Accessibility of healthcare

Accessibility can be defined as the ease with which health services are reached in terms of physical access (geographical distribution), costs, time, and availability of qualified personnel. Accessibility is a prerequisite for a high-quality and efficient health system.

We have defined four sub-dimensions of care accessibility:

Summary of the accessibility indicators
Indicator (ID)ScoreBELYearFlaWalBruSourceEU-15 (mean)
Financial accessibility
A-1 Coverage by the compulsory health insurance (% of the poupulation) green stable 99.0 2017 99.5 99.3 98.1 RIZIV-INAMI -
A-2 Out-of-pocket payments
(% of current expenditures of health)		 green improving 15.9 2016 - - - SHA, OECD 17.7
A-10
NEW 2019		 Out-of-pocket medical spending
(% of final household consumption)		 orange stable 3.0 2016 - - - SHA, OECD 2.6
A-3 Out-of-pocket payments per capita
(in US $ PPP)		 orange improving 738.9 2016 - - - SHA, OECD 732.2
A-11
NEW 2019		 Out-of-pocket payments for dental care
(% of current expenditure on dental care)		 orange deteriorating 57.6 2016 - - - SHA, OECD 59.2
(EU-10)
A-4** Self-reported unmet needs for medical examination due to financial reasons in Belgium (% of individuals included in the survey) red improving 2.0 2017 - - - Eurostat
(EU-SILC)		 1.2
A-12
NEW 2019		 Access to agreed tariffs, conventioned practising GPs (in FTEs per 10 000 population)***** C 7.0 2016 7.4* 6.8* 5.0* RIZIV-INAMI -
A-13
NEW 2019		 Access to agreed tariffs, conventioned practising dentists (in FTEs per 10 000 population)***** C 3.2 2016 2.9* 3.4* 4.3* RIZIV-INAMI -
A-14
NEW 2019		 Percentage of the billed fee supplements to the billed official health insurance fees

↗

 18.5 2017 14.0 20.2 31.5 IMA-AIM -
Health workforce
A-5 Practising physicians
(per 1000 population)		 ↗ 3.1 2016 2.8* 3.2* 3.8* RIZIV-INAMI, OECD 2018 3.5
(EU-10)
A-6 Practising nurses
(per 1000 population)		 ↗ 10.9 2016 11.7 9.8 10.7 FOD-SPF, OECD 2018 9.4
(EU-11)
A-7 Number of nurse vacancies in hospital → 1274 2016 - - - FOD-SPF -
A-8***  Patient-to-nuse ratio red empty 10.7 2010 - - - RN4CAST 9.0
Waiting time
A-9**** Waiting time of more than two weeks to get an appointment with a specialist
(% of population asking an appointment)		 orange stable 38.4 2013 38.6 38.9 36.0 HIS -

 *Based on the place of the physician’s home and not the place of the physician’s practice (potential differences between regions are therefore not highlighted). A recent study based on the place of the GP practice obtained 1.23 practising GP per 1000 population in Brussels in 2017 (while with 2016 RIZIV – INAMI data based on the place of the physician’s home, it was 1.17 per 1000 population).**The principal indicator should be based on the health interview (HIS) survey but only results from 2013 were available. This indicator is therefore currently based on results from the EU-SILC and will be updated on the website (https://www.healthybelgium.be/) when the HIS 2018 results become available. ***This indicator will be updated on the website when results of the ongoing KCE study on nursing staff in hospitals become available. ****This indicator will be updated on the website when the HIS 2018 results become available.*****Conventionned physicians in Belgium are physicians that acceded to the agreed tariffs negotiated by RIZIV – INAMI and sickness funds, meaning that they will not charge supplements to the patients in ambulatory care.

Some of the indicators analysed in other sections of this report may also be interpreted in terms of accessibility:

  • Among preventive care indicators: Percentage of women receiving a breast cancer screening test (P-6, P-7), number of people who do not have regular contacts with a dentist (P-11).
  • Among mental healthcare indicators: Number of psychiatrists (MH-2); Waiting time before a 1st appointment at a mental healthcare facility (MH-3).
  • Among care for the elderly indicators: Percentage of elderly people receiving long-term care in MRPA/MRS facilities (ELD-1) or long-term care at home (ELD-2), Informal caregivers for people aged 50 years and over (ELD-3), Number of available spaces in long-term care beds (ELD-4), Number of not highly dependent persons in MRPA/MRS facilities (ELD-5); Number of geriatricians (ELD-6).
  • Among end-of-life care indicators: Number of patients receiving palliative care (EOL-1); Number of patients receiving palliative care too late (EOL-2).