Health system performance assessment
Authors: Maertens de Noordhout Charline , Devos Carl , Adriaenssens Jef , Bouckaert Nicolas , Ricour Céline , Gerkens Sophie 
Published: January 2025

PART 1  CONTEXT AND METHOD 14 -- 1 CONTEXT AND OBJECTIVES 14 -- 1.1 INTRODUCTION 14 -- 1.2 CONCEPTUAL FRAMEWORK 15 -- 1.3 SCOPE AND OBJECTIVE OF THE REPORT 15 -- 1.4 DEFINITION OF THE CHRONIC DISEASES: A PRELIMINARY CRITICAL NOTE 16 -- 1.4.1 Definition criteria 17 -- 1.4.2 Existing lists of chronic diseases 18 -- 1.4.3 Conclusion 19 -- 1.5 WAYS USED TO IDENTIFY CHRONIC PATIENTS IN NATIONAL DATABASES 19 -- 1.6 SPECIFIC MEASURES FOR CHRONICALLY ILL PEOPLE 20 -- 1.6.1 Measures to improve the quality of chronic patients care 20 -- 1.6.2 General description of main financial protection measures 20 -- 1.6.3 A specific status for persons with a chronic illness 21 -- 1.6.4 Discussion 30 -- 2 METHODS AND DATA 30 -- 2.1 SELECTION OF INDICATORS 30 -- 2.1.1 Preselection process 30 -- 2.1.2 Final selection of indicators 33 -- 2.2 DATA SOURCES 36 -- 2.3 OUTLINE OF REPORT 37 -- PART 2  RESULTS 40 -- 3 CONTEXTUAL INDICATORS 40 -- 3.1 PROPORTION OF PEOPLE WITH THE RIZIV  INAMI CHRONIC ILLNESS STATUS ACCORDING TO THEIR OFFICIAL HEALTH EXPENDITURE 45 -- 3.2 PROPORTION OF PEOPLE REPORTING A CHRONIC DISEASE 46 -- 3.3 PROPORTION OF PEOPLE REPORTING MULTIMORBID STATE IN THE LAST 12 MONTHS 48 -- 3.4 SELF-PERCEIVED QUALITY OF LIFE 49 -- 3.5 CONCLUSION 50 -- 4 QUALITY OF CARE 51 -- 4.1 EFFECTIVENESS OF CARE 51 -- 4.1.1 Effectiveness of primary care for chronic patients with asthma, diabetes or COPD 51 -- 4.1.2 Effectiveness of care for chronic patients with tuberculosis 55 -- 4.1.3 Conclusion 56 -- 4.2 APPROPRIATENESS OF CARE 56 -- 4.2.1 Appropriateness of follow-up for patients with diabetes 57 -- 4.2.2 Conclusion 59 -- 4.3 CONTINUITY OF CARE 60 -- 4.3.1 Assessing informational continuity in general practice, with a distinction between persons with and without chronic illness status 61 -- 4.3.2 Assessing informational continuity in medication, with a distinction between persons with and without chronic illness status 65 -- 4.3.3 Assessing management continuity between hospital and general practice, with a distinction between persons with and without chronic illness status 66 -- 4.3.4 Assessing coordination in ambulatory care for chronic patients 67 -- 4.3.5 Conclusion 69 -- 4.4 PATIENT CENTRED CARE 70 -- 4.4.1 Physician spending enough time with patients during the consultation 71 -- 4.4.2 The doctor gives an opportunity to the patients to ask questions or raise concerns about recommended treatment 72 -- 4.4.3 The doctor involves the patient as much as he wants in decisions about care and treatment 72 -- 4.4.4 Conclusion 72 -- 5 EQUITY AND ACCESSIBILITY OF CARE 73 -- 5.1 FINANCIAL ACCESSIBILITY AND EQUITY IN HEALTHCARE FINANCING 73 -- 5.2 UNMET NEEDS FOR MEDICAL EXAMINATION DUE TO FINANCIAL REASONS 75 -- 5.3 OUT-OF-POCKET PAYMENTS AS A SHARE OF TOTAL HEALTHCARE EXPENSES 76 -- 5.4 CATASTROPHIC AND IMPOVERISHING OR FURTHER IMPOVERISHING OOPS 78 -- 5.5 CONCLUSION 81 -- 6 EFFICIENCY 82 -- 6.1 LOW-CARE DIALYSIS 82 -- 6.2 CONCLUSION 84 -- 7 DOMAINE OF PERFORMANCE 84 -- 7.1 PREVENTION 84 -- 7.1.1 Influenza vaccination among the elderly 87 -- 7.1.2 Breast cancer screening 88 -- 7.1.3 Regular contact with dentists 88 -- 7.1.4 Conclusion 89 -- 7.2 OTHER DOMAINS 89 -- 8 DISCUSSION AND CONCLUSION 90 -- 8.1 STRENGTHS AND WEAKNESSES OF THE BELGIAN HEALTH SYSTEM FOR THE CARE OF CHRONIC PATIENTS 90 -- 8.2 LIMITATIONS 92 -- 8.3 CONCLUSION 94 -- 9 RECOMMENDATIONS 95 -- APPENDICES 97 -- APPENDIX 1. SEARCH STRATEGIES HSPA 97 -- APPENDIX 2. INDICATORS NOT RETAINED 97 -- REFERENCES 99