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

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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

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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 GP’s about the

specific procedures (AMU)– More visibility for the project

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Number of patients 2003

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

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Status of the patients2003

Statuut Brussel Antwerpen Luik TOTAAL

Clandestien 1299 419 144 1862

Illegaal 394 246 182 822

Asielzoeker 132 67 33 232

Art 9 § 3 396 231 167 794

Visum 110 20 40 170

Verblijf < 3 maanden 0 42 0 42

Legaal 77 62 51 190

Andere 34 12 28 74

Onbekend 9 24 8 32

TOTAAL 2451 1123 653 4218

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Nationality of the patients 2003

Nationaliteit Brussel Antwerpen Luik TOTAAL %

Belg 60 52 68 180 4

EU 28 16 20 64 1

Afrika 559 230 213 1002 23

Maghreb 575 144 192 911 21

Europa niet-EU 724 341 149 1214 28

Azië 96 104 59 259 6

Latijns-Amerika 459 241 6 706 16

Noord-Amerika 0 1 6 7 0,15

Onbekend / Andere 10 46 8 54 1

TOTAAL 2511 1175 721 4397

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Lobbying strategy

Focus on all levels involved:Collaboration with local and regional NGO’s and

institutions• Federal: Ministry of Social Integration

• Regional: Flemish, Brussels and Walloon Unions of Cities – section CPAS

• Local: CPAS, city

• Health care suppliers: GP’s

• Political: inform party or opposition members

• Media attention• (International)

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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