fredag 10 maj 2019

Flanders - inspirational weekend reading - Belgium part I

The Future of E-health in Belgium

This week we had the opportunity to hold a seminar together with Flanders Investment & Trade to  explore the latest digitalization partnership opportunities within the Belgian healthcare system. The interest for the seminar was high and it was very nice to see so many Swecare members represented; Zenicor Medical Systems, Raytelligence, Camanio Care, WeCare AB, Predicare, Doctrin and Karolinska Institutet.

Mikael Larsson, foreign investment advisor opened the seminar with a short introduction of Flanders Investment & Trade, which is a government agency supporting companies interested in investing in Flanders with assistance and information. They have more than 70 regional offices worldwide.

Elucidating the Belgian healthcare system within a couple of hours is no easy task but invited guest speaker Peter Raeymakers, from Zorgnet Icuro, gave an excellent presentation.

To understand the basics, he opened the presentation by letting us know that Flanders is the Dutch-speaking northern portion of Belgium. The capital of Flanders is Brussels, which is also the capital of Belgium and home to the headquarters of the EU and NATO. Flanders has its own parliament and government. Flanders, despite not being the biggest part of Belgium by area, is the area with the largest population (68.5%). 7,876,873 out of 11,491,346 Belgian inhabitants live in Flanders or the bilingual city of Brussels.

Present-day Flanders (dark green) shown within Belgium and Europe.
Brussels is considered part of the geographical region but is politically separate.

The Belgian healthcare system is mainly organised into two levels: federal and regional. Responsibility for healthcare policy is shared between the federal government, the Federal Public Service Social Security, the National Institute for Sickness and Disability Insurance (INAMI), and the Dutch-, French-, and German-speaking community Ministries of Health. The federal government is responsible for regulating and financing the compulsory health insurance, determining accreditation criteria, financing hospitals and so-called ‘heavy’ medical care units, as well as legislation covering different professional qualifications, and registration of pharmaceuticals and their price control. The regional governments are responsible for health promotion, maternity and child health services, some aspects of elderly care, implementation of hospital accreditation standards, and financing of hospital investment.

The Belgium healthcare system is divided into state and private sectors, with fees payable in both, funded by a combination of Belgian social security contributions and health insurance funds. With mandatory health insurance, patients are free to choose their own medical professionals and places of treatment. Patients generally pay costs upfront and are reimbursed a proportion of the charges for medical and dental fees, hospital care and treatment, maternity costs and prescriptions through their Belgian health insurance fund. Doctors work in public and/or private settings. Dentists are almost all private. Hospitals and clinics are private and usually managed by universities, religious organizations or mutuelle/ziekenfonds.

In 2013, Belgium’s total health expenditure was 10.2% of the GDP, which is 6th highest among the EU-15 (OECD, 2015). The Belgian health system is primarily funded through social security contributions and taxation. Public sector funding as a percentage of total expenditure on healthcare fluctuates around 70%.

1/3 of the Belgian hospitals are operating in the red and that is due to the increasing cost of healthcare. Another substantial factor in Belgium, are the costs of medical professionals. This is a wake-up call to restructure funding and provision approaches.

As Belgium is on the verge of reforming its health care system, it is the perfect moment for Swecare members to engage in this transformation and benefit from new opportunities. With 11 million inhabitants, an ageing population which increases the need for collaboration in efficient healthcare, couple with the fast pace of technological change, Belgium needs to invest in innovation.

The Swedish think tank Health Consumer Powerhouse (HCP) has been comparing 35 European care systems since 2005 and presented a study in February this year showing that Belgium has risen to the 5th spot in the European health index, up from 8. Belgium is lauded for its quick and good treatments, high levels of child vaccinations, and the affordability of health care. Long waiting lists in mental health care and a lack of information are identified as points where action should be taken.

Now, start-ups are rising in the e-health sector. They provide solutions that combat the healthcare challenges of today:
  • People are making worse lifestyle decisions with higher risks of chronic diseases as a result
  • Rising costs creates friction to democratize healthcare for everyone
  • Seniors are getting older and older

Just to name a few examples of the challenges, Belgium aims to be the place-to-be for HealthTech innovations, attracting talent and innovations from all over the world.

Belgium has big plans for implementing E-health in the healthcare system. It’s now possible to share medical information and ‘documents’ of patients on secured platforms. It is termed the EPD (Elektronisch Patiënten Dossier) in Belgium. Every caregiver will have access to the relevant information of their patient. Easier access supports multidisciplinary care and drives collaboration between the specialists. These elements increase the quality of care. Patients are included in this e-health transformation. They can have access to their medical records, which helps them to be on track with their health. Furthermore, communication between patients, caregivers and other stakeholders will improve with the EPD. Electronic platforms ensure processes to run even smoother.
However, while many health data are being collected and published in Belgium, some data are collected but are not used (e.g. morbidity indicators), while for other areas such as nursing, primary care, psychiatry, elderly and nursing homes, and non-reimbursed payments only limited data are available. In addition, the coordination to integrate the data available for policy decision should be strengthened.

Peter explained more about the national project “eHealth Hubs & MetaHub” coordinated by the eHealth platform is meant to make medical results from hospitals (and in the near future medical laboratories) available to any caregiver who currently is treating the patient. For detailed information see This system supplements the traditional system of addressed ‘email type’ communication to individual referrers.
Before medical data about a patient can be shared, that patient has to grant the “eHealth informed consent” (see Further, care providers declare a therapeutic relationship with the patient.

Communication between the hubs and between external physicians and a hub is according to the KMEHR standard:

M-Health Belgium
Peter also talked about mHealthBELGIUM, which is the Belgian platform for mobile applications that are CE-marked as a medical device. It offers all the relevant and necessary information to patients, healthcare professionals and healthcare institutions regarding these mobile applications. The information on this platform covers CE-marking, GDPR, compliance with security and authentication rules and how the app is financed. mHealthBELGIUM is an initiative of the Federal Belgian Government. This platform of 24 selected projects are operated by Agoria & beMedTech, in close cooperation with NIHDIFAMHP & the eHealth Platform.

The Belgian government with Maggie De Block (minister of Public Health) at the forefront sees these life-changing opportunities. Her aim is to incorporate M-health into the healthcare. But before M-health solutions are implemented, they will go through a validation pyramid. The validation pyramid analyses whether an application is safe, secure and provides benefit to the patient, caregiver or the healthcare system. That is to say healthcare is one of the slowest sectors to adopt healthcare technology. Therefore, to fast-track these applications, this evaluation model will ‘test’ and ‘fail solutions quicker. No more delays of valuable innovations accessing healthcare.

De Block has performed the validation pyramid on 24 M-health applications and published the first results. As expected, the main benefit is that patients are more involved in their health maintenance. They are more willing to follow through with their treatment, feel supported and safely tracked by a caregiver on distance. Giving the patient control, also drives healthier choices in lifestyle.

Peter mentioned that there’s a good chance for you to enter the Belgian market with your health app, but it must be a medical device. Please visit; and read the FAQs and how to apply, etc.

Peter represented Zorgnet Icuro which is a network of health care organizations, general hospitals, elderly care clinics with around 775 members and employing around 129.000 people. Their goal is to exchange information, knowledge and ideas in health care. And to discuss several issues in the healthcare sector.

Before the seminar ended, we had the pleasure to listen to Collective Minds Radiology AB a small start-up which sells a platform for Radiologists. They’ve just entered the Belgian market by landing on a right contact through LinkedIn and had the same morning signed a contract with AZ West Hospital in Veurne and will during next week introduce their platform to other hospitals in the region.

Amber Ryckewaert from Flanders Investment & Trade wrapped up and invited all participants and members of Swecare to join them on a 2-day study visit to Flanders some time during week, 21-25 October 2019. The outline is not ready yet as they wish You to come with your wishes! So, if you’re interested in entering the Belgian market please contact Amber RYCKEWAERT, for more information!

We say a big thank you to Flanders Investment & Trade for making this an interesting event for our members!

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