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Highlights

Funding for ambulance and PIT 

“Since the reform of the funding for ambulance services and the introduction of the fixed invoice price to the patient, the subsidy granted to the ambulance services has increased significantly.”                                    
 

In 2018, the way in which ambulance service subsidies were allocated was reformed[1]. Previously, ambulance services received a flat-rate payment for each on-call rotation they operated. Since the reform, the subsidy for an ambulance service consists of two parts:

  • Activation premium: subsidy for the journeys made. Since 2018, this premium has been calculated on the basis of the number of journeys made and the total number of kilometres travelled in the past year. In 2024, this calculation method was revised in favour of funding calculated prorata on the number of kilometres travelled during the previous year. This amount is defined annually by the minister. In 2024, this premium stood at 2 euros per kilometre travelled.
  • On-call bonus: subsidy for operating their on-call rotation(s). The ambulance services are remunerated on the basis of a points system, depending on the number of on-call rotations they operate, their opening hours (day, night, Sundays and public holidays, etc.), accommodated or unaccommodated on-call rotations.

The above relates to the funding of regular ambulance services and PIT functions.

Funding for ambulance and PIT

Since 2018, the subsidy granted to the ambulance services has increased considerably due to the introduction of a fixed invoice price, which ambulance services can charge to the patient[2]. This amount was set at 70.92 euros in January 2024. In many cases, this fixed invoice price was lower than what the ambulance services previously charged their patients. To compensate for this loss of income, the subsidy from the government was substantially increased. Moreover, in 2020, an extra one-off subsidy of 8 million euros was awarded to the ambulance services due to the COVID-19 pandemic.

In recent years, political lobbying has highlighted the structural underfunding of emergency medical assistance. Consequently, the budget of 146,170,000 euros awarded in 2024 is an increase of 54,980,000 on 2023.

Funding of MUG/SMUR
The Medical Emergency Group (MUG/SMUR) function is partly funded via the Financial Resources Budget (FRB)[3] for hospital funding. In this context, the MUG/SMUR function is funded on a flat-rate basis with a single amount being granted for each accreditation. This means that no account is taken of the real cost and that no contribution for the MUG/SMUR can be charged to the patient. At 1 January 2024, this flat-rate funding amounted to 365,351.63 euros per recognised MUG/SMUR function[4]. The MUG/SMUR function is also funded by charging specific fee codes to the patient and the health insurance.

Emergency Medical Assistance Fund
The Emergency Medical Assistance Fund (FAMU) is a guarantee fund for unpaid invoices after a emergency medical assistance intervention. The ambulance services can submit their unpaid invoices to the FAMU and the fund pays a fixed price amount to them. This fixed price amount is a percentage of the uniform 112 rate and is set annually by the minister. For 2024, this percentage is set at 60%, which is the legal minimum.

How the Fund works was changed in 2023. Two major changes were made:

  • The FAMU itself will no longer recover the unpaid invoices from the patients (as it has done until now).
  • The ambulance services must first try and recover the unpaid invoices themselves for up to 12 months after the intervention (compared to 6 months previously). Any invoice which is not fully repaid after this period may be submitted to the FAMU.

The FAMU is a non-profit organisation created by the insurance companies determined by the King. The FPS Public Health funds a third of it with the insurance companies covering the other two thirds. In 2024, the FPS’ contribution will be 594,000 euros. The Fund is managed by a board of directors comprised of eight people, half of whom represent the State with the other half representing the insurers.

Find out more:
https://www.famu-fdgh.be

[1]The legal basis for this reform is the Royal Decree of 6 December 2018 establishing the terms and conditions for granting the allowance referred to in Article 3ter of the Act of 8 July 1964 on emergency medical assistance

[2]This was laid down in the Royal Decree of 28 November 2018 on invoicing following the provision of emergency medical assistance by an ambulance service.

[3]See Key Data in Healthcare - General Hospitals for more information on the Financial Resources Budget.

[4]The funding for the MUG/SMUR function is described in Article 68 of the Royal Decree of 25 April 2002 on the establishment and settlement of the financial resources budget for hospitals.