Minister

DepartementWVG

Youth Welfare

Flemish Agency forCare

and Health

Care

InspectoratePC Geel

PCRekem

Flemish Agency of Disabled Persons

Child and Family

Strategic Advisory Council

Flemish Care Fund

Fund for Youth Welfare

Policy Council

Management committee

Flemish Ministry of Welfare, Public Health and Family (WVG)

1. Health and health care policy in Flanders (Machteld Wauters - VAZG)

2. VIPA: funding health care infrastructure (Christophe Cousaert - VIPA)

3. Innovation initiatives: Primary Care Safe and Flanders’ Care (Machteld Wauters)

Health and health care policy in Flanders

Machteld WautersFlemish Agency for Care and Health

Health in Flanders

• Belgium: regions and communities

• Competences in health

• Flemish policy in health– Public health – Health care

Belgium

Political situation

• (De)federalisation process: since 1980 responsibilities for health care are increasingly delegated to regional level (‘devolution’)

• Complex: 6 authorities responsible for health matters in Brussels!

• Interministerial conferences to ensure consistency and complementarity of policies

Belgium Flanders (person-related matters)

Health/Health Care

- Organic laws

- Basis rules planning/ financing infrastructure

- Financing regulation operating costs hospitals/nursing homes

- Health insurance system

- Preventive health care

- Health promotion

- Implementation hospital standards, quality assurance policy

- Ambulatory mental health care

- Coordination home care

Infrastructure - DBF 40%

- Basic rules planning/financing infrastructure

- Subsidizing 60%

- Specific legislation quality

Competences healthcare Belgium/Flanders

Health care budget

107

17200

0 5000 10000 15000 20000

x 1 000 000 euro

Budget

FedHinsur

Flanders

Flanders

• Competences in health and health care

• Policy in public health

• Policy in health care

Flemish competences in health

• Health promotion

• Prevention of noncommunicable and communicable diseases

• Implementation of hospital standards, quality assurance policy in health services

• Subsidizing health care infrastructure

• Ambulatory mental health care

• Coordination of home care

Objectives of the Flemish health policy• Promote the choice for healthy

lifestyles

• Prevent diseases, their risk factors and complications

• Stimulate and monitor the performance of health care services

• Tune the supply of health care to the needs of the population

• Provide accessible and affordable care

• Strengthen active participation and correct treatment of users of care

Flemish agency

Flemish Agency for Care and Health

• The mission of the Agency is to create the conditions to promote, protect and restore the welfare and health of the current and future population of Flanders, aiming for an optimal level of welfare and health of all citizens.

Flemish preventive policy

Decree on preventive health care 2003

working with health targetsMETHODOLOGY

Decree on preventive health care 2003

• Epidemiological basis for policy • Health conference large societal basis

– Health targets (SMART)– Prevention strategies

• Approved by Parliament• Executed by government political

commitment

Decree on preventive health care 2003

• Epidemiological basis for policy

• Health targets

• Prevention strategies

• Implementation of policy

Health in all policies

•Partner organisations

•Organisations in the field

•Logo’s

•Individual providers

Main causes of death per age groupMen Women

<10 years Several causes of death, but small numbers

10-14 years

Transport accidents15-19 years

20-24 years

Suicide25-29 years

30-34 years

Suicide35-39 years

40-44 years

Breast Cancer

45-49 years

50-54 years

Lung Cancer

55-59 years

60-64 years

65-69 years

70-74 yearsIschemic Heart Disease

75-79 years

80-84 years Ischemic Heart Disease Cerebrovascular Conditions

>85 years Heart Decompensation, Complications and unclear Heart Conditions

Evolution of deaths preventable by primary prevention (1999 – 2008)

Flemish health targets

1. Diet and physical activity 2. Tobacco, alcohol and drugs3. Breast cancer screening4. Suicide prevention5. Injury prevention6. Prevention of infectious diseases by

vaccination

Health care

• Belgian Health care system

• Flemish competences and policy

Belgian health care system

• Compulsory public health insurance system• Independent medical practice• Free choice of health care provider by the

patient• Fee-for-service payment of providers, with

reimbursement

Flemish competences in health care

Implementation of hospital standards, quality assurance policy in hospitals and nursing homes

Subsidizing health care infrastructure

FLEMISH LEVELFEDERAL LEVELEXPLOITATION

INFRASTRUCTURE

€

Division of competences in Belgian health care policy : hospitals

Basic legislation

Basic legislation

Execute (recognitions)

Inspection of recognitions

Strict legislationVIPA

Funding 40% (BFM) €

- BFM (budget financial resources)

- RIZIV €

Subsidy/guarantee60% €

Flemish competences in health care

Implementation of hospital standards, quality assurance policy in hospitals and nursing homes

Subsidizing health care infrastructureCoordination of primary care and home

careAmbulatory mental health care

Flemish policy in health care

Priorities:Stimulate and monitor the performance of health care

servicesTune the supply of health care to the needs of the

populationProvide accessible and affordable careStrengthen active participation and correct treatment

of users of care

VIPA - Flemish Infrastructure Fund

Christophe Cousaert

Flanders, Belgium

1. VIPA: Flemish Infrastructure Fund

2. Funding hospital infrastructure

3. Facts and figures

4. Policy health infrastructure

1. VIPA: Flemish Infrastructure Fund

Minister

DepartementWVG

Youth Welfare

Care and Health

Care

InspectoratePC Geel

PCRekem

Flemish Agency of Disabled Persons

Child and Family

Strategic Advisory Council

Flemish Care Fund

Fund for Youth Welfare

Policy Council

Management committee

Policy area Welfare, Healthcare and Family (WVG)

“VIPA’s mission is to develop initiatives and provide funding for a high-quality, accessible and affordable infrastructure for the provision of care and services

within the framework of matters relating to the individual.”

Mission

Key assignments

The funding, in any way, of infrastructure of welfare and care 1.

The coördination, steering and direction of public-public and public-private partnership (PPS)

2.

The promotion of knowledge and expertise in terms of concept, finances

and technical engineering3.

The building up and management of financial reserves4.

Scope of application

Hospitals, psychiatric care homes, psychiatric hospitals

Elderly homes, day care centers, short stay centers, local service centers

Preventive and ambulatory healthcare

Facilities for youth welfare

Facilities for disabled persons

Creches

General welfare centers

1.

2.

3.

4.

5.

6.

7.

2. Funding hospital infrastructure

Funding hospital infrastructure

40%

60%

New building, renovation, purchase + renovation

Max. m²/resident (f.e.: 110 m²/res. general + 25% university; 90 m²/res. psychiatric)

Moveable investments = 60% accepted costs

Basic rules

60% accepted costs < max. cost price 1.100 €/m²(priority renovations = 10% Flanders)

Budget Financial Resources – 40% write-off amounts

Alternative funding hospital infrastructure

Agreement in principleFlemish minster

20 years utilisation grants linked to utilisation norms

(f.e.: occupancy rates, …)

I. Approved strategic care plan (ticket to start)

II. Approved technical-financial plan (businessplan + plans of architect)

II.1. Agreement in principle (no commitment) (= spreading funding over economic life of infrastructure (20 years))

II.2. Funding (utilisation grants) during 20 years linked to functional application to be justified

(by reviewing utlisation norms)

Procedure alternative funding

3. Facts and figures

Facts and figures

10,6 mio inhabitants 6 mio inhabitants

45.000 hospitalbeds 31.000 hospitalbeds

100 general hospitals 71 general hospitals

Number of general hospitals (incl. university hospitals)

2000-2010

91 88 85 85 83 81 7975 74 71

0

10

20

30

40

50

60

70

80

90

100

2000 2001 2002 2003 2004 2005 2006 2007 2008 2010

Facts and figures - evolution

- 20%

Incl. 4 university hospitals – excl. 39 psychiatric hospitals

Evolution number of hospital beds (general + university)

2000-2010

31.474 31.279 31.115 31.141 30.939 30.952 30.844 30.872 30.840 30.787

25.000

26.000

27.000

28.000

29.000

30.000

31.000

32.000

33.000

34.000

35.000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2010

Incl. 4.600 university beds – excl. 10.000 psychiatric beds

One day hospital: 34% in 2000 to 47% in 2008 (+ 85% treatments)

Facts and figures - evolution

Average capacity general hospitals2000-2010

362 372 384 384 392 402 411435 441

460

0

50

100

150

200

250

300

350

400

450

500

2000 2001 2002 2003 2004 2005 2006 2007 2008 2010

800 mio € (80 mio €/year)

2010-2014: 1.800 mio € (360 mio €/year)!

Facts and figures - evolution

4. Policy health infrastructure

Quality of infrastructure Comfort

Healing environment: accent on userscomfort

Indoor climate: lower CO2-emissions

Sustainable and energy-efficiënt construction: sustainability criteria

Evolution to high-tech hospitals: best practices?

Quality of infrastructure Art

Design meets art – art meets design

Flemish government subsidizes art works integrated ininfrastructure projects

Networking

Future challenges = working together

Evolution to centers of excellence in specific segments

Innovation and Entrepreneurship in Care

Care: large economic impact

16% active population

8% GDP Flanders(unchanged policy)source: Planbureau

+ 70.000 jobs 2014

• Investing in qualitative and accessible care – Maximizing societal added value

• Investing in innovative care– Maximizing new perspectives in (health) care

• Investing in strong entrepreneurship in view of– Market innovation in Flanders– Maximizing economic added value– International valorization

Flanders’ Care

Care & Innovation & Economy

Kris Peeters, Flemish Minister-president

economy

Jo Vandeurzen,Flemish Minister

care

Ingrid Lieten, Vice Minister-presidentinnovation

Flanders’ Care mission statement

To measurably improve the quality of care through innovation and responsible entrepreneurship

Governance Structure

Innovation perspective

RESEARCH &DEVELOPMENT

Quality of Care

IMPLEMENTATION INTERNATIONALVALORIZATIONDEMONSTRATION

Economic Development

Policy instruments: finding synergies!

CareInnovation Entrepreneurship

Policy

Impulse office

Seed CapitalDemonstration projects

Innovativetendering

““Bridging the Gap”Bridging the Gap”

• Inform and sensitize stakeholders: – Care organizations– SMEs and other private companies– Knowledge sources

• Guidance:– Guide initiatives through the different government instruments of policy domains:

• Welfare, Public Health and Family Affairs (WVG, VIPA, …) • Economy, Science and Innovation (EWI: IWT, AO, PMV,…)• Flanders International (VI: FIT, VAIS,..)

• Brokerage:– Direct towards the most optimal government instrument for optimal use and

exploitation• Customized service • Start up: end of October

Impulse office Flanders’ Care

• €20 mio venture fund• Managed by PMV (Participatie Maatschappij Vlaanderen)• Supports entrepreneurship in care • for a more effective implementation of care technology• And a more innovative product and service offering in care• Target group: start-ups, young companies (SMEs) and

companies starting up new activities.• Complementary to the existing sources of seed capital• Necessary because of barriers specific to the care sector

– Long pre-commercialization trajectory– Diversity of stakeholders– Reimbursement system(s)– …

• Strong involvement care stakeholders in decision making process

Seed Capital in Care

Care for Talent• Competence buildup • For innovative solutions in care• Concept document: ‘making work of work’• General practitioners and specialists• Nurses and other care professionals• Primary healthcare conference

(December 2010)+ 70.000

Jobs in care

• Similar challenges all over EU• Importance of regional positioning

– Regions holding the implementation key– ‘Smart specialization’ – Requires a bottom-up approach

• Collaboration will yield societal benefits– Innovation absorption– Market development– Quality of care increase

• Benchmarking

EU perspective

• Flemish health portal:

www.zorg-en-gezondheid.be

• Contact: – internationaal.azg@wvg.vlaanderen.be– vipa@vlaanderen.be