Proposition 50K1650

Projet de loi contenant le cinquième ajustement du Budget général des dépenses de l'année budgétaire 2001.

General information ¶

Submitted by

Groen Open Vld Vooruit PS | SP Ecolo MR Verhofstadt Ⅰ

Submission date

Feb. 22, 2002

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

budget national budget

Voting ¶

Voted to adopt

Groen Ecolo PS | SP Open Vld MR

Voted to reject

LE

Abstained from voting

CD&V N-VA FN VB

Party dissidents ¶

• Josy Arens (LE) abstained from voting.
• Alfons Borginon (Open Vld) abstained from voting.

Contact form ¶

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Discussion ¶

April 25, 2002 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, I ask for the word for the arrangement of the work on this second item of the agenda. Our group would like to ask a number of precise questions on this budget adjustment and more specifically on measures against bioterrorism. If I am not mistaken, it is a sum of 296 million Belgian francs that is transferred from one budget item to another.

Our questions relate not so much to the budgetary technical aspects, but rather to the substantive aspects. We would find it no more than normal if Minister Aelvoet would be at our address when answering questions about this technical adjustment which, however, a few months ago caused some panic. Their

As it is our parliamentary right, we would have liked to have received clearly disguised technical answers to our questions. We therefore suggest that Ms. Aelvoet would join this meeting. In this way, she can give us the necessary answers.

Mr. Leterme, while you spoke, I tried to find out in the document exactly what you were talking about. Which categories are you right about?

Mr. Speaker, we are in a limited general discussion of the bill containing the fifth adjustment of the General Expenditures Budget. In the chapter for which Ms Aelvoet is responsible, an additional EUR 296 million is intended to be provided to combat a number of urgent measures to combat bioterrorism, such as the antrax incidents. We have five precise questions that we may ask the Minister of Finance, but we would like to get clear and correct answers.

Are you talking about section 62 at the end of the document?

and yes.

It is always possible to answer precise questions. Several questions were asked in the committee.

The committee report is quite short.

Only Mr. Mayeur and Germeaux have asked a number of questions to which Ms. Aelvoet has given a clear and clear answer. I do not know if there are other questions.

What the Minister of Finance says is correct. I recall that at the beginning of my parliamentary career in dealing with a draft law for the protection of privacy — specifically the telephone call — the current House Speaker taught me that the essence of a plenary discussion involves, among other things, the opportunity to be given to colleagues to ask their questions in the plenary session.

I will try to reach Mrs. Aelvoet. First, I will address another agenda issue.

I propose that we go to see Minister Aelvoet and, in the meantime, move to point 3 of the agenda.

Mr. Speaker, if the hair does not fit, she may come tomorrow after the interpellations.

Mr. Tante, I heard that you and your committee are available.

I have not yet heard any questions.

Can you ask these questions now?

How will we organize the debate?

This is not a question for the Minister of Finance.

No, it’s about vaccines, the way of distribution, and so on.

If you can agree, I will let the Minister of Finance go. I will then try to reach Mrs. Aelvoet. In the meantime, I will address the next agenda point for which Minister Vandenbroucke should be here.

It is possible that the questions will be asked now. Maybe I can answer myself? I cannot answer until I have heard the questions.

If the questions are already asked, I may have to interrupt the discussion. This is what Mr. Leterme wants.

Do other members want to intervene?

Mr. Speaker, I found your proposal to take point three first and point two afterwards, to allow Mrs. Aelvoet to join the meeting, a good proposal.

I would suggest to let the Minister of Finance go. Minister Vandenbroucke will be there.

With regard to the budgetary technical aspects, we have no more questions for the Minister of Finance.

( ... ...

I don’t hear anything, Mr. Tante.

Sometimes it is also good that nothing is heard.

If I say that, it goes wrong again, of course. If you say that, on the contrary... You will ask to Mrs. Aelvoet de nous rejoindre si elle peut se libérer.

We will then conduct the discussion later. I am also waiting for Minister Vandenbroucke who was asked at 18.30. I’ll ask Mrs. Aelvoet to come. The questions will surely pay you, I am sure.

Mr. Minister, can you stay a little longer and wait for your colleague of government to join us?

I move on to the next point. Their

We will soon be discussing the draft law.

Mr. Speaker, Mr. Ministers, Mr. Colleagues, the bill on the maximum amount to be charged in healthcare insurance is an important bill that we discussed in our meetings of the Social Affairs Committee of 27 March and 17 April 2002.

In his introductory explanation, the Minister of Social Affairs first recalled that the health insurance in our country has as its primary objective to offer the whole population protection against the cost of disease. by

Although special measures have been taken over the years to ensure better access to health care for insured persons in certain social and financial conditions, these measures have not prevented that still regularly, the disease may lead a household into significant or even insurmountable financial difficulties.

Two risk groups should be given special attention: the so-called chronic patients and their families, as well as all households that, escaping the social categories defined by the law, are nevertheless faced with significant health costs with insufficient income to cope with them. by

It was therefore important to provide for a significant measure that would provide faster and stronger protection to the households that need it most. This is the purpose of this bill, the maximum to be charged. A first step was made in 2001 by extending the benefit of the social exemption and tax exemption to essential medicines, i.e. categories A and B.

The basic principle of the maximum to be charged is the establishment of a limit to the health expenses that a household must bear. If this limit is exceeded, the insurer grants an intervention equal to 100%. The spending threshold is set according to household income and the personal interventions that are accounted for are the same for all income categories. by

In addition, special protection is granted to children under the age of 16. If these support moderators tickets for a certain ceiling (650 euros), they will benefit from an intervention equal to 100% regardless of the amount of household income of which they are part. by

Finally, in the event that the child is disabled and if he is benefiting from family allowances increased at the time of entry into force of this law, this ceiling is reduced to 450 euros.

The maximum to be charged is a protective measure that will be implemented promptly by insurance organizations in favour of persons belonging to a specific social category or to a household with modest incomes. In the latter case, an income survey will be carried out in collaboration with the Ministry of Finance. by

The proposed provisions shall take effect on 1 January 2002. It should be noted that for households with incomes below 13,730 euros, the maximum to be invoiced will be applied at the beginning of 2002 for the benefits made in 2001.

There were many speeches during the general discussion. I will repeat some of the most significant ones. Ms. De Block and Cahay expressed their desire that the discussions that will take place in June next in the framework of the Round Table of Social Solidarity enable a timetable for the integration of the small risks faced by self-employed workers in the mandatory health care insurance.

Underlining that the health care provided to children with chronic disease cannot be linked to the income of the parents, the two speakers welcomed the special protection that the bill tends to introduce in relation to children.

Our colleague Luc Goutry expressed his support for the bill because this text, he said, is part of the continuity of a previously initiated policy regarding access to health care and the special attention that should be paid to chronically ill people and households with low or modest incomes. by

However, in relation to the contributions paid by all workers and in relation to the selectivity that the maximum to be billed introduces in the system, the interviewer was concerned about the current and future financing of the said system, but also about the risk of a desolidarization by the part of higher incomes and that of a growing disresponsibility of patients.

With regard to the benefits that are accounted for in the maximum invoice and the people who belong or not to one or another of the social categories defined by the project, our colleague Goutry asked various questions and questioned the illogical or even discriminatory nature of the system. This is the case, according to the speaker, of the distinctions operated according to the age of the child and the exclusion, on the basis of article 37, 9° of the bill, of beneficiaries of an integration allowance belonging to categories 3 and 4 of the maximum to be billed determined according to the social category.

Ms. Genot stressed that the ceiling on healthcare costs, if it is useful and necessary, does not exhaust the debate on accessibility issues. In fact, moderator tickets would account for only one-third of household spending on health care.

Furthermore, the question of controlling the use of the franchise must arise first and foremost in terms of liability of the service providers.

Considering that the system proceeds from a generous intention, Mr. Valkeniers expressed some concerns about the proper implementation of the system, both by patients and providers.

by Mr. Bellot, on the other hand, questioned the link between the mechanism of the maximum to be charged and that of supplementary health insurance.

Your rapporteur expressed satisfaction with the implementation of a mechanism that enhances access to care for the whole population. Given the problem of delayed care in our country, increased selectivity is a necessary evil, in a context where the means of insurance are and will always be limited.

Finally, my colleague Mr. Wauters, chairman of the committee, concluded the general discussion by stating that the proposed text meets one of the most important challenges of this legislature. The speaker considers that selectivity is necessary, especially for the most precarious categories and for chronic patients, but that it will need to be subject to continuous evaluation so that solidarity remains an acceptable and tolerable principle for all.

In his answers, Mr. The Minister, while admitting that the maximum amount to be billed is not the miracle formula, believes that it will not allow to meet all patient expectations. He argued that the text constituted a first step by which certain benefits are collected and accounted for in a new franchise system.

The problem lies not in the allocation of a budget but above all in the detection, in a manner consistent with social justice, of the real needs in health care and to meet them then, in an instrument that works properly.

by Mr. The Minister noted that social justice is measured by the way in which the authority intervenes towards the most disadvantaged and that the selectivity of the maximum amount to be invoiced is more gradual, somehow less brutal than the one that was previously established by social and tax exemptions.

Regarding the maximum right to invoice in the head of self-employed workers, the minister referred to the planned reform of their social status. Its option is that these workers must be integrated into the general insurance scheme, so that they receive the same protection for small risks. In the current state of affairs, if the self-employed has subscribed to a supplementary insurance, the moderators tickets paid for large and small risks are taken into account in determining the applicable ceilings. On the other hand, the exemption from the beneficiary's personal quota-part only applies, in the head of the self-employed, for the benefits of the compulsory insurance "health care".

The child’s limit age — i.e. 16 years — for the application of special protection has been fixed taking into account budgetary imperatives, but also because this age coincides, in pediatric medicine, with the transition from childhood to adulthood.

In addition, the Minister explained that social categories for which there was no income control within the framework of the social franchise, will no longer automatically benefit from the maximum to be billed determined according to the social category.

The philosophy of the bill is that the mechanism is applicable, not so much because the beneficiary is unemployed, disabled, retired or disabled, but mostly because this beneficiary only has low incomes. For example, beneficiaries of an integration allowance — categories 3 and 4 — benefit from a significant neutralization of their spouse or partner’s income: a discount of 700,000 francs. The conventional control of income is therefore heavily reduced, which explains the scope of Article 37 nonies.

The revenue control operated by the mutualities will be carried out in the same way as the control exercised with respect to the beneficiaries of the increased intervention of the health insurance, first on the basis of a declaration on the honor of the beneficiaries and then on the basis of the information that will be provided by the tax administration. In the event that within the same household, persons are assigned to different insurance organizations, the one of them to which the elderly person is affiliated shall manage the file on the basis of the information transmitted by the other insurance organizations. by

Neither the granting of the maximum to be invoiced nor the amounts reimbursed under this scheme shall be limited by any financial intervention of a supplementary insurance. Legal persons offering such insurance shall, however, be informed, in accordance with Article 3 of this draft, of the refunds received by their insured.

Finally, the Minister answered a whole series of punctual questions. He addressed various particular issues and provided, in addition, details of the timetable for the implementation of the new system, as well as a list of health benefits that will be taken into account in the new franchise. This list is in the report.

Many questions have been asked, ⁇ by Mr. Goutry, as regards the scope or technical understanding of certain provisions. Legal corrections have been made and some amendments have been adopted by our committee. I refer to this in the written report. The entire draft law, as amended and corrected, was adopted by 7 votes and 2 abstentions.

After reading this report, I would like to make a brief speech on behalf of the Socialist Group. Although the link between income and level of social coverage of healthcare is contrary to the basic principle of social insurance that means that everyone contributes according to their contributive capacity but receives benefits according to their needs, so without discrimination on the basis of income, our group supports this bill which is of great importance in terms of accessibility to care for the whole of our population, especially for low-income categories and chronically ill.

As a committee, I spoke of a necessary evil, but I will also take back the words of our colleague Wauters on this subject, who very well recalled in committee that the selectivity in favor of target groups is important and that the solidarity between the different socio-professional income is equally, but that it will also be appropriate to monitor the evolution of the new franchise, so that it remains acceptable and sustainable for all. I would add that this is a fundamental requirement if we want to avoid any risk of desolidarization compared to a selective system that carries a always possible risk of overconsumption. A system as complex as the one presented to us today cannot be perfect at first. It will first need to be implemented in practice and then evaluated, refined and eliminated its perverse or discriminatory effects. by

We see overall four advantages to the introduction of the maximum to be charged in health insurance.

Personal interventions in health expenses that will be accounted for within the maximum to be billed are much wider than they were with the mechanisms of social and tax exemption and this without differentiation according to whether the person belongs to a certain category, to a household with modest income or to a household to which neither of the two criteria can be applied.

Approaching effective equality between households in comparable social situations. Indeed, the guarantee exists that a household with low or modest incomes will be quickly reimbursed, which was not the case before, since the benefit of the social franchise was reserved only to very specific social categories.

The transition from the notion of mutual household to the notion of real household provides more effective protection, given that it is the set of personal quotas of all members of the household that will now be accounted for.

Finally, the last asset of this reform, a special protection for children under the age of 16, regardless of the amount of income of the family cell of which they are part. In the twenty-first century, it is indeed unacceptable for families to face very heavy financial burdens to ensure the essential care for their unfortunately seriously ill child.

In conclusion, the principle underlying the bill is to respond to social justice by first of all detecting the priority health care needs and placing them in a new instrument whose future evaluation will tell us what its strengths are but ⁇ also its weaknesses.

On this basis, the Socialist group will, of course, support this bill.

Mr. Speaker, Mr. Minister, Colleagues, of course, first of all, on behalf of our group, I would like to thank the reporter, Mr. Delizée, for his comprehensive and objective report on this important work, namely the discussion of the maximum invoice. I would also like to thank the Chairman of the Commission and the colleagues of the Commission for the necessary attention and time allocated to discuss this important draft together. I think we have been able to do that extensively, as this belongs to such a technical design, and I want to thank the colleagues for their willingness to listen.

Despite our vigilant and critical intervention, we naturally support the system of the maximum invoice. The underlying mechanism must, in fact, ensure that the costs for people who are vulnerable in the field of health care are plafoned, so that they do not become insecure of subsistence due to the increase in the amount of costs. We support such a system, such a mechanism of franchise to fix the costs at a certain maximum amount. That is obvious. This, by the way, is a continuation of what in the previous legislature – that may be said for a moment – was brought into existence or learned out, in particular the social and fiscal franchise. We also paid much attention to this at the time in the Social Affairs Committee and succeeded in establishing a revolutionary model of social and fiscal franchise. With regard to the tax franchise, a check is always done with retroactive effect on people’s income to check whether the costs they have in terms of medical care do not become too large in proportion to their income. With the social franchise, one had essentially the same target groups as now with the maximum invoice. In fact, there hasn’t changed so much in that area. The social franchise dates back to the previous legislature after meeting several times in the cabinet together with the socialist colleagues and under the impulse of Ms. De Galan. The initiative was supported by the then coalition partners.

It is also a scheme that has so far yielded many fruits. I think the social franchise has been used frequently and has often proven its usefulness to the people. However, many people are somewhat protected from the flooding of the high costs they have when their illness becomes chronic and prolonged and when the accumulation of costs increases.

Despite this positive approach to this mechanism, we will still abstain from voting on the text of the draft. We do that, not because we are against the system, against the mechanism of the maximum invoice, but because the bill shows a number of shortcomings and shortcomings that we explained during the discussion in the committee. We have also submitted amendments in this regard. You will notice, colleagues, that we have ⁇ ined three amendments before the vote. We submitted many more amendments, but we had a good discussion. The Minister has been able to sufficiently refute several times the comments that we had submitted in the amendment. On three principled points, however, we would like to maintain our amendments.

In the future, together with many socially sensitive members in this hemisphere who are also active in the committees, we will be a calling party for the establishment of an efficient system of cost reduction for vulnerable groups. The Minister applied the system applicable to the social franchise. On the one hand, there are certain groups that benefit from this scheme anyway because, because they are covered by the status of the preferential scheme, they have undergone an income control demonstrating that they are vulnerable in terms of their income, but carrying risks in terms of costs. They belong to the group of the WIGWs. On the other hand, there are the persons with limited income for whom the cost counter deduces from a certain income — either 18,000 Belgian francs, or 26,000 Belgian francs.

Although we support the mechanism, we have a number of substantial comments regarding the draft and therefore we will abstain from voting.

Mr. Minister, as I said before in the committee, we will have to evaluate carefully who exactly is being helped with this system. The target groups were defined and of course we hold assumptions, but in fact it is still not quite clear which groups will be helped exactly. It would be appropriate to properly record this and produce statistics in order to demonstrate that the system of the maximum invoice is applied to the most vulnerable target groups, as intended.

Indeed, taking into account the reactions from all sorts of angles, I get a vague uncomfortable feeling. Some individuals informed that, despite the system of the maximum invoice and the various systems of accommodation of problems in chronic sick and the like, and despite the fact that they do not enjoy generous income, they still fall out of the boat. In fact, they would still be able to save it, as they say, with their income, but by the accumulation of costs and by the fact that they fall precisely outside the scope of the systems connected as a chain — one statute automatically gives right to the other — they fall into trouble. If they were to compute their costs, they would be high. Since the tax franchise for data subjects comes into effect later and is linked to their income, this also does not provide a solution to the high costs.

You have to dare to advance. This system is, by way of speech, a test system that needs to be properly evaluated. We must be especially careful that no false sense of security is created and we should not have the impression of having everything arranged.

I understand your pride in this system, Mr. Minister, although I would like to relieve it immediately, since it is a derivative of the social franchise and therefore not a brand new invention. Anyway, you made great efforts in this regard and I also understand your enthusiasm, but at the same time I warn you not to use this system as a passe-partout solution for all problems. After all, too often things are presented in such a way that the system of the maximum invoice will provide a solution for everyone who falls out of the boat.

In my second comment, I would like to warn you of excessive expectations. Currently, an amount of rounded 3 billion Belgian francs is allocated as a first subsidy of the system, but that means only a fraction of the total medical costs. The medical costs paid in our country by the patients from their own pockets amount to 450 billion Belgian francs; the brake fees — the personal imposition — of reimbursable funds amount to 150 billion francs.

Of this, 2% or 3 billion Belgian francs go to the maximum invoice. That’s at an amount of 450 billion a pearl shell, but at an amount of 150 billion in brake funds that can be substantial. After all, there are many brake money carriers that do not need the additional protection. We must be vigilant. Hence my question: is the 3 billion that is now provided also the limit? Should we do it with it? If we are unable to sustain the system, will flashing lights start to burn, as with the other expenses in health insurance? Should we then look at how we can manage the system or are the flashlights an incentive for you to decide that we have underestimated the costs, based on simulations? Are you willing to adjust these amounts? Are you willing to raise more resources in the future — if necessary — to keep our system working properly? That is the fundamental question I would like to ask you, Mr. Minister.

My colleagues, I have a third comment. The Minister has already given an initiative in this regard in the committee. We did not really extend the debate. I invite you, Mr. Speaker of the Commission, to initiate the discussion on solidarity versus insurance at some time. Social security is an excellent example of a system in which we are generous in redistributing resources. People with high incomes feed the system extremely generously, while they themselves make little claim to it. People who can no longer no longer feed the system can benefit considerably from it. This is a difficult balance exercise. We must always keep an eye on a certain balanced relationship. In all the debates on social security reform, and in almost all political groups, it was agreed that it is not only a system of solidarity, but also an insurance. That is why we are talking about social security. If it is a system of insurance, colleagues, then we must also link the premium and the benefit. The modal families, the two-payers who both deposit their contribution to the system and hopefully need to make as little use of it as possible, still contribute very solidally to the system. We must be careful that we do not create a system in which selective assistance becomes excessive. We stand behind the starting point. Chronically sick and vulnerable people need to be helped. The question is whether we can ⁇ that with the system of social security or should we seek other forms of solidarity to be able to control one and another?

I refer to the Flemish health insurance, to the system of increasing the income of elderly persons with a limited pension, to the system of income replacement benefits, to the cost-covering system of integration benefits, to the system of the Flemish Fund — where a number of interventions can be obtained — and to the solidarity fund in the RIZIV. We must beware of too much "covering", one above the other system, not only because of its complexity, but also to avoid a Matthew effect. I am talking about an effect that, on the one hand, increases income and, on the other hand, better covers costs. In such a system there is a danger of coverage of certain persons, while the risks in those specifically outside the scheme are covered in a different way. I think of the modal citizens, who must ultimately feed the social security system.

I pull my neck out a little here. I know that these are difficult debates, but we must be careful not to get into a story like the migrants. Anyone who dares to challenge that system is almost immediately stabbed to the wall as someone with whom it is not discussed or as someone with a certain vision. Solidarity is so fragile that we need to continue the debate on this subject. We must not continue to devote too much of everything to this general solidarity, without knowing exactly where we want to come out.

Mr. Minister, Mr. Chairman of the Commission, I urge that we continue the debate on the possible blind spots. I think of the fact that some groups are very well covered against future risks, while at certain crosspoints blind spots arise because other groups are outside the scheme. I’m talking about those who, due to the chain system, fall out of all arrangements and thus fall into the trouble. Colleagues, we know that social security in the future will need a lot of resources and will continue to need, among other things, because of the reduced activity rate, the increased benefits, bridge pensions. Whatever can be said about this, the pressure remains heavy. The figures of the RVA and the employment plan in the light of the European directive prove that. We will also need a lot of money for the problems associated with ageing. Money will be needed to make rest homes affordable and increase pensions. These are challenges that come upon us. We will have to ensure that we can continue to pay for all this in a solidary system.

After the discussion in the committee on Mrs. Avontroodt’s proposal to require health funds to exchange data with private insurance companies, I was very pleased that the whole committee wants to know that there is no privatization in social security but absolutely wants to maintain a solidary system that is accessible, affordable and performing for everyone. This is a courageous attitude. It is a pleasure for the democratic parliament to do this. As an opposition party, the CD&V will give its full support to this.

Mr. Minister, I would like to make a complaint in connection with the action of Ziekenzorg-CM "5 for 12". We must dare to ask ourselves how we can work as efficiently as possible. What we are doing right now is correcting on the spending side. People have costs because of their medical condition. The costs accumulate. At a certain point, the costs are no longer borne by the interested parties but by the community. At the same time, I think, we should also think about measures to increase incomes. In this way, people who are vulnerable will have a greater support for themselves, so that they are less quickly at the limit of their capabilities in terms of accumulation of costs. If the requirements of Health Care are implemented and the income of single disabled persons is substantially increased, the income of the head of family disabled persons is protected and the partner income is adjusted so that one falls back on a lower benefit less quickly, we will do important prevention not only for those who suffer costs but for everyone who is facing disability problems. I hope we will not hide behind the MAF. At this moment, you are holding off the boat of the income-increasing measures. You refer to initiatives that are being implemented such as the MAF, the cumulation of certain forms of employment. This should not make us fall asleep. We should not assume that the MAF is sufficient and that income-increasing measures can wait. On the contrary, this should become a big priority. People with an income of 34 to 36,000 francs per month are impossible to run a household if they are narrow in their earnings because they cannot work or are sick.

My fourth point is about the importance of tariff agreements for the future. The system of the maximum invoice is based on objective brake fees, proven amounts with a maximum amount. There must be tariffs. If not, you pay blue and the amount of the maximum invoice is insufficient. You have stated in the committee that you consider these tariff agreements very important. I would like to emphasize that it is very important that such tariff agreements are also concluded in the future. At the moment, this is not obvious. I refer, among other things, to the Chineseists, many of whom are unwilling to join the convention, and to the doctors who—appropriate or inappropriate, I leave this in the middle, often as a means of blackmail but often also out of need—threaten with blasting conventions. Such conventions are very important for the future.

One last note, colleagues, is about the target groups. It is said that it is a generous system, that it is intended to provide a real safety net for vulnerable people by avoiding cost accumulation and thus not creating existence uncertainty for these people; I call it a missed opportunity, a discrimination, incomprehensible that then one suddenly arbitrarily excludes two categories. I have moved heaven and earth in the committee to make adjustments in that area and to come to a better system. I have tried to prove, Mr. Minister, that logic is searching when you exclude the categories 3 and 4. It’s about people who have gotten something, but it’s not about many. I asked the figures recently and it is only about a few thousand people. If they are excluded, they will not be the ones who will put the land in rear and roar. It is a little symbolic that vulnerable groups are fishing, namely people of categories 3 and 4. Those involved often have many points — more than 12 or 15 points — and they have a great lack of self-reliance. It might be that some of them are able to form a relationship and start cohabiting with a partner who also has an integration approach. We are now going to say that these people are already well on the greenhouse, that we have already done an income test and that we thus throw them out of the system. Although it may be only one-third of them, yet one-third of these few thousand people would no longer be able to join the system, God knows why. Be honest: we have not received an adequate answer, except the principle that it is and will be.

Mr. Minister, I have pared you by asking what you do with the people who get an exemption of 500,000 Belgian francs if they combine their satisfaction with an income or salary. They will continue to enjoy the system of the maximum invoice, while the people I mentioned before can no longer rely on that system. People who enjoy a benefit of 500,000 Belgian francs can already fall under the system, even if they have one franc, even if they perfectly comply with the regime of the maximum invoice, while those of category 3 and 4, since they have already received a so-called “premium of love”, are not allowed to pass through the box for a second time. We just say, we will shut you out.

Mr. Minister, I understand you even less with regard to the increased child allowance. I saw you then react non-verbally and I understood that not so well, because I have always taken a consistent position on that. How can you make it clear that children for whom an increased child allowance is already paid are the lucky ones who will be able to invoke an acquired right. They will further fall under the system, while children who, after the publication of the law, become victims of a condition entitled to an increased child allowance, will be excluded from the system, under the pretext that for them a new arrangement will be developed that will cover their costs. But, of course, this is equally true for the first group, of which we say that there the acquired right plays. I have already said many times, on the occasion of the discussion of the welfare of disabled persons, that we have never had more discussions than about acquired rights. Either one acknowledges that there is a right and then it must not be acquired, then it is simply a right, or we find that the right is no longer responsible, but we do not dare to take it away and let it so. We do not want to shake the neck for this, we pretend that the law will fade out of its own, but no new candidates should be added. Such a thing cannot be defended and it will encounter misunderstanding and lead to misunderstandings. People will wonder how this is possible, why such an arbitrary decision is made, why they fall under that regime and someone else not.

Therefore, I have made two proposals, Mr. Minister, and I repeat them on this tribune. It would be much better to continue on your drive and ensure that all children up to sixteen years of age can enjoy the system — of course also disabled children with increased child allowance — and to exclude children from sixteen years of age, although we actually have no understanding of that either.

Either it is said that up to 16 years all children, of course also disabled children, are eligible for increased child allowance and from 16 years no one anymore, but then it is also no one anymore. Then it is equal for everyone. There should be no distinction between those who have an acquired right and the others. We must then only key to other systems that are also cost-covering such as the increased child allowance and then we must see that we can give a solid answer there because there is a test based on self-saving.

Or it is said, if we want to fulfill certain commitments, that it is better for everyone older than 16 years who enjoys an increased child allowance, because the others we exclude, let it continue to enjoy. They will not use it if they do not need it. Children who are mentally disabled and have little medical expenses are not covered by the maximum invoice. They do not need it. Therefore, we have proposed that everyone remains in the system until we can prove to parents and children that our child allowance system has improved and then we take out all these children through a simple legal adjustment. Then we can offer an adequate solution. It was, therefore, more correct to determine the categories clearly here through a royal decree or another way.

These are the most important comments from our group, the group leader will support me in this. The first addresses general principled observations about the social security system and about the mechanism of the maximum invoice. But our last two comments are really principled, they go to the ground. They are of the kind that they fight discrimination. We will discuss them further in three amendments.

I hear that you will therefore continue to speak on the amendments submitted by you and your colleagues. I see that you and Mrs. Trees Pieters submitted three amendments again. We will address them in the discussion of the articles.

Mr. Speaker, the PSC Group will abstain from this project regarding the maximum to be charged in health insurance, for several reasons.

This project unquestionably contains positive and interesting elements. We obviously, like everyone else, have the concern to cover more chronically ill, the most disadvantaged and to provide interventions in favor of those who, in terms of income, are the least well-established in our society.

There are a number of technical remarks to be made — and I quite agree with what Mr. said. Goutry — for example, with regard to the issue of children 16 years old. Obviously, the distinction is quite theoretical. Between 16 and 18 years of age and even beyond for children who still receive family allowances, it is clear that there is no break and that the age of 16 is purely theoretical. These are elements that can be corrected in the future and one could stop there by saying that one adheres to a logic that has already been inscribed in the social franchise and in the tax franchise. Despite some imperfections, we are pragmatically in a situation that improves things and we could simply say that everything that brings improvement must be approved.

There are two main reasons for our abstention. The first is that we are clearly in a system of selectivity and that selectivity is for us the way to shake down the whole regime of our social security. This is based on fairly simple data. At the level of revenue, there are two sources of intervention: on the one hand, what is called alternative financing, that is, the tax according to progressivity, so it is a solidarity through progressivity. On the other hand, in terms of social contributions, it is proportionality. In the social contract that exists in our society, it is through these two mechanisms of solidarity that our social security system, based on insurance, is founded. If there is a strong solidarity mechanism at the level of the contribution to the resources of this insurance, it is obvious that with regard to the consequences of this insurance, that is, the benefits, the logic requires that these benefits are valid for all beneficiaries of the insurance. This is what constituted our Providence State where the social contract allowed everyone to join the system.

I know very well that I play here the Cassandre of our social state, but I remain convinced that, blow of cane after blow of cane, we will gradually arrive at a dismantling of this basic principle. In other words, the richest will consider that it is not normal that they contribute significantly, if this significant contribution does not provide a number of benefits in the benefits. The very essence of this social pact will thus gradually give way to a logic of selectivity. We start with a selectivity that seems seductive at the level of benefits, we will continue — this has been written by the minister recently — considering that we cannot do everything in our system and that selectivity must therefore be the rule. This is precisely the Anglo-Saxon system, the system that came from the deformation of the Beveridge system. This is what, in the long run, kills the existing social pact.

Any derivative in this matter is extremely dangerous. by Mr. Delizée also expressed some fears and some reservations. I go further by saying that there will come a time when these fears and reservations will turn into regrets.

I very much like the idea that the great merit of social security is that, born the day after the war by a pact between all the Belgians, it is the very foundation of solidarity in our society. And it is not through selectivity that this solidarity is ⁇ ined, even if it does not seem important at first.

The second point — we see it every day — is that the maximum to be charged may, tomorrow, serve as an alibi to a major change in moderator tickets. Because in fact, the maximum to be charged is a reinsurance of moderator tickets that is based on a logic of protecting the weakest. That is, gradually disappears the idea that the moderator ticket is, in itself, something heavy, difficult and heavy on society, since one can say: "the weakest are protected."

For comparison, I would take the American "Medicare" system. This is a system where there is a very large participation of people in social security, which is corrected at the level of the weakest by a system of medical intervention. This is much more than a moderators ticket.

Through a logic like this, we are not attacking the very foundations of our social security system — do we need important moderator tickets? Should Moderators Increase Tickets? Or should we, on the contrary, take care to reduce the weight of moderator tickets? — but it is replaced by a completely different logic, which is to say that, for the viability of the system, it is necessary to increase the moderators tickets, to make a selection at the level of services. This is already the case with the nomenclature in physiotherapy and the application of the reference price in the pharmaceutical sector. And these weighings, considered as necessary, are compensated, for the weakest, by the system of the maximum to be charged.

I believe that by doing this, we will destabilize the system. And tomorrow, in a logic of active social state, we will talk less and less about this fundamental social contract that has been, for ⁇ fifty years, the very foundation of life and solidarity in society.

In short, this project contains good things. Therefore, our vote will not be negative. Unfortunately, I fear that what I say today, others will repeat it later, but this time in a much harder form to affirm that we have failed the transformation, the modernization of social security to switch from a “bismarck” social protection system to an English system, “beveridgien”, where the state will take more and more importance and adjust its logic according to its needs at the level of its revenues and expenses, leaving the social partners impoverished in the face of this change of social regime. by

I hope that this evolution will be stopped, but this is an additional blow to the Providence State principle to which we are so attached.

Mr. Speaker, Mr. Minister, dear colleagues, the accessibility of health care is a major concern for both the government and this Parliament. However, the costs that chronically ill people sometimes face have made us think about the effectiveness of our social protection. This concern was even reflected in the government agreement in the formation of this government.

The extension of the maximum invoice that we discuss today is partly a solution to this problem. I say in part because, of course, costs that are not reimbursed by the RIZIV today and often still constitute an important part of the costs, of course, are also not covered by the maximum invoice.

Rightly, the members of the committee stressed that the maximum invoice should not be announced as a deus ex machina that will solve all problems. The maximum invoice is an improvement in relation to the current situation, but not all healthcare expenses will be reimbursed. A realistic representation of the public opinion should avoid disappointment. Their

The maximum invoice may be a new word, but the goal is not new. The former Minister of Social Affairs had given a first step to better protection by introducing the tax and social franchise. Their

The maximum invoice therefore uses the same techniques, but with a few differences. First, she is faster. Second, there is no longer a distinction based on the patient’s social status, but on the basis of the taxable income. For 2001 expenditure on medicinal products of categories A and B shall be included for the calculation of the ceiling. For a lot of people, this means a significant advance, because medicines often mean a big hole out of a family budget.

From 2002 the costs of hospitalization may be included and from 2003 the material supplements will be considered. Of course, this timeframe will be determined by the financial repercussions of the measures and possibly also by the budgetary capabilities. At cross-speed, the expenditure is now estimated at 85 million euros. It is of course important that we closely monitor the financial repercussions.

In the system that prevails today, there are two categories of people: people with low incomes, who get a quick refund, and people with higher incomes, with a refund through the tax. For the first category I think it’s a trend break is no longer belonging to a certain category and therefore getting a refund, but simply the fact that someone with a lower income faster gets the right to a refund. Therefore, we appreciate the approach of the Minister, in which an equal arrangement is developed for, on the one hand, beneficiaries of the WIGW statute, subsistence minimum tractors, beneficiaries of the guaranteed income for the elderly and, on the other hand, people who have a low income from work. These people now have the same advantage. It is no longer given exclusively to certain social categories. For the VLD, this is a great progress. Working with social categories is stigmatizing for those involved. Moreover, it leads to great injustice for those who work and receive a low salary for it. The falls of inactivity that exist today but are slowly being eliminated are the result of this type of measures.

Mr. Minister, I hope that this method of work will also be an inspiration for future measures. We are referring to the WIGW statute. Many people who return to work after being unemployed for a period of time or having ⁇ the subsistence minimum find that starting to work is punished. It would be good to think about this in the future.

In addition, the position of the chronically ill child is also well regulated. It is clear that having a chronically ill child means a heavy financial burden for the family. It is therefore positive that the maximum invoice is applied separately to that child, regardless of the family’s income. This means that families with high health expenses for children will get it a little easier in the future. During the committee meeting, transitional measures were discussed, in which children, who today are entitled to an increased child benefit, will automatically enjoy the regime of the maximum invoice. After 2002 this will no longer be automatic. I think that the special scheme for children provides sufficient guarantees and that it is fair.

For the VLD, the position of the self-employed in this scheme is of course important. For the self-employed, the maximum invoice applies, though in limited form. For those who are additionally insured for small risks, all brake fees, both for large and small risks, will be taken into account to calculate the ceiling. However, the brake fees for the high risks will only be refunded if the maximum invoice applies. It is of course positive that the maximum invoice also applies to self-employed persons, but we believe that the discussion at the committee meeting has made clear that this majority should make the integration of small risks in the mandatory health insurance for self-employed persons an absolute priority.

If we do not, we will create a new group of disadvantaged people in our society. For those who are supplementally insured as self-employed, this path may be a disappointment. As a self-employed, one assumes his responsibility towards society and his own family by supplementing insurance for small risks. It is then determined that the small risks are taken into account for the calculation of the ceiling, but not for the calculation of what is to be reimbursed through the brake fund.

Finally, the question arose whether the self-employed person who is additionally insured by an insurance company can also rely on the fact that his brake fees for small risks are taken into account in the calculation of the ceiling. Chronically ill people with high spending on medicines will see the bill as a punishment for the many years of contributions they have already paid, for the responsibility they have taken on. It is not good that politics does not honor people. The different structures of health insurance for employees and self-employed, respectively, is an explanation, but not an excuse. We therefore expect that a solution will be sought at the round table, announced for June. The sooner, the better for us, Mr. Minister. You know that.

It may be good that we will evaluate the application of the maximum invoice for the first time next year. That evaluation should cover both cost and coverage, in other words the concrete implications for families compared to the current situation. Together with other colleagues in the committee — such as Mr Valkeniers — I think that the necessary caution should be demonstrated with regard to possible abuses. Once the ceiling is reached, a certain nonchalance can arise over the use of health care due to the so-called free character. This, of course, is not the purpose of the maximum invoice. However, it is not an imaginary danger. We believe that this aspect should also be an element of the evaluation. A responsibility of the patient is, in my opinion, equally permanently necessary in order to keep the invoice and cost of health care generally affordable. Despite this cautious comment, we therefore fully support the extension of the maximum invoice.

The system of the maximum amount to be invoiced is both a simple and brilliant idea.

In fact, the problem that is constantly arising is that of access to care for all and equally. Many systems have already been invented, but until now, we have never found a system as simple and effective as the one we are interested in today.

In my opinion, this system has the merit of making the accessibility of care quite efficient. The Reform Movement will therefore support this bill which it considers to be an excellent initiative.

We are faced with a paradox: the more science and technology progress, the more medical progress increases and the more accessibility becomes difficult to guarantee. If we do not take care, in a few years, this accessibility will be less and less possible as our increasingly evolving society succeeds in achieving significant scientific and technological advances. Therefore, it was necessary to find a system that guarantees this accessibility and accompanies the technological and scientific progress.

It is obvious that the maximum to be charged brings some difficulties in application. Don’t be fooled, it will sometimes be difficult. The difficulty will be in the control to avoid suffocation of the system, but also in the integration of care that comes into account because there will always be choices to make. At some point, it will be necessary to stick to the objective data of therapeutic and diagnostic techniques, to integrate them into the maximum amount to be billed and ⁇ to exclude from the system certain types of care, diagnostics or therapeutics that have not proven themselves in a sufficiently obvious way. They should not enter the system. Indeed, if one does not make a certain selection in terms of integration into the system, the latter will suffocate due to budgetary constraints that will make their application impossible. This will require additional efforts from the government and your department, Mr. Minister, to define treatments and diagnostics that objectively contribute to public health and which must therefore be part of this system, which allows access to the best care and quality care.

The fact that I have provided full coverage for children under the age of 16 seems to me an additional reason to welcome the vote on this bill. In fact, when the life of a family turns, solidarity must be total. We know how many families of sick children are experiencing dramas and suffering in their hearts and souls, but also how difficult they are to manage the family budget.

Today, we are taking a step towards a system that improves accessibility and is deliberately part of the most humanistic projects we have had to discuss during this legislature.

I would like, however, as others have already done, to put a benchmark to all these positive aspects. I want to talk about the creation of new discrimination against independent workers.

At a time when everyone agrees that the inequality of treatment between self-employed and employees must be drastically reduced — and, if possible, gradually eliminated — it is clear that in this case the risk lies in creating a new discrimination.

It will therefore be appropriate, in the context of discussions on the social status of self-employed persons, to take into account the need to ensure a parallel treatment between the different categories of workers, otherwise we would have created new frustrations in a category of the population and ⁇ an unequal treatment in terms of access to care, which is the opposite of the aim pursued.

These are the elements that I wanted to emphasize. I consider, like my group, that this project is ⁇ what we did best during the legislature to improve accessibility to care. There is an extremely important progress here. The challenge and challenge is to ensure the proper functioning of this measure and the enforcement of the law; it is also to ensure mechanisms both of control and selection of care that are integrated into the system that is based on objective data, otherwise the risk of suffocating this system. by

These are the few points I wanted to highlight as part of the contribution of my group’s support to this bill.

Mr. Speaker, Mr. Minister, colleagues, the maximum invoice replaces the system we used to have with the social and fiscal franchise. As a result, people with a protected status did not pay more than 375 euros for their medical care until 2000. For other families, the settlement of health expenses occurred only two years later, based on their tax return. Mr. Minister, as a social party, the Flemish Bloc can substantially fully support the improvement of the social protection of families with low and modest incomes. We only suspect that very soon the demand will be raised to raise the ultimately very low income ceilings, as provided as a condition for enforcing the right defined in the bill. In this sense, we must ensure that our social security support remains sufficiently broad. In other words, people who enjoy a better income must ultimately continue to receive sufficient incentives to participate in the solidary social security system. Let there be no uncertainty about our group, we continue to fully support that solidarity system.

Mr. Minister, colleagues, in every presentation on the budget, the Flemish Bloc hits the nail of the social status of the self-employed. Everyone knows that as far as small healthcare risks are concerned, self-employed persons are not yet covered by the system of compulsory medical insurance. Therefore, they cannot fully benefit from the existing maximum invoice. We deeply regret that and we hope that the announcement that there will be real work made from 2003 on improving the social status of the self-employed will not continue to get stuck in the classic purple-green show of beautiful announcements. We hope that there will be real work done for a better status for the self-employed.

Mr. Minister, the Flemish Blok is happy to join the commentary of the Family Union, which does not understand why children over 16 and disabled children over 16 who have a right to an increased child benefit cannot enjoy the maximum invoice. At the edge of the committee discussions, you expressed your intention to solve this problem through an adjustment of the child allowance scheme for disabled children who are entitled to increased child allowance. In all humility, I would dare to recommend to look at a bill of the Flemish Bloc. We have already recently submitted a bill aimed at easing and expanding the system of increased child allowance for disabled children. Let us not call each other a lie bed; much should no longer be studied. The Flemish Blok has submitted a bill that can bring you ideas.

Mr. Minister, the MAF is also triggering a huge flow of data. Information is exchanged between the Reichsregister, the RIZIV, the Fiscal Authority and the Hospital Funds. These services all give in their administration a different interpretation of the concept of "family". The health funds work with mutualist families where they ultimately talk about members holders who pay contributions. The tax authorities determine the attack on the basis of the tax families. The maximum invoice presented here for discussion today works on the basis of the actual family, in other words everyone who lives under the same roof. It could therefore sometimes be that the arrangement relating to your maximum invoice is very complex in the implementation. Of course, the health funds play a crucial role in this. They are assigned a number of new tasks. You will undoubtedly remember that I had the courage in the committee to ask the relevant question to what extent financial compensation for insurance institutions was negotiated.

I must honestly say that I appreciated your clear and unambiguous response at that time. The Flemish Bloc will carefully ensure that no additional resources, no so-called additional administrative costs are allocated to the health funds. We believe that the money of health insurance should be used efficiently and used efficiently. The money of social security is therefore not intended to provide all sorts of interest organizations in this deserted country with a well-invested sandwich.

Mr. Speaker, Mr. Minister, colleagues, our group can recognize itself in broad lines in the present bill. The comments I have made on behalf of my group make us abstain during the vote.

Mr. Speaker, Mr. Minister, for the Greens, a very important point of the government agreement is being realized. We would like to congratulate you, Mr. Minister, on this very socially inspired bill that will be approved later.

We have jointly engaged in the struggle to ensure access to healthcare for all, but especially for low-income people. We believe it is important that chronically ill people will no longer be punished. We also find it very interesting that you also include children who are seriously chronically ill in this bill. This is a very social measure.

We see this as a substantial improvement of the social and fiscal franchise through the integration of the brake fees, the medicines of category A and B, the hospitalization costs and later also the material supplements. With this design, we come substantially to the families affected by very heavy healthcare costs.

We find it positive that the most vulnerable groups and low-income groups are better protected. We support the selective approach in favor of these groups, especially since this system is built on a basis of solidarity between high and low incomes.

In addition to this solidarity, social security also includes the insurance principle. This insurance principle must be kept in mind. We must ensure that everyone continues to believe in the system. It would be a pity, Mr. Minister, if higher incomes would leave the system to reinsure themselves privately. We need to think about whether we should keep the different income stairs, which are now built in. Chances are high that people with very high incomes will leave the health insurance because they get nothing back from that health insurance. We believe that at such a time the general system should continue to apply to all so that other income groups also retain their rights. It would be a shame, Mr. Minister, if we should build a second pillar in long-term health care. We believe that the general system should continue to apply.

It is important that there is a guarantee regarding tariffs. I know that it is also your concern that the medico-mut in this takes its full responsibility. Here too, we must take care that there are no deviations in the medico currency and that only the lowest incomes would be given tariff certainty, while for higher incomes one could go to more differentiated rates. For these groups the higher contribution would therefore be registered. I think we should keep in mind that there are no exceptions for these groups.

We all know that the brake money is quite high. There are 150 billion contributed by the people themselves. We believe that there is a limit to that too. That is why we supported the social and tax franchise, because such a heavy burden was placed on the patients. We wanted to support systems that destroy that. We must keep that in mind.

Mr. Minister, we must also find a solution to the brake money in hospitals. We know that there has been an accident in the social and tax franchise. People who stay in general or psychiatric hospitals for a long time are actually denied part of the maximum invoice. The committee has asked for this attention and should be addressed in the short term, so that those who have to bear the heaviest costs can also fully benefit from the maximum invoice.

Another point concerns medical equipment, implants and prosthetics.

Mr. Wauters, I find it somewhat strange that you at the time in the opposition had rightly criticized the fact that the system of the franchise was very inaccurate for those who stayed in a hospital for a long time, while you now rightly cite this and state that you have not been able to find a suitable solution. It is a bit painful to find that something that you have fought for for years and that you were so convinced of and almost could convince us, is not a point that you have scored for yourself.

Mr. Goutry, we have scored on many points. I think the system is so generalized for the modest incomes that we are on our way. In 2001 we took a first step, in 2002 a second and in 2003 a third, as the minister promised. It will also include the elements relating to medical equipment and people staying in hospitals and psychiatric hospitals, as the minister said in the committee. It will cost a little, but the patients also contribute a lot. We are so socially mobilized that we want to take social measures there too.

The last point is the feasibility of the system. Some health funds pull the emergency brake and ring the bell because they would like to do this and implement it in cooperation with the minister, but encounter problems regarding different concepts of family. It is precisely that link between the Rijksregister, RIZIV, fiscal and hospital funds should be done well.

With the implementation of the system, the social objective of the system will also need to be realized and we hope that a good cooperation can be found. Someone from the Christian Mutualities said he hoped that no wheel falls off, because if a wheel falls off, there could be accidents, which will increase the cost of healthcare. I think, Mr. Minister, that we must prevent this and ensure that the draft law is implemented incorrectly. Then we will realize an important priority of the government.

Mr. Speaker, Mr. Minister, colleagues, I have heard ministers say today that they will do everything, that there will be changes, that great plans will be drawn up. I think that Minister Vandenbroucke has proved in this file that he adds the act to the word. He has proved that he is carrying out a plan and that he is carrying out a major reform. Minister Vandenbroucke, out of category, has demarcated in this course and presents us a reform in this draft on the maximum invoice in healthcare, which will receive the full support of the SP.A group. After all, it is one of the most important achievements of the government and at the same time one of the most important social reforms of recent years.

We have known for 15 years that social security is very good to cover small, not so common health bills optimally. The RIZIV has been created for this and it is very skilled in doing so. Our health care system, on the other hand, reimburses poorly the costs of chronic diseases, the frequent, small and large hospital bills, the medicines bills and the doctor bills. Tens of thousands of people — not only those with low incomes, but also those with middle incomes — are in financial difficulties when there is a cumulative of health problems and a long-term chronic disease picture that causes the disease spending to accumulate. The maximum invoice in healthcare provides without too much ideological troelala and prietpraat a concrete answer to the very concrete questions for improvement, so that life in often difficult circumstances becomes sustainable and happier. It is therefore appropriate that we support the reform with full conviction. What we also support with full conviction is the question asked by Minister Vandenbroucke in connection with this matter, in particular to continue with the refinancing of healthcare and RIZIV in our country. I truly think that the MAF has grown from the finding that there is a lot of money shortage in health insurance and that the approval of the MAF reform should automatically lead to the political conclusion that we will need to continue to release a lot of extra money for health insurance in the coming years.

The question that Minister Vandenbroucke raised yesterday through the media to provide additional €2 billion for health care over the next few years is correct. It is also crucial in the budget negotiations, either during this legislature or during the next.

The maximum invoice is a very good start, but will only be able to guarantee solid social coverage when a refinancing of the health care facilities is carried out. This is the most important political conclusion of this discussion. We will undoubtedly return to this in the future, with other coalition partners. Hopefully they will also realize that the mechanism of the MAF reform requires more money for health care.

I’ll be a little smaller than Mr. President. Peeters who was ⁇ inflamed, even though I agree with the end of his speech. Our ministers have already had the opportunity to support such requests in recent negotiations.

( ... ...

You can burn up for a project.

Yes, absolutely of course. We feel that this project is positive and is going in the right direction. It was indispensable for a whole range of categories such as major sick and chronic heavy sick. However, we believe that we must remain doubly modest. by

First of all, given the budget, the impact of the mass will be relatively limited. As mentioned by Mr. Goutry just recently, it is 3.4 billion while patient intervention is 150 billion. You cannot do miracles. Our words to people must be clear, otherwise they will not understand. They are told that everything will go well in the sector and they realize that in reality, this is not the case. This is very unhealthy. So, in this area as in others, it is important to speak "true".

Then, even for people who will benefit from this maximum to charge, it must be noted that a whole series of fees will not be taken into account as certain medications, long-term hospitalizations, etc. by

I also add the problem of selectivity. We are delighted that we have no longer remained in a state-only logic and have moved to a income-category logic. This is a step forward. The system will remain inaccessible to a whole number of people in cases where they need it. It is known that many people do not go to the doctor because they have to pay a certain amount for the visit and medications. They wait a long time before making a decision.

Mr. Minister, you have repeatedly stated that you intend to continue working on the third-party paying system to make it easier to employ by a number of actors who are afraid to use it given its complexity. It will have to be done with energy and these are less expensive measures because they already work. Currently, people are already paying the moderator ticket but they will make a difference if they don’t have to pay off before being refunded. It matters psychologically and it doesn’t cost much in our system.

Another issue is selectivity. Like others, we are worried, but not as much as Mr. Visitor because we consider that all individuals will be able to find their share in the maximum to be charged. For larger incomes, the very high ceiling still concerns them and it will always be interesting for this category of people to stay in the system. However, it is necessary to be cautious because, at the level of the insurance market, this category enjoys the lightest premiums.

Another aspect is that a number of people take the maximum in billing as a pretext to request an increase in the moderator ticket or to prohibit the absence of a moderator ticket in a number of cases. It is unquestionable that this maximum to be charged can be used for this.

Furthermore, can the income categories delimited by the maximum to be billed be used by other actors? Could hospitals use these categories to determine supplements? Have you already envisaged this case? Imagine that hospitals decide to act as such and proceed to a certain selectivity. Is it clear that these categories of income cannot be used for other things? It will then become “even more interesting” for some people to get out of our system if these categories are used in multiple locations.

The last point I will highlight. It is clear that it will be necessary to remain attentive to the cost that this will represent for mutual companies on the administrative level. This cost should not be so large that they can no longer perform other essential tasks in our eyes, such as checks for example. We believe that they have an important role to play in this matter.

Of course, we support this project, but we want to remain vigilant on all the aspects I just mentioned.

Mr. Speaker, Mr. Minister, colleagues, first and foremost I would like to join the discussion of my colleague, Dr. De Block, but I would like to add a few nuances.

As a doctor, both former general practitioner and former specialist, it is normal for me today to look forward to the maximum invoice for the patients who have high medical costs. If one sees how expensive certain examinations and interventions become, that is for many patients otherwise not to pay.

After so many years, it is also normal to make a small reservation here and there. As you know, your predecessor, Ms. De Galan, had already begun the development of a support measure for chronic patients. At the same time, such a system was initiated in France, but it had to be stopped shortly thereafter because it was no longer affordable. Mrs. De Galan then proposed to make a choice among the chronic diseases, but she later saw that such a thing is not possible. Eventually, she abandoned her plan.

There will be an evaluation, which my colleague has already cited. The control services clearly show that once the patient is entitled to the social franchise, the expenses increase. There is abuse somewhere. Some people — family members or neighbors — benefit from a system to which they have no right. We used to have the same problems with the booklets of the war invalids and the booklets of the railway staff. Their system was, after all, more advantageous than the ordinary health funds. I would not like to see you happening the same thing as Mrs Vogels, your colleague in the Flemish government, and you have to determine in June that there is no money in cash for health insurance. I hope you are not scared of that fate, but I think you can better count. You’ve probably made your accounts better by a better cabinet.

I also fully agree with my colleague that we should not have a shame to place the patient for his responsibility. Patients should know that abuse eventually ends up in their own heads.

I would like to make another comment. I have read in the journals of the medical funds that the application — the handling of the files — will not be easy. This will be quite complicated. Mr. Minister, if it turns out that this indeed requires a lot of work for the health funds, they will immediately demand that their administrative costs increase. I want to make the question clear. This plan should not involve an increase in administrative costs. In the past, the health funds have, in this respect, already overtaken us more than once. In the past, they have always said that their costs were only 5%, while in private insurance, the costs — administrative costs — were 12.5%. I asked this when we met with the insurance companies. These figures are correct, but in those 12.5% there is also 10% "courtage".

In the 12,5% there is a portion of brokerage costs. This means that the private insurers do it with 2.5%. In a time of rationalization — fewer post offices, fewer stations — I wonder whether it is necessary that in every small municipality three to four offices of different health funds should be closed. There, in my opinion, savings are possible. Their

Mr. Minister, do you think that the medical funds, given the current administrative costs, will be able to cope with the additional work? Will you keep your leg stiff when they come up with new demands and do not provide additional resources? To these questions I would like to get an answer.

The VLD is happy with this plan. I congratulate you. Mr. Peeters has already done that. I note that the enthusiasm in your party is not as great as I expected. For such a plan, I would have expected that the SP.A faction would have been fully present to cheer for such an outcome.

The [...]

I know which community you belong to. I don’t think that blackmail is in fashion.

Mr. Valkeniers, Mr. Goutry wishes to interrupt you.

Mr. Chairman of the Justice Committee, I know that you are an eminent lawyer. However, I think you are not very good at home in this matter.

Mr. President, I would like to point out to Mr. Valkeniers that the support for Vandenbroucke of the VLD group is greater than that of the SP.A group.

Mr. Goutry, I am pleased that you make that comment. It proves, after all, that the accusation of not being a social party — an accusation we have always received — was a false accusation!

The committees held a thorough and constructive debate in the committee. The debate was prepared by a number of broad discussions that we had following many questions from the members of the committee. I am grateful to them for that. Both from the majority and from the opposition, very useful contributions have been made that have improved the work.

I can be short. First, I would like to remind you of the purpose of the design. I will then refer to the critical considerations that have been made.

The goal of the design is to create a new kind of security in our society, the certainty that the costs that families or single persons must bear because of health problems never start to weigh too heavily, never cover too much of their budget, never exceed a certain limit. We have a very basic insurance policy. We want to ensure that the weight of strictly necessary medical expenses never exceeds a certain limit that becomes too heavy to carry in relation to the family budget.

Het spreekt voor zich dat men dit dan moet uitdrukken in relation to tot de omvang van het gezinsinkomen. This is essential yesterday. I am thus actually a little verbaasd door of geformuleerde kritieken likef said a gevaarlijk soort van selectiviteit zou introduceren. I want to repeat what I said in the past. In a very synthetic way, I will react to the attention of those who claim that we are dangerously sliding towards selectivity. These people forget that the current system already has a selectivity as it is based on social categories, including VIPO and assimilated, and income. In fact, a preferential rate has been provided in order to protect certain people. The system is therefore doubly selective: it privileges certain social categories and those with lower incomes. This selectivity, therefore, has existed for a long time and I have never heard of Mr. He says it is a scandal. by

However, the current system does not lack flaws because now it is all or nothing. If the criteria are met, the preferential rate is granted, but if the income exceeds the estimated amount by a franc, the benefit is lost. The VIPO status also causes a lot of jealousy, as evidenced by the social permanences. by

Furthermore, the selectivity that currently exists does not meet the real problem, namely the accumulation of moderator tickets, medication costs and hospitalization. This selectivity is advantageous only for the reimbursement of individual benefits but it offers no solution to the accumulation of costs. by

I appreciate you very much, Mr. Viseur, but I consider that your interventions testify to an unlikely conservatism. Every change is bad, but what exists is excellent. The current system is detrimental. I want to introduce a new principle, a kind of insurance, but you find that is not appropriate. You claim that I am introducing an Anglo-Saxon system here. It is not true. In English, what we do here is a “back to basics”. When Mr. Van Acker created the social security system, he said it was necessary to adopt a system that prevents disease from leading to poverty. I also want to prevent the disease from leading to financial uncertainty.

Mr. Speaker, I am very proud that the Minister says that I am conservative when it comes to social security. This is a system I want to maintain. It is true that at present, it already contains selective elements. You mentioned this, Mr. Minister. Tax exemption and social exemption are also included. by

Thanks to this system, a change is underway: now, selectivity becomes the rule. This is not a return to the base. It is the evolution towards a system where selectivity becomes the rule and the pretext for not trying to do everything. What was the goal of the 45 system? It was, in parallel with the development of our financial means, to try to cover the whole and maximum of the costs. And during your speech published in the latest issue of the "Christian Mutualities", you stated: "We can no longer do everything!". In this case, one enters into a logic where selectivity becomes the rule. That is why the negative effects will not be measured today, but in 5 or 10 years, we will cry together.

Mr. Speaker, I have touched the subject of selectivity in a very moderate way. I was already pleased when I heard that the minister formulated his criticism in French, which made me suspect that it was more directed against colleagues Genot and Viseur. Their

Mr. Minister, you will not prevent us from conducting a good debate on selectivity. This does not mean that what is happening is wrong. I only said that we will have to look at how we will continue to bind solidarity to insurance in the future. This does not mean that this could not be done now, but it is a debate that we should always keep an eye on. Moreover, it is necessary to work not only on the side of expenditure but also on the side of income. Imemrs, you could make selectivity so heavy on the side of spending because you don’t do the necessary on the side of income. I have cited the examples of the minimum income for the disabled. Such a discussion should be conducted with a great sense of relativization.

Mr. President, I think Mr. Viseur does not know well the history of social security and the different political parties. Years ago I heard from the SP here advocating that nationalized medicine, like in England, was the ideal.

However, I think that Mr. Vandenbroucke, who has been in England for a while, has seen there that it is not an ideal at all and that he has ⁇ not been inspired by this system.

Mr. Viser, I think your complaint was very wrong.

To summarize my argument, Mr. Viseur does not understand that is that society has fundamentally changed since 1947. The risk profile has changed. I will give you two examples that inspired this project.

What were the post-war precarious categories across Europe? First were the pensioners. It was obviously necessary to establish a selectivity in favor of pensioners, because they were often poor. Then there were the widows and the orphans. It was easy to create a selectivity around a VIPO concept.

But today, a woman who works part-time and is isolated with two dependent children may have a significantly lower income than a pensioner. Nowhere is it protected by the current system because it does not fall into the typical post-war categories. Therefore, the donation must be changed. A much simpler principle is to compare the impact of medical costs with the family budget. This is an assurance principle.

Then, not only is it elementary to assert that it is necessary to prevent disease from leading to financial precariousness and poverty, like Achille Van Acker, but much more, the system tends to be universal as it covers all social categories and all income categories. The system is gradual, which is much smarter than ⁇ ining a system based on existing selectivity.

This system tends to become universal because, as some have said, it is important to integrate the self-employed, which presupposes integration into the general health care regime — and that is one of my ambitions. To be honest, I do not understand the literature aroused by the so-called risk of selectivity. For decades, there has been a double selectivity of social and income categories; it is an ultra-simple system that creates a lot of frustrations with a wrong goal, because there is no protection in case of accumulation of situations.

I present a system that no longer makes any distinction between social categories and which has the sole purpose of ensuring citizens that the impact of medical costs never exceeds a set limit in comparison with the family budget.

I assume that we will not easily agree on this, but what we do about it is actually a back to basics. In other words, from the fundamental objectives of social security in the society of the 21st century, seek to establish a universal protection that does not distinguish between rank or status, but merely takes into account the weight of medical expenses on the family budget and incorporates insurance there. Even though I know that some people don’t like to see things change, changes need to be made.

In such debates I am often struck by the self-satisfaction we demonstrate with regard to our healthcare system. We pretend to have the best system of all time, but that is not the case. There are increasingly gaps in chronically ill people. I emphasize once again that the phenomenon which concerns us in particular, especially chronic and prolonged severe illness, did not exist to that extent in 1945. To say crucially, people did not live so long at that time. Thanks to medical advances, people with chronic diseases today can live long and quality lives, but that is ⁇ expensive. This risk profile did not exist to that extent in 1945.

We must apply the values of 1945 to the society of 2002, Mr. Viseur, and I see that you have a little trouble with that.

Mr. Speaker, there were specific questions that I would like to address now so that I do not have to do so again during the debate on the amendments.

First, Mr. Goutry asked if the effort made here is limited and whether the system of flashlights will be applied. The answer is, no. On the contrary, if we would find that the budgets released by the system of the maximum invoice would rise rapidly, the reasons for this would be examined. This should not be the reason for applying an automatic correction through the flashlights. This regulation does not fall under this.

Secondly, as regards child allowance, I conduct extensive consultations with the Family Union. I plan a fundamental reform of the increased child benefit for disabled children, where we are again facing a form of stupid selectivity, which will have to be replaced by a wise selectivity. It is my intention to allow a lot more children into the system and I want to bring more gradation into it. That is why I do not want to maintain the link with the maximum invoice or with the social franchise. For the children covered by the current regime, I wish to respect the acquired right. The text of the law has been inspired by the consultation I have had on this with the Family Union and I think that is the best solution.

I also explained in the committee why it is fair to really look at the income in the categories 3 and 4, where the persons concerned can enjoy the so-called ‘price of love’ system, and not to automatically leave people in the system. I explained why I think this is fair. In fact, we could overlook that if we would allow them to enter the system without a doubt, they could have a very important income supplement.

Mr. Valkeniers asked me if the health funds can cope with it. I have conducted extensive consultations with the health funds and I think they can handle it, although it is a complex scheme. We have been discussing this project for one and a half years and it will not lead to an increase in administrative costs. On the contrary, we need clarity on the long-term evolution of administrative costs. In addition, we need a greater accountability of the health funds in terms of the use of their administrative costs, with a greater variable portion that we only pay on the basis of the quality of their management. I want to further concrete this reform in the coming weeks and months.

I think I have answered most questions.

Ms. Genot is concerned about the future behavior of hospitals. A true saying, you do not see very well how the hospitals could begin to differentiate and function of revenues the tariffs fixed either by conventions, or by the law on the hospitals. And what concerns the supplements demanded, this risk exists effectively. C'est d'ailleurs déjà le cas aujourd'hui mais je ne vois pas très bien how this system could incite the managers of hospitals and the doctors of hospitals to establish the distinctions that do not exist today. If it should arrive, it should immediately examine the situation. But you do not think that this project risks to have this consequence. I would like to reaffirm that it is my ambition to obtain a universal protection to which self-employed persons also belong, without distinction of rank and status, but at the same time with more attention to moderate care in health care, while distinguishing in the context of specific pathologies. A diabetic patient requires a different reception than a pain patient or a psychiatric patient. For this kind of distinction in the organization of treatment we must undoubtedly have more eye. However, I wish that financial protection is universal, without distinction of rank or status, and provides a new kind of security, namely that people know in advance that the expenses they must bear themselves do not exceed a certain ceiling. That ceiling must of course take into account the family income.

Mr. Speaker, that was my brief and synthetic response to a debate that will undoubtedly continue in the future. It is my conviction that we will continue to invest a lot in healthcare, not only in 2002 and 2003, but also afterwards. In my view, a decent society must ensure that every citizen as a citizen has access to the best possible care, without any financial obstacle.