Proposition 54K0408

Projet de loi modifiant l'arrêté royal n° 38 du 27 juillet 1967 organisant le statut social des travailleurs indépendants, visant la non prise en compte de la prime "Impulseo 1" dans le calcul des cotisations sociales.

General information ¶

Authors

MR Daniel Bacquelaine, Caroline Cassart-Mailleux, David Clarinval, Denis Ducarme, Benoît Friart, Luc Gustin, Kattrin Jadin, Benoît Piedboeuf, Damien Thiéry

Submission date

Oct. 7, 2014

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

social-security contribution social security self-employed person

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo LE PS | SP DéFI ∉ Open Vld N-VA LDD MR PP VB

Abstained from voting

PVDA | PTB

Contact form ¶

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Discussion ¶

July 15, 2015 | Plenary session (Chamber of representatives)

Full source

I refer to the written report.

Mr. Speaker, dear colleagues, the text that is submitted to us today holds me ⁇ at heart because it touches on a very worrying situation: the shortage of general doctors in some regions of our country. The finding is not new: rural areas of our country are ⁇ affected by this problem. We have been working on solutions for many years, but the issue is unfortunately still topical. 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 ensures that every citizen has access to quality and accessible health care coverage.

However, in some regions of the country, we see situations of insufficient medical supply. In rural areas, but not only, we encounter a very low density of working general practitioners, which poses a problem for ensuring quality, continuity of care and accessibility, especially during guards. For some time already, our work having begun under the auspices of Minister Laurette Onkelinx, we are working on the attractiveness of general medicine.

In April 2010, our group received the support of the plenary assembly members on a proposal for a resolution on the attractiveness of general medicine. At the time, we had drawn up 18 concrete measures to boost the attractiveness of medicine. In the continuation of this resolution, my approach consisted in concretizing in bills some points of the 2010 resolution so that the legislator can grasp the problem. Two bills concerned the Impulseo Fund, which was set up to facilitate the implantation of young doctors or the relocation of current medical practices to areas with low medical density. Now regionalized, the fund’s intervention is carried out through the granting of two types of aid, namely, either the granting of a loan without interest for a maximum amount of 15 000 euros for any new facility of general practitioner, or the granting of a single amount of 20 000 euros for doctors who settle in a so-called priority area or who move their medical practice from a non-priority area to a priority area.

These are the areas where the demand for new facilities is the greatest. This sum of 20,000 euros aims to help fund their facility and start a sometimes difficult medical practice. As a result, in 2011, I was able to implement the tax rate. In a nutshell, the tax administration considered that the amount of 20,000 euros as a professional income of the doctor that he had to declare. A significant portion of this aid was absorbed by the tax. The law passed on 14 July 2011 aimed to subject this premium to a separate tax at a reduced rate of 16.5%. In doing so, the attractiveness of the Impulseo premium was guaranteed.

Today, the bill that is being submitted to you concretizes the second aspect, that is, the social aspect. Since this premium of 20,000 euros is considered a professional income of the doctor, it leads to an increase in social contributions. Since this is an incentive premium that is not intended to compensate for any loss of income, it makes sense that the Impulseo premium is removed from the base of the calculation of social contributions and their rates. This is the text that is presented to you today. For information, this still represents an aid of ⁇ 3 000 euros for every doctor who will come to settle in rural areas.

Allow me to thank all the groups, both the majority and the opposition, who once again supported this text. We voted unanimously for the resolution and the first law. I hope that we can be unanimous on this second law. I would also like to thank Mr. De Bloch and Mr. Minister Borsus, who also supported the approach. I also thank Mrs. Natacha Beugnier and the collaborators who have followed this matter with perseverance for so many years.

I hope we can vote unanimously on this bill.

I thank you for your attention.

The deployment of employees does not always go without problems. The problems, which are significant, are situated at different levels. At the federal level, we are very pleased that, on the basis of the proposal of colleague Clarinval, we have found a broad support to approve the proposal for a resolution to address the problems related to the dispatch of workers. We ask the government to implement the proposed measures.

We support the principle of free movement of workers. If the European rules are applied correctly, there is no problem. For example, the European Draft Directive stipulates that employers in the European Union must apply the labour and wage conditions of the country in which the worker is employed, or the conditions in force in the country of origin of the worker, if they would be more favourable than those in the country of employment. Social security contributions, on the other hand, are always paid in the country of origin, which provides a significant advantage in countries with low contributions.

The abuses are also legio.

Especially in the transport, meat and construction sectors we see a lot of fraud. For example, there are companies that do not pay social security contributions anywhere, including in the country of origin, which is also very reluctant to cooperate in the detection of fraud. Some set up postbus companies to send workers to Belgium and escape the social contributions in our country. Often these workers do not even come from abroad.

This, of course, creates false competition, as such undertakings can be between 20 and 30 % below the market price. Many SMEs in Belgium, especially in the construction sector, continue to lose contracts to foreign companies and to Belgian construction companies that engage foreign subcontractors who do not respect the rules of the game. For example, workers from Germany, where hourly wages range between three and eight euros, come here to work in the slaughterhouses. Let us also not forget the human suffering. Such practices bring humanitarian circumstances: one does not pay overtime; one does not respect working hours or one does not report work accidents. In many cases, we can speak of a modern form of slavery.

Ladies and gentlemen, there is an error here. There is another text.

I will not repeat this part of my speech.

(Mrs. Lanjri spoke on the draft resolution no. 1111 on dispatched workers

To be quite clear, we now move on to the general discussion about the Impulseo premium.

Mr. Speaker, the so-called priority areas, the rural areas of this country, are facing the phenomenon of a shortage of general physicians. The age pyramid and demography indicate that over a decade, this problem will become more and more acute. Previous governments and this assembly in previous legislatures have attached themselves to this issue, have taken measures that have ⁇ resulted in improvements and have undoubtedly allowed to stop a phenomenon, without solving it altogether.

by Mr. Clarinval has already made a part of the story but I would like to briefly remind that it was Minister Rudy Demotte who launched the first Impulseo project in 2006, then supplemented by Ms. Onkelinx, Minister of Social Affairs, with Impusleo 3, to provide specific aid to general practitioners who settle in the so-called priority regions. It is true that, under the guidance of Clarinval, this parliament, all mixed parties, majority and opposition, voted, by a very broad majority, a resolution to propose a series of complementary measures. This is where this proposal, which aims at obtaining a special tax arrangement, should be placed, once again to encourage people to stay in the priority areas.

We have said well in the committee, this measure is positive and our group will support it at the time of the plenary vote, but it will obviously not solve the whole problem. I think that Parliament could go back to the debate at the start, in a general way, to consider these eighteen measures, which could be done in a complementary way. We are open to this work. We definitely need to continue, update and amplify it because the problem will become more and more acute in the coming years.

I also wanted to remind you that the custody system for general practitioners, set up by Ms. Onkelinx during the previous legislature – the call number 1733 launched experimentally in a series of sub-regions of this country and which is now becoming widespread – also aimed at making the benefits of general practitioners that were completely stuck in their professional and private life by the underemployment situation in these regions tolerable. I think it all goes in the same direction.

Mr. Clarinval, I confirm that the Socialist group will support, as in the committee, this bill and we are demanding a much wider reflection on the question of this shortage and its consequences in the coming years.

Finally, as I pointed out in the committee, there is also the question of financing. I think here of the lack to earn of social security which was estimated at 600,000 euros. This, in itself, is not a significant amount. We are therefore in favor of the measure, but we want to draw attention to the social security deficit. We therefore asked the government and, in particular, Ms. De Block, to find ways to provide compensation through alternative financing. But I do not doubt that the authors of the bill, among whom Mr. Clarinval, will be attentive, as part of the tax shift that is being negotiated, to the fact that the shift of income on large fortunes and other allows, through this alternative financing, to compensate for the amount in question.

In any case, we will be attentive to the overall financing of social security because, in the end, if the deficit should increase, it would be patients across the country who would suffer the consequences through austerity measures or through a decrease in reimbursement. The challenge is therefore also to make medicine accessible to all and everyone, in all regions of the country.

That being said, we will vote on this bill that is favorable to general physicians exercising their activity in the so-called priority areas.

I would also like to say to Mr. Clarinval that, as was the case for the work on the resolution and tax measures, we will support his proposal that aims to exempt from social contributions the Impulseo 3 premium granted to encourage the installation of doctors in areas in scarcity.

However, I insist: such measures are not enough to attract doctors to areas identified in scarcity. Therefore, work must also be carried out in the field of health, in particular to improve guard devices that allow doctors in these areas to work in a decent manner. In addition, it will be indispensable – I want to emphasize this point because it is topical – not to rely on the current “dynamic” cadastre to identify doctors according to their specialization as well as the needs for the future. During the discussions we had in the Health Committee, we realized that there was a lack of important information, such as the necessary devices to ensure the transmission of the patient from an elderly doctor to a younger doctor.

It was equally essential to take into account the type of consultation and the time spent on it. We do not have any of these data. We must take this into account so that the entire territory is sufficiently covered by the medical disciplines that will have to work in multidisciplinarity.

This measure aims to allocate the money only to the installation of doctors who agree to go to an area in shortage, and that they are not penalized in relation to the income they will get from their professional activity.

These are the measures I wanted to highlight.

Mr. Speaker, dear colleagues, in order to effectively replicate the fact that we will support this bill, as it was adopted in a committee, I would like to draw attention to the need for a more comprehensive analysis, in particular for the placement of doctors at the level of priority areas or rural areas.

Let us not forget that beyond the diagnosis and treatment that doctors mention, there are also, in the healthcare sector, a number of other operators: fitness therapists, nurses ... Positioning in this type of priority area is also difficult for them.

The proposal as presented to us is a means or an element of the solution. It is important to work more intensely if we want to respond to the sharpness of the situation. If no action is taken, in a few years, whole areas will be without doctors, which will cause difficulties in terms of health care coverage in rural areas or elsewhere. It is necessary to stimulate this type of place and strengthen the attraction of the profession with regard to general practitioners in the first place, but more generally with other actors in the healthcare sector.

Mr. Speaker, I would like to conclude by saying that we will support this bill by repeating a new request in order to be able to discuss the situation more globally, in particular the paramedical sector and health care in rural areas, a topic that deserves our full attention.

Mr. Speaker, on behalf of the FDF, we will support this bill. I would like to emphasize that we are ⁇ sensitive to this problem of risk of medical shortages in rural areas. The FDF has initiated a resolution in this sense, which is more focused on the INAMI quota for municipalities ⁇ affected by this risk of shortage.

We have the support of two parties. I wish that both of my colleagues in the MR would also support us; indeed, it is by working together that we can move forward. We are absolutely in favor of this bill and we will vote on it.

Mr. Speaker, I would like to thank the colleagues for their intervention and their support for this bill, which, as Mr. Delized, is the result of a long-term work initially conducted with Minister Onkelinx and then with Minister De Block. This is a work that is done in continuity.

I obviously agree with the point of view mentioned: it is not only this bill that will solve the problem of the painfulness and lack of attractiveness of the rural area for general medicine. But it is a small stone that is inserted into the building that aims to increase the attractiveness of general medicine in rural areas.

I am quite willing, as colleagues request, to participate in a more comprehensive debate. The resolution we voted for at the time included eighteen measures. We can evaluate the implementation of this resolution, update and supplement it. by Mr. Lamotte pointed out that other important elements are in the hands of the Communities and should be implemented there.

I am fully willing to start a comprehensive debate on this issue and I thank my colleagues for their support for this text.

The FDF proposal deserves our full attention and we will consider it with MR’s colleagues. I am currently unable to comment on this text.