Performance of the Belgian health system
Authors: Devos Carl , Cordon Audrey , Lefevre Mélanie , Obyn Caroline , Renard Françoise , Bouckaert Nicolas , Gerkens Sophie , Maertens de Noordhout Charline , Devleesschauwer Brecht , Haelterman, Margareta  , Léonard Christian , Meeus Pascal 
Published: January 2025

1. QUALITY OF CARE: EFFECTIVENESS 37 -- 1.1. HOSPITAL ADMISSIONS FOR ASTHMA (QE-1) AND HOSPITAL ADMISSIONS FOR UNCONTROLLED DIABETES OR COMPLICATION OF DIABETES (QE-2) 37 -- 1.1.1. Documentation sheet 37 -- 1.1.2. Results 39 -- 1.2. 5 YEAR RELATIVE SURVIVAL AFTER BREAST CANCER (QE-3) AND AFTER COLORECTAL CANCER (QE-4) 43 -- 1.2.1. Documentation sheet 43 -- 1.2.2. Results 45 -- 1.3. IN HOSPITAL MORTALITY AFTER ADMISSION FOR ACUTE MYOCARDIAL INFRACTION (QE-5) -- OR ISCHAEMIC STROKE (QE-6) 55 -- 1.3.1. Documentation sheet 55 -- 1.3.2. Results 56 -- 1.4. IN HOSPITAL MORTALITY AFTER COLORECTAL SURGERY (QE-7) 61 -- 1.4.1. Documentation sheet 61 -- 1.4.2. Results 62 -- 1.5. AVOIDABLE MORTALITY: AMENABLE MORTALITY (QE-8) & PREVENTABLE MORTALITY (QE-9) 64 -- 1.5.1. List of available conditions 66 -- 1.5.2. Amenable mortality 68 -- 1.5.3. Preventable mortality 73 -- 2. QUALITY OF CARE: APPROPRIATENESS OF CARE 78 -- 2.1. APPROPRIATE FOLLOW-UP OF DIABETIC PATIENTS (QA-1, QA-2) 78 -- 2.1.1. Documentation sheet 78 -- 2.1.2. Results 79 -- 2.2. PRUDENT PRESCRIPTION OF ANTIBIOTICS IN THE AMBULATORY CARE SECTOR (QA-3, QA4, QA-5) 85 -- 2.2.1. Documentation sheet 85 -- 2.2.2. Results 87 -- 2.3. MEDICAL IMAGING FOR SPINE (QA-6) 99 -- 2.3.1. Documentation sheet 99 -- 2.3.2. Results 100 -- 2.4. BREAST CANCER SCREENING FOR WOMEN YOUNGER THAN THE RECOMMENDED AGE TARGET GROUP FOR SCREENING (QA-7) 111 -- 2.4.1. Documentation sheet 111 -- 2.4.2. Results 112 -- 3. QUALITY OF CARE: SAFETY 115 -- 3.1. PREVALENCE OF HEALTHCARE-ASSOCIATED INFECTIONS (QS-1) 115 -- 3.1.1. Documentation sheet 115 -- 3.1.1. Results 116 -- 3.2. INCIDENCE OF HOSPITAL-ACQUIRED MRSA (QS-2) 119 -- 3.2.1. Documentation sheet 119 -- 3.1.2. Results 120 -- 3.3. POSTOPERATIVE COMPLICATIONS (PATIENT SAFETY INDICATORS) (QS-3, QS-4) 123 -- 3.3.1. Documentation sheet 123 -- 3.3.2. Results 125 -- 3.4. PRESSURE ULCER IN PATIENTS HOSPITALISED (QS-5) 130 -- 3.4.1. Documentation sheet 130 -- 3.4.2. Results 131 -- 3.5. POLYPHARMACY AMONG THE ELDERLY (QS-6) 135 -- 3.5.1. Documentation sheet 135 -- 3.5.2. Results 136 -- 3.6. PROPORTION MRSA AND 3GC/4GC I/R ESCHERICHIA COLI IN ACUTE CARE HOSPITALS (QS7, QS-8) 143 -- 3.6.1. Documentation sheet 143 -- 3.6.2. Results 145 -- 4. QUALITY OF CARE: CONTINUITY 151 -- 4.1. PERCENTAGE OF PERSONS WHO HAVE A GLOBAL MEDICAL RECORD (GMR) WITH A GENERAL PRACTITIONER (QC-1) 151 -- 4.1.1. Documentation sheet 151 -- 4.1.2. Results 152 -- 4.2. USUAL PROVIDER CONTINUITY INDEX (QC-2) 158 -- 4.2.1. Documentation sheet 158 -- 4.2.2. Results 159 -- 4.3. GP ENCOUNTER WITHIN 7 DAYS AFTER HOSPITAL DISCHARGE (% PATIENTS 65+) (QC-3) 163 -- 4.3.1. Documentation sheet 163 -- 4.3.2. Results 164 -- 4.4. PROPORTION OF ADULT DIABETICS (UNDER INSULIN) WITH A CONVENTION, A PASS/PRECARE TRAJECTORY OR A CARE TRAJECTORY (% OF PATIENTS, 18+) (QC-4) & PROPORTION OF ADULT DIABETICS (RECEIVING ONLY GLUCOSE-LOWERING DRUGS, EXCLUDING INSULIN) WITH A CONVENTION, A PASS/PRE-CARE TRAJECTORY OR A CARE TRAJECTORY (% OF PATIENTS, 50+) (QC-5) 168 -- 4.4.1. Documentation sheet 168 -- 4.4.2. Results 171 -- 4.5. PATIENTS WITH CANCER DISCUSSED AT THE MULTIDISCIPLINARY TEAM MEETING (%) (QC6) 177 -- 4.5.1. Documentation sheet 177 -- 4.5.2. Results 179 -- 5. QUALITY OF CARE: PATIENT CENTEREDNESS 184 -- 5.1. PATIENTS EXPERIENCES WITH AMBULATORY HEALTHCARE SERVICE (QP-1, QP-2, QP-3, QP-4) 184 -- 5.1.1. Documentation sheet 184 -- 5.1.2. Results 185 -- 5.2. PROSTATE CANCER ACTIVE SURVEILLANCE AND WATCHFUL WAITING (QP-5)  TESTICULAR CANCER ADJUVANT THERAPIES (QP-6) 190 -- 5.2.1. Documentation sheet 190 -- 5.2.2. Results 192 -- 5.3. MEASUREMENT OF PATIENT EXPERIENCES AFTER HOSPITAL STAY (PREMS) (QP-7) 201 -- 5.3.1. Documentation sheet 201 -- 5.3.2. Results 202 -- 6. ACCESSIBILITY OF CARE 203 -- 6.1. HEALTH INSURANCE STATUS OF THE POPULATION (A-1) 203 -- 6.1.1. Documentation sheet 203 -- 6.1.2. Results 204 -- 6.2. OUT-OF-POCKET PAYMENTS AS A SHARE OF CURRENT EXPENDITURE ON HEALTH (A-2), PER CAPITA (A-3), AND AS A SHARE OF FINAL HOUSEHOLD CONSUMPTION (A-10); OUT-OFPOCKET PAYMENTS ON DENTAL CARE AS A SHARE OF CURRENT EXPENDITURE ON DENTAL CARE (A-11) 207 -- 6.2.1. Documentation sheet 207 -- 6.2.2. Results 208 -- 6.3. SELF-REPORTED DELAYED CONTACTS WITH HEALTH SERVICES FOR FINANCIAL REASONS (% OF HOUSEHOLDS) (A-4) 217 -- 6.3.1. Documentation sheet 217 -- 6.3.2. Results 219 -- 6.4. ACCESSIBILITY TO AGREED TARIFFS: PRACTISING GP IN FTES ACCEDING TO THE AGREEMENT (PER 10 000 POPULATION) (A-12) AND PRACTISING DENTISTS IN FTES ACCEDING TO THE AGREEMENT (PER 10 000 POPULATION) (A-13) 229 -- 6.4.1. Documentation sheet 229 -- 6.4.2. Results 230 -- 6.4.3. Documentation sheet 234 -- 6.4.4. Results 235 -- 6.5. CATASTROPHIC OUT-OF-POCKET HEALTH CARE EXPENDITURES (A-15) 242 -- 6.5.1. Documentation sheet 242 -- 6.5.2. Results 244 -- 6.6. PRACTISING PHYSICIANS PER 1000 INHABITANTS (A-5) 245 -- 6.6.1. Documentation sheet 245 -- 6.6.2. Results 246 -- 6.7. PRACTISING NURSES ON THE HEALTH SECTOR PER 1 000 INHABITANTS (A-6) 254 -- 6.7.1. Documentation sheet 254 -- 6.7.2. Results 255 -- 6.8. NUMBER OF NURSING VACANCIES IN HOSPITALS (A-7) 261 -- 6.8.1. Documentation sheet 261 -- 6.8.2. Results 262 -- 6.9. PATIENT-TO-NURSE RATIO (A-8) 267 -- 6.9.1. Documentation sheet 267 -- 6.9.2. Results 269 -- 6.10. WAITING TIME FOR AN APPOINTMENT WITH A SPECIALIST (A-9) 273 -- 6.10.1. Documentation sheet 273 -- 6.10.2. Results 273 -- 7. EFFICIENCY OF THE HEALTHCARE SYSTEM 274 -- 7.1. ONE DAY SURGICAL HOSPITALISATIONS (E-1) 274 -- 7.1.1. Documentation sheet 274 -- 7.1.2. Results 275 -- 7.2. PRESCRIPTION OF LOW-COST DRUGS IN AMBULATORY SETTING (E-3) 280 -- 7.2.1. Documentation sheet 280 -- 7.2.2. Results 281 -- 7.3. BIOSIMILAR TREATMENTS (E-4) 283 -- 7.3.1. Documentation sheet 283 -- 7.3.2. Results 283 -- 8. SUSTAINABILITY OF THE HEALTHCARE SYSTEM 289 -- 8.1. CURRENT EXPENDITURE ON HEALTH AS % GROSS DOMESTIC PRODUCT (GDP) (S-1), CURRENT EXPENDITURE ON HEALTH IN  PER CAPITA (S-2) & CURRENT EXPENDITURE ON HEALTH AS % FINANCED BY GOVERNMENT/COMPULSORY SCHEMES (S-3) 289 -- 8.1.1. Documentation sheet 289 -- 8.1.2. Results 290 -- 8.2. MEDICAL GRADUATES (S-4) 296 -- 8.2.1. Documentation sheet 296 -- 8.2.2. Results 297 -- 8.3. SHARE OF FOREIGN-TRAINED PHYSICIANS (S-14) 302 -- 8.3.1. Documentation sheet 302 -- 8.3.2. Results 303 -- 8.4. MEDICAL GRADUATES BECOMING GPS (S-5) 307 -- 8.4.1. Documentation sheet 307 -- 8.4.2. Results 308 -- 8.5. MEAN AGE OF PRACTISING GPS (S-6) 311 -- 8.5.1. Documentation sheet 311 -- 8.5.2. Results 311 -- 8.6. PROPORTION OF PRACTISING PHYSICIANS AGED 55 YEARS AND OVER (S-7) AND PROPORTION OF GENERAL PRACTITIONER AGED 55 YEARS AND OVER (S-15) 315 -- 8.6.1. Documentation sheet 315 -- 8.6.2. Results 316 -- 8.7. S-8 NURSING GRADUATES (S-8) 321 -- 8.7.1. Documentation sheet 321 -- 8.7.2. Results 322 -- 8.8. NURSING STUDENTS FOLLOWING THE BACHELOR ROUTE (S-9) 328 -- 8.8.1. Documentation sheet 328 -- 8.8.2. Results 329 -- 8.9. PROPORTION OF PROFESSIONALLY ACTIVE NURSES AGED 50 YEARS AND OVER (S-10) 333 -- 8.9.1. Documentation sheet 333 -- 8.9.2. Results 334 -- 8.10. SHARE OF FOREIGN-TRAINED NURSES (S-16) 337 -- 8.10.1. Documentation sheet 337 -- 8.10.2. Results 339 -- 8.11. CURATIVE CARE BED-DAYS (NUMBER PER CAPITA) (S-11) 342 -- 8.11.1. Documentation sheet 342 -- 8.11.2. Results 343 -- 8.12. PERCENTAGE OF GPS USING ELECTRONIC GLOBAL MEDICAL RECORD (EGMR) THROUGH MYCARENET (S-13) 347 -- 8.12.1. Documentation sheet 347 -- 8.12.2. Results 348 -- 8.13. ELECTRONIC GLOBAL MEDICAL RECORD (% OF ALL GLOBAL MEDICAL RECORD) (S-17) 349 -- 8.13.1. Documentation sheet 349 -- 8.13.2. Results 349 -- 9. CONTEXTUAL INDICATORS OF EQUITY 351 -- 9.1. GINI INDEX (EQ-1) 351 -- 9.1.1. Documentation sheet 351 -- 9.1.2. Results 352 -- 9.2. FINANCING PROGRESSIVITY (EQ-2, EQ-3) 369 -- 9.2.1. Documentation sheet 369 -- 9.2.2. Results 371 -- 10. PREVENTIVE CARE 375 -- 10.1. VACCINATION AGAINST SELECTED CHILDHOOD INFECTIOUS DISEASES (P-1, P-1, P-3) 375 -- 10.1.1. Results 377 -- 10.2. VACCINATION AGAINST INFLUENZA FOR THE ELDERLY (P-4) 379 -- 10.2.1. Documentation sheet 379 -- 10.2.2. Results 380 -- 10.3. INCIDENCE OF MEASLES (P-5) 386 -- 10.3.1. Documentation sheet 386 -- 10.3.2. Results 387 -- 10.4. BREAST CANCER SCREENING (P-6, P-7) 393 -- 10.4.1. Documentation sheet 393 -- 10.4.2. Results 394 -- 10.5. REGULAR CONTACTS WITH A DENTIST (P-11) 400 -- 10.5.1. Documentation sheet 400 -- 10.5.2. Results 401 -- 11. MENTAL HEALTHCARE 405 -- 11.1. SUICIDE RATE (MH-1) 405 -- 11.1.1. Documentation sheet 405 -- 11.1.2. Results 406 -- 11.2. NUMBER OF PRACTISING PSYCHIATRISTS PER 1000 POPULATION (MH-2) 411 -- 11.2.1. Documentation sheet 411 -- 11.2.2. Results 412 -- 11.3. WAITING TIME FOR A FIRST FACE-TO-FACE CONTACT IN A CENTRE FOR AMBULATORY MENTAL HEALTH (MH-3) 417 -- 11.3.1. Documentation sheet 417 -- 11.3.2. Results (Flanders) 418 -- 11.4. INVOLUNTARY COMMITTAL IN PSYCHIATRIC HOSPITALS (MH-4) 421 -- 11.4.1. Documentation sheet 421 -- 11.4.2. Results 422 -- 11.5. PROPORTION OF VISITS TO THE EMERGENCY ROOMS IN GENERAL HOSPITALS FOR MENTAL HEALTH RELATED PROBLEMS (MH-5) 424 -- 11.5.1. Documentation sheet 424 -- 11.5.2. Results 426 -- 11.6. ANTIDEPRESSANT MEDICATION (MH-6, MH-7, MH-8) 431 -- 11.6.1. Documentation sheet 431 -- 11.6.2. Results 432 -- 11.7. PRESCRIPTION ON ANTICHOLINERGIC ANTIDEPRESSANT DRUGS AMONG THE ELDERLY (MH-9) 442 -- 11.8. NUMBER OF HOSPITALISATIONS DAYS IN PSYCHIATRIC HOSPITAL WARDS PER CAPITA (MH-10) 442 -- 11.8.1. Documentation sheet 442 -- 11.8.2. Results 443 -- 11.9. UNPLANNED HOSPITAL RE-ADMISSIONS FOR MENTAL ILLNESS (MH-11) 444 -- 11.9.1. Documentation sheet 444 -- 11.9.2. Results 444 -- 12. LONG-TERM AND ACUTE CARE FOR THE ELDERLY 447 -- 12.1. ELDERLY POPULATION RECEIVING LONG-TERM CARE, IN INSTITUTION (ELD-1) OR AT HOME (ELD-2) 447 -- 12.1.1. Documentation sheet 447 -- 12.1.2. Results 449 -- 12.2. INFORMAL CARE AT HOME FOR ELDERLY PERSONS (ELD-3) 454 -- 12.2.1. Documentation sheet 454 -- 12.2.2. Results 455 -- 12.3. BEDS IN RESIDENTIAL LONG-TERM CARE FACILITIES FOR THE ELDERLY (ELD-4) 457 -- 12.3.1. Documentation sheet 457 -- 12.3.2. Results 458 -- 12.4. LOW CARE-DEPENDENT PERSONS IN RESIDENTIAL AND NURSING FACILITY FOR ELDERLY (ELD-5) 461 -- 12.4.1. Documentation sheet 461 -- 12.4.2. Results 462 -- 12.5. SUPPLY OF HEALTHCARE PROFESSIONALS: NUMBER OF PRACTICING GERIATRICIANS (ELD-6) 464 -- 12.5.1. Documentation sheet 464 -- 12.5.2. Results 464 -- 12.6. FALL INCIDENTS IN THE ELDERLY (ELD-7) 466 -- 12.6.1. Documentation sheet 466 -- 12.6.2. Results 467 -- 12.7. PRESSURE ULCERS (GRADE II-IV) IN THE ELDERLY (ELD-8) 469 -- 12.7.1. Documentation sheet 469 -- 12.7.2. Results 470 -- 12.8. PREVALENCE OF MRSA CARRIAGE IN LONG-TERM CARE FACILITIES (ELD-9) 471 -- 12.8.1. Documentation sheet 471 -- 12.8.2. Results 472 -- 12.9. PRESCRIPTION OF ANTICHOLINERGICS IN THE ELDERLY (ELD-10) 475 -- 12.9.1. Documentation sheet 475 -- 12.9.2. Results 477 -- 12.10. PRESCRIPTION OF ANTIPSYCHOTICS IN ELDERLY IN (ELD-11) VERSUS OUTSIDE RESIDENTIAL/NURSING FACILITY (ELD-12) 482 -- 12.10.1. Documentation sheet 482 -- 12.10.2. Results 482 -- 13. CARE AT THE END OF LIFE 489 -- 13.1. PATIENTS WITH TERMINAL CANCER WHO RECEIVED PALLIATIVE CARE (EOL-1) 489 -- 13.1.1. Documentation sheet 489 -- 13.1.2. Results 491 -- 13.2. CANCER PATIENTS WHO DIED WITHIN ONE WEEK AFTER START OF PALLIATIVE CARE (EOL-2) 494 -- 13.2.1. Documentation sheet 494 -- 13.2.2. Results 495 -- 13.3. CANCER PATIENTS WHO RECEIVED CHEMOTHERAPY IN THE LAST 14 DAYS OF LIFE (EOL3) 499 -- 13.3.1. Documentation sheet 499 -- 13.3.2. Results 500 -- 13.4. DEATH AT USUAL PLACE OF RESIDENCE (AT HOME OR IN RESIDENTIAL CARE) (EOL-4) 503 -- 13.4.1. Documentation sheet 503 -- 13.4.2. Results 505 -- 14. MOTHER AND NEWBORN 510 -- 14.1. NEONATAL MORTALITY (MN-1) 510 -- 14.1.1. Documentation sheet 510 -- 14.1.2. Results 511 -- 14.2. APGAR SCORE AT 5 MINUTES (MN-2) 519 -- 14.2.1. Documentation sheet 519 -- 14.2.2. Results 519 -- 14.3. CAESAREAN SECTIONS (MN-3) 523 -- 14.3.1. Documentation sheet 523 -- 14.3.2. Results 525 -- 14.4. INDUCTION OF LABOUR (MN-4) 542 -- 14.4.1. Documentation sheet 542 -- 14.4.2. Results 542 -- 14.5. EPISIOTOMY (MN-5) 548 -- 14.5.1. Documentation sheet 548 -- 14.5.2. Results 548 -- 14.6. VAGINAL BIRTH FOLLOWING A PREVIOUS CAESAREAN SECTION (VBAC) (MN-6) 552 -- 14.6.1. Documentation sheet 552 -- 14.6.2. Results 553 -- 14.7. VERY PRETERM BIRTHS IN HOSPITAL WITHOUT NICU (MN-7) 559 -- 14.7.1. Documentation sheet 559 -- 14.7.2. Results 559 -- 14.8. SCREENING DURING PREGNANCY (MN-8) 561 -- 14.8.1. Documentation sheet 561 -- 14.8.2. Results 563 -- 14.9. LENGTH OF STAY FOR A NORMAL DELIVERY (MN-9) 573 -- 14.9.1. Documentation sheet 573 -- 14.9.2. Results 574 -- 14.10. ANTENATAL CONSULTATIONS (MN-10) 580 -- 14.10.1. Documentation sheet 580 -- 14.10.2. Results 582