LM luckily started to finance them.
Belgium should follow the example of European biggest market Germany here with the so-called sand box model: take the decision to prescribe and reimburse medical apps that are M2 on mobile health pyramid for 1 year. Within that period, providers have the chance to conduct and publicly present a final reimbursement study. Final take up in the public system is possible after 1 year.
Belgium is now making a leap into telehealth, but still has some hurdles to overcome before becoming the Nafi Thiam of digital health.
Click here if you want to know how telehealth is organised in other European countries.
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