The ability of the system to provide and maintain sufficient infrastructures and (innovative) health technologies, including health products, medical equipment and information technology (eHealth), is an essential factor to ensure that our health system will still be performant and relevant tomorrow.
In this section, we will examine this aspect of sustainability through indicators relating to infrastructures (S-11), to the use of information technologies (S-27) and to the availability of health products (S-28):
- The number of curative care bed-days (S-11)
- The proportion of GPs who meet certain thresholds for the use of eHealth services (S-27)
- The number of notifications of temporarily unavailable packs of medicines for human use with a critical impact (S-28)
Further information on the hospital infrastructure can be found in the section on key data in healthcare.
|Health technologies: eHealth
|GPs meeting the thresholds for a selection of 6 eHealth services eligible for the integrated practice bonus (% of active GPs)
|Health technologies: Health products
|Notifications of temporarily unavailable packs of medicines for human use with a critical impact (Number)
|Curative care bed-days (number/capita)
The number of curative care bed-days (also known as “inpatient days”, i.e. the total number of days spent in Belgian general hospitals by all patients over the course of a year) gives an indication of the population’s need for acute care beds and thus of the infrastructure required to fulfil this need. The evolution of this number over time can alert us to a potential threat to the sustainability of the system, should the available infrastructure become insufficient to cover the needs of the population. For this indicator, we have chosen to present the number of inpatient days per capita, i.e. the average number of days one person will spend in hospital over the course of a year.
- The number of inpatient days per capita in acute care beds in Belgium decreased from 1.1 in 2010 to 0.9 in 2021.
- The number of inpatient days per capita is substantially higher in Brussels than in Flanders and Wallonia (1.30 vs 0.87 and 0.88, respectively) because people living in the surrounding area are frequently hospitalised in Brussels, as evidenced by the lower figures in Flemish (0.57) and Walloon Brabant (0.34).
- Likewise, the province of Luxembourg totals a relatively low number of inpatient days per capita (0.65) due to the low density of hospitals in this province. It is possible that a number of patients are hospitalised over the border.
- In 2021, the number of curative care inpatient days per capita in Belgium was similar to the EU-14 and EU-27 averages at around 0.9 per capita.
- During the COVID-19 pandemic, there was a sharp decrease in the number of curative care inpatient days in Belgium (-18.2%) due to the postponement of non-urgent care, which ensured hospital capacity overall was not threatened during the pandemic. This decrease was stronger than the EU-14 (-11.4%) and EU-27 (-15.2%) averages.
Data source: RHM - MZG, based on the accurate length of stays
The use of digital technologies in health care can have several benefits, such as ensuring access to the right information by the right people at the right time (thus improving the quality and efficiency of care) or simplifying time-consuming tasks for healthcare professionals, freeing up time for direct interaction with patients.
To promote the use of eHealth services, a financial bonus is offered to GPs who reach certain activity thresholds for ten of them (including online prescription, online invoicing, use of certain electronic forms, etc.). The total bonus is calculated based on the number of services for which the threshold is reached. This indicator assesses the percentage of GPs who reach these thresholds for a selection of six eHealth services.
- The share of GPs meeting the thresholds for the 6 selected eHealth services increased from 51.2% in 2019 to 71.4% in 2021.
- This percentage is lower in Brussels (45.8% in 2021) than in Flanders (78.0%) and Wallonia (66.6%).
- The eHealth services for which the thresholds are reached most often are the online registration of informed consent for patients who have a Global Medical Record (GMR) with their GP (95.1% in 2021), the use of MyCareNet to manage the electronic GMR (93.4%) and the online prescription of medication (91.8%).
Data source: RIZIV-INAMI
Notifications of temporarily unavailable packs of medicines for human use with a critical impact (S-28)
When it comes to pharmaceuticals, even temporary shortages and supply interruptions can have a very real impact on the ability of the system to provide patients with the treatments they need, though this is fortunately not always the case.
A shortage occurs when supply does not meet demand at a national level. In Belgium, a medicine is considered unavailable when its manufacturer is unable to deliver the required quantities within 3 working days. This issue is becoming increasingly common in many countries for a number of reasons, like delays or other problems affecting production, an increase in demand, recalls or various practical or legal issues, and has been made even more prominent by the COVID-19 crisis.
Periods of unavailability, interruptions and discontinuations of three working days or more have to be notified to the Federal Agency for Medicines and Health Products (FAGG/AFMPS). Since December 2019, they are also published on PharmaStatus by the FAGG/AFMPS. This information is then fed directly into the electronic prescribing system to alert prescribers in real time. The system classifies shortages based on their impact on patients; it is important to be aware some of them have few or no consequences from a clinical point of view, as suitable alternatives are often readily available.
A shortage or unavailability can be temporary or permanent (when the product is withdrawn from the market altogether); our indicator focuses on temporary disruptions.
- In Belgium, the number of shortage notifications increased from 621 in 2015 to 3044 in 2022, probably at least in part due to an improved monitoring. Over the same time period, their average duration fell from 123 to 51 days.
- In 2022, 37% of shortage notifications concerned medicines with at least three alternatives available, 30% were short-term issues and only 1% could be considered critical, i.e. having a substantial impact on patients.
- The number of notifications with critical impact increased from 21 to 36 between 2020 and 2022. In 2022, the average duration of those critical shortages was 155 days and 56% of them concerned immunoglobulins (used to fight off infections, particularly in people with a weakened immune system). This is not a new problem, but it was further amplified during the COVID-19 pandemic due to an increased demand and a reduced collection of the plasma used to produce this type of medication.
- Medications targeting the nervous system (25%) and the cardiovascular system (16%) totalled the largest share of notifications in Belgium in 2022. This is in line with previous years and with the trend observed in most OECD counties for the 2017-2019 period.
Data source: FAGG - AFMPS