Proposition 53K0302

Projet de loi modifiant l'article 171, 4°, du Code des impôts sur les revenus 1992.

General information ¶

Authors

MR Daniel Bacquelaine, David Clarinval, Denis Ducarme, Philippe Goffin, Kattrin Jadin, Marie-Christine Marghem, Damien Thiéry
Open Vld Maggie De Block

Submission date

Oct. 6, 2010

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

direct tax doctor tax incentive tax on income bonus payment

Voting ¶

Voted to adopt

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

Voted to reject

VB

Abstained from voting

∉ N-VA LDD

Party dissidents ¶

• Peter Luykx (CD&V) abstained from voting.

Contact form ¶

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Discussion ¶

July 14, 2011 | Plenary session (Chamber of representatives)

Full source

We suspend the session for a few minutes to give time to Mr. Hendrik Bogaert, who is the rapporteur, to join us.

Here is the speaker, Mr. by Bogart. We continue the agenda with its report.

I knew today would be a special day.

Ladies and gentlemen, Mr. Speaker of the Chamber, colleagues, the Committee on Finance and Budget discussed the bill during its meetings of 6 and 13 July 2011. First there was an introductory presentation. Mr. David Clarinval refers to the debate that took place during the previous legislature in the Committee on Public Health on the attractiveness of general medicine, ⁇ in rural areas and areas with medical shortages. That debate has resulted in a resolution calling on the various competent ministers to take a set of specific measures. A number of measures have been implemented by the Deputy Prime Minister and Minister of Social Affairs and Public Health, in charge of Social Integration.

The present bill implements measure 16 of the resolution, namely providing for a lower tax on the premiums for doctors established in areas with few general doctors and deposited in the window of Impulseo I. The Impulse Fund was created to encourage young general physicians to settle in areas with few general physicians per inhabitant. The Fund provides two types of support: the grant of interest-free loans of a maximum amount of EUR 15 000 when a general physician begins a practice within four years of his recognition or after his return from a developing country and the one-off grant of EUR 20 000 to physicians who settle in a so-called priority zone or who move their practice from a non-priority zone to a priority zone. These are areas where there is a high demand for new medical practices.

Currently, the tax administration charges that amount of 20 000 euros to the professional income of the general physician, who must therefore declare it in the year in which he receives it. Consequently, doctors are taxed on the full amount. If they have made investments, tax deduction is only possible through a depreciation spread over several years. So much of that installation support goes to taxes.

Therefore, the bill aims to tax an amount of 20 000 euros separately at a reduced rate of 16.5%.

Mrs Rutten and I consider it contradictory that the government, on the one hand, provides a premium and, on the other hand, recovers part of it by taxing the premium.

In addition, the CD&V group supports the present bill.

Mr Van der Maelen asks what the budgetary impact of the bill is. Mr. Coëme also wants to know what budgetary implications the bill has.

Minister Reynders emphasizes that premiums in taxation are always considered to be income on which taxes are due. The government can choose to reduce the tax or reduce it to zero. The Minister points out that there are costs associated with this.

However, he says that the government has no problem with the bill. He does not have information on the amount of premiums paid by the government within the framework of the Impulse Fund. For this purpose, he will obtain the necessary data from the FOD Public Health.

Mr Mathot proposes that the Court of Auditors request a study on the budgetary impact of the bill. Furthermore, he asks whether the imminent savings in healthcare still leave room for such initiatives.

Chairman Gerkens notes that 22 million euros were registered for the one-off Impulse premiums in 2011. A reduction of the tax rate on premiums to 16.5% will cost between 5 and 7 million euros. Asking the Court of Auditors for a study to calculate the budgetary impact of the bill appears therefore superfluous.

However, the Minister responds that the budgetary impact of the bill should be estimated at around 6 million euros. The reduction of the tax rate from approximately 45 % to 16,5 % on a one-off premium of EUR 20 000 would therefore still mean an advantage of EUR 6 000 for the general practitioner concerned.

During the meeting of 13 July 2011, Minister Reynders ⁇ that the Minister of SMEs, Self-Employed Persons, Agriculture and Scientific Policy, under whose authority the Participation Fund falls, as the technical operator for the scheme referred to in this bill, provided the following information concerning the Impulse Fund.

There was a total of 13.2 million euros in 2009 and of 16.7 million euros in 2010. For 2011, the Participation Fund estimates the aid amounts in the same order of amounts, resulting in a budgetary impact of 2 million euros on the basis of 2010 figures.

Ms. Wouters has a number of questions on tax matters. The question arises whether the premium can be partially regarded as a capital subsidy. It also makes a comment on the selected rate. In the latter case, the premium would be taxed at 34 %. How do the applicants of the proposal respond to the difference in treatment?

The Minister notes that there is already a logical difference in the tax treatment of the professional income of a physician who works as a natural person or as a company.

Mr Goyvaerts notes that Ms. Wouters drew attention to some important problems associated with the implementation of Impulseosteun I, II and III. He points out that his group has always advocated for tax simplification.

In the end, the entire thus amended bill is adopted with 12 votes against 1 and 4 abstentions.

The Impulseo Fund was created to encourage doctors to settle in so-called low medical density areas. Indeed, some regions experience a real shortage of doctors and the citizen faces great problems in getting the appropriate care. Their situation is very problematic.

My group obviously supports all initiatives aimed at helping and supporting both doctors and their patients in access to care. In our time, it is indispensable that this accessibility does not vary from one citizen to another.

The premium is 20,000 euros for any doctor who settles in a so-called priority area or who moves his medical practice from a non-priority area to a priority area. This amount is intended to encourage the installation of these doctors and to finance the start of a sometimes difficult medical practice. This amount shall be allocated to them and shall be deemed to be acquired definitively at the expiration of the fifth year following the date of establishment of their practice. The tax administration considers this aid of 20,000 euros as a professional income of the doctor that he must declare in the year he receives it. It follows that doctors are taxed on the whole of this sum. A significant part of this installation aid is thus absorbed by the tax.

What is proposed today, and we support, of course, is that this premium will be subject to a separate tax of 16.5%. Aid to the agricultural sector is already taxed separately because it is a sector that needs support.

The health and health care sector requires all our attention and support. The proposal is well-founded and balanced. So, for my group, things are clear. It is essential that the healthcare sector is supported as much as possible and that access to care is enhanced for all citizens in need, regardless of their place of residence, age or even status.

Onkelinx, Vice Prime Minister and Minister of Health, has continuously worked for the maintenance and especially the improvement of medicine for all, by issuing budgets for general physicians, especially young physicians, who settle in areas with low medical density.

Its action also facilitated the conditions of access to the Impulseo Fund.

The measure we are about to vote for is therefore perfectly in line with the policy of Ms. Onkelinx, which is why, I repeat, my group will support it.

Mr. Speaker, colleagues, I would like to defend the position of the N-VA, because we abstained as one of the only ones.

Some things are not quite clear to us. We would like to emphasize in particular the fact that here a very small group of general practitioners, who receive financial support through Impulseo I, gets even more benefits by taxing their premium of 20 000 euros at a marginal rate of 16,5 %. In this way, this small group of doctors will be extra benefited.

The N-VA wants to further develop the story of Impulseo. We are committed to implementing Impulseo III. Currently, Impulseo I provides financial support to general practitioners to establish themselves in rural areas with few inhabitants. With regard to Impulseo II, the State Council asks whether there is no discrimination in that regard. For us, it is therefore necessary that Impulseo III comes.

Impulseo III applies to all general practitioners, while Impulseo I applies to certain areas and Impulseo II only to group practices. It is intended to motivate family doctors to continue to exercise their profession. We do not fully understand why, first and foremost, a small group should be further favored. On the other hand, we also ask ourselves why this should be done through taxation. If that premium does not prove to be sufficient, it can, in our opinion, be resolved in another way. We would like to ask the ladies Onkelinx and Laruelle to increase the premium if it turns out that the premium is insufficient.

I would like to point out that this premium is not only for the investment to settle in such a zone, but also for the deprivation of income because one is in rural area. There are very many workers who would find it very pleasant to be taxed on some of their first 20 000 euros less or at a marginal rate. The National Commission of Physicians urges the government to implement Impulseo III. Currently, 60 to 70 percent of medical practices are made up of solo doctors. They are still in the cold with this measure. It is discrimination against them. We cannot support this bill.

First of all, I would like to thank Mr. President. Bogaert for his excellent report, which arrived just on time.

The text that is presented to us today is ⁇ important to me, because it aims to resolve in part a worrying situation: the shortage of doctors in certain regions of our country, in rural areas, but also in some disadvantaged neighborhoods of our big cities.

Our healthcare system has, so far, enabled the existence of a medicine recognized as one of the best, accessible to all and meeting the requirements of free choice of the patient and the freedom of therapeutic and diagnostic of the care providers. It is based on the principle of solidarity, which guarantees to every citizen a quality and accessible health care coverage.

However, in some regions of the country, situations of insufficient medical supply alert us. Currently, we find mainly in rural areas, but also in some difficult neighborhoods of our large cities, a very low density of general practitioners in activity, which poses a problem for ensuring the quality and continuity of care and accessibility, especially during guards.

That is why, for some time already, we have begun an important work within this Chamber on the attractiveness of general medicine. In April 2010, our group received the support of MEPs from the Public Health Committee and the Plenary Assembly on a proposal for a resolution on the attractiveness of general medicine. There are no less than eighteen concrete measures that we set out in this resolution, in order to boost the attractiveness of general medicine.

The text presented to us today is part of the continuation of this resolution. My approach was to concrete in a bill some points of the resolution so that the legislator can concrete the examination of the problem.

Furthermore, I would like to emphasize that on her part, Mr. Minister Onkelinx has, despite the current context, also continued some of the measures set out in this resolution. In particular, I think of the custody houses, the implementation of the cadastre or the organization of medical guards.

The Impulseo Fund is one of the elements set up to promote the implantation of young doctors or the shift of current medical practices to areas with low density. The fund’s intervention is made by the granting of two types of aid: a loan without interest for a fixed amount of up to 15 000 euros, for any new installation, and the single grant of an amount of 20 000 euros for physicians who settle or move into the so-called priority area.

This sum of 20,000 euros aims to help fund their installation and the start of a sometimes difficult medical practice. Currently, the tax administration considers this amount of 20,000 euros as a professional income of the doctor that he must declare in the year he receives it. A significant part of this aid – ⁇ half – is thus absorbed by the tax.

The proposal under consideration today therefore aims to subject this premium to separate tax at a reduced rate of 16.5%. In doing so, the attractiveness of the Impulseo Fund is guaranteed.

The discussion in the committee was interesting and enabled to produce a large majority in favor of our text. That is why I would like to thank today my colleagues of the MR, co-signators of the text, Mrs De Block also co-signator, Mr. De Block. Minister Reynders who put his weight in the balance at the right time, Mrs Gerkens, Chair of the Commission, for her effective support and, of course, all the colleagues from the various parties who voted favorably this text yesterday, in the committee. Among these, a special thank you to Mrs. Vienne who arrived at the right time; would I dare to talk about the woman who falls to the pit?

In response to the questions that Ms. Wouters recently raised (why the tax path rather than the social security path), I will say that this decision was made at the time of the review of the resolution. It was a choice of the commissioners at the time to use the tax route instead of increasing the premium, another possible path that was not chosen then.

I think like you that there is a reform to be carried out in the Impulseo aid. That is why it is important to have a government that can lead this research and debate. Unfortunately, we are not at this stage today. Therefore, we have the opportunity to bring a small stone to the building in this matter. I would like to thank all the colleagues who will bring this stone.

Mr. Speaker, I wanted to explain why the Ecolo-Groen group! He also supports this bill. It is rare for us to support provisions using the tax tool because this means the redistribution of tax revenues.

In this case, this Impulseo I premium was awarded to doctors in areas called and recognized in shortage, whether rural areas or difficult neighborhoods. This premium is granted to cover significant installation costs and a start of the service period is not always very profitable because it requires a patient and that involves long trips in rural areas. This premium was granted to cover actual expenses and is taxed in the same way as other income.

This reduces the scope and ability for the doctor to have a tool that helps him.

That is why we supported this proposal. The latter concrétises one of the elements of the resolution in favour of general medicine adopted during the previous legislature. Of course, it does not tend to implement all the instruments that would support and develop general medicine.

That said, I insist on the fact that the balance of the Impulseo I action is not faramineous. Indeed, this measure alone is not enough. Installation in a difficult area, especially rural, requires assistance at the level of the organization of the guards. We will also have to look at this aspect.

We need general doctors. However, the latter are unfortunately in decreasing numbers because, today, medical students prefer to opt for a specialization rather than to go to general medicine even if it has acquired a specialization status. Work must therefore be done to try to convince medical students of the importance of a comprehensive approach and patient proximity.

In addition, hospitals lack specialized doctors and, in doing so, they employ generalists to whom they grant a fixed remuneration greater than they could earn by exercising their profession, ⁇ in areas with shortages.

In short, we need to look at a whole series of measures in order to complement the bill under consideration.

I would also like to say to Ms. Wouters that Impulseo I, which is a facility premium, cannot be placed on the same level as the Impulseo II and III premiums, which are intended to contribute to the financing of the administrative personnel made available to doctors. This is a personal aid of a different nature, which must therefore be treated differently. Impuseo II and III suffer from imperfections. It will be up to the Health Commission to improve these tools to help doctors, regardless of the form in which they are grouped.

We are fully aware that this is a first phase to support the Impulseo device.

For environmentalists, this will need to be accompanied by a approach to regulate the medical supply in the territory. We will probably need to use a more incisive way to get doctors to go where they need them and not just where they want to settle.

We will implement all these complementary tools through other texts that, I suppose, you will approve in the same way, since you share the same concern.