Proposition 52K2172

Projet de loi portant des dispositions diverses en matière de santé.

General information ¶

Submitted by

CD&V Leterme Ⅱ

Submission date

Sept. 25, 2009

Official page

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Status

Adopted

Requirement

Simple

Subjects

alcoholic beverage pharmacist health care profession protection of animals first aid emergency medical treatment medicinal product young person infancy social security public health medical institution health insurance

Voting ¶

Voted to adopt

Groen CD&V Ecolo LE PS | SP Open Vld MR

Abstained from voting

Vooruit N-VA LDD FN VB

Party dissidents ¶

• Magda Raemaekers (Vooruit) voted to adopt.
• Peter Luykx (CD&V) abstained from voting.

Contact form ¶

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Discussion ¶

Nov. 12, 2009 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, dear colleagues, the Public Health Committee discussed this draft during its meetings on 20 and 27 October last month. The draft introduces a number of amendments to existing laws as well as to the KB no. 78 which regulates the exercise of health professions.

I will limit myself to a few amendments. For the other amendments, I would very much like to refer to the written report that gives a full summary of the implemented legislative changes.

The first law to be amended is the law on hospitals. It is a clarification. Dentists, clinical biologists and pharmacists employed in a hospital are equated with a hospital physician.

Another amendment stipulates that documents in the hospital that conflict with documents that the patient receives for signature at the time of admission regarding the rates are void.

These articles were unanimously adopted.

The second amendment concerns the Law on Patient Mobility. The entry into force of this law is postponed by one year.

Another amendment stipulates that the Observatory for Patient Mobility is now considered a joint institution of the RIZIV and the FOD Public Health.

Both articles were unanimously adopted.

The law on the protection of the health of users in the field of food and other products is also amended. It is forbidden to sell, donate or offer alcohol to min-16-year-olds. This amendment was adopted with 13 votes in favour and 1 abstinence.

The Animal Welfare Act is also undergoing a small adjustment. This makes it now possible to seize animals held by people who were banned from keeping animals. This article was also unanimously adopted.

Changes will also be made to the compulsory insurance for medical care and benefits. Thus, the draft extends the increased benefit to two new categories, namely the single-parent families and the long-term unemployed. That article was adopted with 13 votes for and 1 abstinence.

As regards the Committee for the Permanent Review of the Nomenclature, it is now provided that all members, except those with an advisory vote, may be elected as chairman. Both the government and colleague Burgeon submitted a number of amendments that were accepted.

The amended bill was approved by the committee with 11 votes for and 3 abstentions.

Mr. Speaker, I really wanted to intervene on this law containing various provisions on health to say that our group approves...

Mr. Speaker, it might be good if the Minister responsible for such an important draft were present. I would like to ask you where the competent minister, Ms. Onkelinx, is?

The government is represented by Minister Magnette. I hear that Ms. Onkelinx is currently answering questions in the Senate.

Can you live with it? Thank you for your understanding.

Mr. Speaker, our group will approve, as it has done in committee, this bill containing various provisions. It contains many technical adjustments that do not involve major issues, but it nevertheless contains extremely important provisions.

First, we are pleased to see that this bill incorporates proposals from our parliamentary initiatives. One of these proposals, submitted by Ms. Gerkens, aims to make obligatory the display of tariffs by doctors. This proposal has been fully incorporated in the law that we are going to vote today. A bill submitted by Ms. Almaci and myself on animal welfare aims to allow officials of the Health Administration to seize the animals of owners in breach for ill-treatment. It was also included in the bill under discussion.

In addition, I would like to come back very briefly on two elements.

The first concerns the issue of selling alcohol to minors. The Minister proposes to clarify the legislation on this subject. The sale of alcohol to children under the age of 16 will now be prohibited. Between 16 and 18 years of age, only the sale of low-alcoholic beverages will be allowed.

You know that the CRIOC recently issued a report demonstrating that the law on the sale of alcohol and spirits to minors was not enforced in 91 to 92 percent of cases by merchants, and mostly ignored by the population. Thus, although it was prohibited, alcoholopops were allegorically sold to minors, sometimes only 12 or 13 years old. In addition, it was believed that the sale of beer was prohibited to minors. In short, there was a lack of knowledge of the law and therefore of its application.

I don’t think the provision we’re going to adopt today will make the law miraculously enforced one hundred percent in all stores. We will vote on an important text but the provision is far from solving everything unless serious means are put in place. One advantage of the provision in question is that it will be up to the SPF Health to control the trades in parallel with the control it exercises on the sale of tobacco. There will therefore be a harmonisation of the controls gathered in the hands of the SPF Health. However, one cannot be everywhere and change practices at once.

How will the merchants do to know the age of the youth to whom they will sell alcohol? Will they dare to ask for the identity card? How else can we distinguish between young people under 16, young people under 16 and young people under 18? This can be difficult in practice. Despite the means of control, the legislation will probably be imperfectly or partially enforced.

That is why I would like to insist on behalf of my group that this provision regarding the sale of alcohol to minors be accompanied by other measures that the federal government in particular could take. Since the Minister of Consumer Protection is present, it is worth recalling the legislation on alcohol advertising. The Arnoldus Convention with the alcohol sector was transformed by Minister Demotte, at the time, into a mandatory rule. This advertising legislation says that it cannot target minors, that it cannot value youth’s alcohol consumption behaviors. But again, in practice, we see the omnipresence of alcohol advertising. It is present in places frequented by young people, including sports clubs where beer brand sponsorship is displayed everywhere.

Nevertheless, our company continues to implicitly promote alcohol consumption. The valorisation of alcohol consumption, of which adolescents are major victims, passes between the grids of a ⁇ loose regulatory net.

Mr. Minister, you had acknowledged that this prohibition of sale provision was still insufficient and you expected your colleagues to supplement this provision with consumer protection measures and possibly taxation. The federal government and colleagues are therefore involved in supplementing and making fully effective a mechanism aimed at reducing overconsumption of alcohol among young people.

The prevention and awareness-raising campaigns that must take place concern the federated entities. A huge work remains to be done.

I do not know to what extent you will be able to exercise this control over sales. Do your services have enough staff to do so? It is a question of budgetary resources. You know we voted in favour of this measure. However, before your arrival, I said that one should not directly expect a miracle, given already the difficulty of implementing the current legislation.

Madame Snoy, I totally agree. As I said, this is a first step that falls within my competence but must be complemented by various other measures that have been discussed in particular at the interministerial conference of Public Health.

When it comes to control, we are making a special effort. We have additional staff and a transfer of the department of the Ministry of Finance and Economic Affairs, which has this habit of control with the provisions on tobacco, was operated to Health. By surrounding ourselves with specialists, we will try to be much more effective in tackling this problem that affects many young people.

The CRIOC had put the finger on this lack of enforcement of the law. In a statement, he appreciates the measure we are taking today but also points out the need to monitor implementation, including allowing either CRIOC or other consumer organisations to conduct tests to verify traders’ attitudes.

I also wanted to add a word on the issue of the attractiveness of health professions. You have expressed your interest in promoting the profession of nurse. We agree that it should be valued.

One question seems to arouse reactions among nurses: the attractiveness of the hospital specialist nurse profession is supported and strengthened, especially in neurology, but what will be done for all nurses and how?

From this point of view, from what I was able to consult from your draft budget, we find 75 million to value the profession of hospital nurse, but 1.5 million to value the profession of home nurse. This is the eternal question of the first line: how to give more importance, more priority to this first line compared to the hospital?

We will therefore remain demanding a revaluation of the first line, especially of nurses at home.

This is what I wanted to say about this bill that we will approve.

In terms of attractiveness, I would prefer that we talk about it more broadly when submitting the budget. You will see and better understand the work done to support nurses, not only hospital nurses but also those who work in the front line, at home.

I look forward to seeing this and I only ask you to believe it.

Mr. Speaker, Mrs. Minister, dear colleagues, during this debate, I would like, on behalf of our group, to address more specifically five themes of this project: the provisions relating to the prohibition of selling alcohol to minors, the extension of the system of increased intervention, the mode of remuneration of pharmacists, the information of service providers as to their status of conventional or non-conventional and, finally, hospital pediatrics.

The MR Group approves without reservation the Articles 12 and 13, which amend the Law of 24 February 1977 on the Protection of Consumer Health to group, harmonize and clarify the measures relating to the prohibition of selling, serving or offering alcoholic beverages to young people under the age of 16, as well as spirits to young people under the age of 18.

Alcohol abuse causes irreparable damage to health. Therefore, we must take all necessary measures to combat this plague.

Among young people, two alarming new phenomena are denounced by specialized observers: the rejuvenation of consumers, on the one hand, and the increase in binge drinking or immediate drunkenness, on the other.

Therefore, it is urgent to react to clarify the legislation as best as possible and, above all, to enforce it.

From now on, the control of all these measures will be entrusted to the inspectors of the SPF Public Health. It will, of course, be necessary to give them the means to be truly operational and effective. We would like a regular evaluation of their work and the enforcement of the legislation to be organized and communicated to your Health Commission.

With regard to Article 19 and the automatic extension of the system of increased intervention (so-called BIM) to long-term unemployed persons under the age of 50 and single-parent families, we recall that these two categories of persons were already covered in a similar way by the Omnio status. However, unlike the BIM system, which is automatic, the Omnio status imposes a proactive approach in the head of the applicant who must submit an application for intervention and attest not to exceed a certain threshold of income. Today, 600,000 people likely to benefit from the Omnio status would not have taken the necessary steps to obtain it. We will therefore open them the path of automatic law.

This measure is eminently social but legitimately questions can be raised about the effectiveness of the information and about the social monitoring provided by insurers and social services. In fact, it would have been more responsible, I think, to strengthen the information of the most precarious populations and to maintain the procedure thus imposing a responsible approach to applicants to obtain a special status.

Finally, we once again draw the attention of the government to the fact that this social benefit could become a new trap for employment since a return to work would deprive the family concerned of increased reimbursements and would therefore influence their net incomes in due competition.

There will also be some difficulties in controlling the status of single-parent families by insurance agencies that will still have to be overcome. But we have noted that the Minister was aware of these difficulties and is considering the creation of a working group to analyze employment traps and make proposals to remedy them.

We are pleased to join this discussion group.

The Minister also announced its desire to set up a permanent evaluation of this legislation. We will encourage them on this path.

Articles 25 and 26 aim to clarify and improve the future system of remuneration for pharmacists. The MR has long claimed the establishment of a delivery fee to value precisely the active role of the pharmacist in the health care system.

From a preparer of medicines, the pharmacist has become a dispenser and a consultant in the field of medicines. He is a major player in proximity medicine, a first-line provider. Certainly, the case progresses but rather at the speed of the turtle step than the leopard jump because at the mega-Council of Ministers of Ostende, in March 2004, an orientation note aimed at ensuring the accessibility, quality and sustainability of the services in the pharmaceutical sector already provided that a reform of the role and remuneration of the pharmacist would be implemented for 2006.

Today we are announced the launch of the new remuneration system in March 2010; I call for this fundamental reform not to be delayed.

Articles 51 and 52, which deal with the obligation of care providers to inform their patients about their status as a contracting or non-contracting, appear to us to be ⁇ important in the context of patient protection and compliance with the law on their rights. I will remind you that if we are attached to the current system of the freedom of the doctor to adhere or not to the convention and to practice the tariffs in force, we would like in corollary that each patient is properly informed and that each doctor clearly assumes their choice and makes it known.

I would like to add that it is desirable that this mandatory information is also applicable to technical acts that are often requested by telephone communication of the patient to a medical secretariat. It happens, unfortunately, that patients receive the bad surprise of an overload of fees under the pretext that the doctor who carried out the protocol of the technical act was out of agreed hours at the time he did it.

Finally, I will refer to the amendment submitted by the majority that aims to provide a legal basis for the King to establish flat-rate fees in order to stimulate the presence of pediatric specialists in hospitals. This arrangement was expected by the profession and is necessary to enable a redistribution of hospital pediatrics.

It is also essential for ensuring the framework and quality of hospital pediatric care. It is therefore reasonable to welcome the adoption of this provision.

Here, Mr. Speaker, Mr. Minister, Ladies and Gentlemen, are the various comments that our group wanted to make during this debate.

According to the common practice, the present Health Act is a collection of legislative changes. I will limit my discussion to four concrete points.

One item from the Health Act that has ⁇ led to debate is that the increased reception was extended to unemployed and single-parent families. Not only does it reopen the debate about the controllability of what single-parent families exactly are, it further obscures the picture of new unemployment drops. Apparently, the legislator cannot allow people to be divided into categories, rather than looking at the income of those concerned.

I hope, Mrs. Minister, colleagues, that in this legislature we will not start creating new income gaps, after we have worked hard for two legislatures to eliminate those inactivity gaps. Even in these times of crisis, it is essential that policy continues to send signals that work must pay more than not work. Moreover, with a major budgetary problem and with the ageing, which will weigh heavily on our social security over the coming decades, that message must come more clearly than ever from the policy.

The ban on the sale of alcohol to young people received general support in the committee. However, a pain point remains the control. This pain point is also felt in the ban on the sale of tobacco products to young people. At the same time, the merchant is given the role of a police officer and that really does not fit in our Flemish nature.

More important than another prohibition is the need to teach young people how to handle alcohol. Forbidden things are beautiful. They are quickly approved. They give us a good conscience. In theory, they are even easy to control. At the same time, however, we must realize that the consumption of what is forbidden, just because it is forbidden, is made extra attractive. The ban will not actually solve the problem. Benefits exist. Pleasures will always exist. You will always find a way to get there. The real question is how we arm our young people with this responsibility to jump. It is especially regrettable that so little, even insufficient attention is paid to it!

Governments appear to have a very difficult time with laws that do not come from the government, but that have been approved by the Parliament and are thus carried out by our assembly.

After all, the government cannot fail to change everything afterwards. I give two concrete examples in the Health Act to which it was encrypted: the Law on Patient Mobility and the Law establishing the Committee for the Permanent Review of the Nomenclature. Not by chance they are two difficult laws about delicate files, which have remained lying for too long and in which solutions are not immediately available.

The law of 4 June 2007 aims to promote patient mobility. The law is postponed by one year. Patient mobility is a reality today. Putting our heads in the sand and denying the phenomenon is no longer possible. It is really important to lead the phenomenon in good course, to adjust our structures and to set up instruments so that we as a country can prepare well, map the negative effects and address them afterwards.

The law was adopted in consultation with the various majority parties. Several health funds were asking party and I really hope that the government will succeed in enforcing the law and turn the challenge into a great success. The establishment of an observatory for patient mobility is already a very good step in the right direction.

The second file in the series concerns the Committee for the Permanent Review of the Nomenclature. That committee was established by the law of 27 April 2004. That is now five years ago. Since then, the law has been subject to the change urge of the successive ministers responsible for Public Health. This law was a parliamentary initiative. The numerous amendments almost suggest or suspect that the competent ministers do not have much sense of setting up the committee. Once again, the Minister has promised to appoint a chairman so that the committee can finally start effectively.

The importance of the committee, colleagues, cannot be underlined enough. In our health insurance system, intellectual performance is really heavily underestimated. This has negative consequences for general practitioners and specialists, who primarily work with intellectual performance. Psychiatrists, child psychiatrists and pediatricians are the most well-known examples. It is therefore not a coincidence that there is little interest among the students of medicine.

I hope that this amendment will be the last necessary to make the committee work in the facts.