Proposition 54K1161

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

General information ¶

Submitted by

MR Swedish coalition

Submission date

June 11, 2015

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

pharmacist health expenditure doctor medicinal product health policy health care medical device paramedical profession patient's rights mutual assistance scheme public health health insurance

Voting ¶

Voted to adopt

CD&V ∉ Open Vld N-VA LDD MR

Voted to reject

LE DéFI

Abstained from voting

Groen Vooruit Ecolo PS | SP PVDA | PTB PP VB

Party dissidents ¶

• Olivier Maingain (MR) voted to reject.

Contact form ¶

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Discussion ¶

July 1, 2015 | Plenary session (Chamber of representatives)

Full source

I refer to the written report.

Mr. Speaker, colleagues, the draft law containing various health provisions gathers several necessary and useful measures in the field of health care. The following measures are part of the package.

I knowingly start with the measures that directly benefit the patient: more transparent information for the patient on the financial side of health benefits; the enhancement of patient participation through additional subsidisation of patient associations to enhance their representation; the maximum social invoice for children with disabilities; the abolition of erectile supplements in two or multiple rooms in the day hospital; the reduction of the flat-rate fees for medical imaging and clinical biology; the establishment of a legal regulation on the brake payment for living organ donors; the obligation for mutualities to increase financial transparency and the establishment of a system of exchange of information between fertility centers in relation to excess embryo and gametes.

When someone speaks, it is appropriate to listen.

Thank you, Mr President.

So that was a non-exhaustive list of the elements that benefit patients.

In addition, I will provide a number of other measures, including the structural involvement of nurses in home care within the mandatory health insurance, a register for heavy equipment inside and outside hospitals, the financing of hospitals in case of epidemic or pandemic and adjustments to enable the election of the Order of Doctors.

The committee discussed the draft law during its meeting of 16 June 2015. In the overall vote there were 11 votes in favour and two abstentions.

Amendments were made, among other things, to the KB no. 78 concerning the exercise of health care professions. On Thursday 18 June 2015 the KB of 10 May 2015 coordinating the KB no. 78 of 1967 concerning the exercise of the health care professions published in the Belgian Staatsblad. As a result of that publication, it was necessary to make corrections to the text adopted by the Committee on Public Health. These are purely legal and technical changes. Instead of the provisions of the previous KB no. 78 to be amended, the corresponding provisions of the Act on the Health Care Professions, coordinated on 10 May 2015, are amended and references are made to the provisions of the latter law.

Consequently, substantial adjustments were made to the draft Articles 59, 75, 76 and 76 Partim. Those adjustments will be incorporated into the text adopted by the plenary session.

We had a very positive and constructive discussion. Everyone had the opportunity to express their opinion on the proposed provisions.

On behalf of the MR, I would like to remind you that the various provisions concrete the points of the government agreement. We can only rejoice. Patients and service providers, including pharmacists and medical imaging technologists, are directly affected. Transparency measures are also planned, in particular at the level of insurers.

We are also reassured with respect to the acquired rights and language rights that have been drafted in agreement with the National Council of the Order of Doctors, to allow the necessary changes in view of the near elections.

Ladies and gentlemen, I will also briefly comment. This has already been discussed in the committee. We are also pleased with this bill because it contains matters that are important to us, such as accessibility and affordable care. I then think of the abolition of honorary supplements in double or multi-person rooms in day hospitalizations, the extension of the social invoice, as well as the included provisions on the mandatory third-payer scheme at the home doctor for 1.9 million patients with a preferential scheme. That is important to us.

In this case, the comments from the field are taken pragmatically into account. Transparency is also important for our group, and then I think of the provisions related to the health funds. With this draft, they will now be obliged to publish their statutes and annual accounts. This is not the end point for us either. In the long run, we hope that there will be full transparency in how the health funds use the funds they receive from the government.

For us, it is also important to pay attention to the new benefits. From now on, the health funds will need the approval for these benefits from the Board of Directors of the Landsbond. This is also a first step that, as far as we are concerned, can go further and become evidence-based medicine.

Since my colleague Capoen has played a role in this, I would ⁇ also mention that it is good for the minister to intervene and, with this draft, ensure that the advising doctors can no longer enjoy a social status. There are also issues about patient involvement, more transparent accounts, or patient associations that get more involved.

In short, a law containing various provisions has a vague title, but that does not mean that there are no matters in the law that are very important to us. I will mention two more: the abolition of the barrier money for people who donate alive, and finally an obligation to communicate between fertility centers about the six-woman rule. This is a first step in a file that I personally hope many more will be put forward.

To conclude, our group will support this draft because it contains very important matters for us.

Ladies and gentlemen, dear colleagues, laws containing various provisions are sometimes disrespectfully referred to as “waste-baking laws”. However, this is not at all the matter here. The draft law presented here contains a whole set of technical provisions, but also a number of substantive, very relevant and important measures.

With this bill, a number of measures will be taken that will increase the accessibility of healthcare. I think, for example, of the mandatory third-payer scheme at the general doctor for persons enjoying an increased benefit, the extension of the maximum social invoice and the prohibition of honorary salary supplements in two- or multi-person rooms in daytime hospitalization.

This government is accused of saving, even saving on care. This is not the case at all; witness to this are these measures that remove thresholds to care for people who have it less wide.

We are also pleased that measures are being taken to reduce or abolish the brake money for individuals who choose to help a person in need through organ donation. It is not possible for anyone who commits such an altruistic act to be punished financially.

The financial transparency of our health care is also increased, both at the level of the evidence, linked to the electronic invoicing and the third-party payer scheme, as well as in terms of the transparency of the health funds, which will be obliged to make their statutes public and submit their annual accounts to the National Bank of Belgium.

Last but not least, we also welcome the patient associations being upgraded, both financially and in terms of representation in the board of directors of the Knowledge Centre for Health Care.

This bill deserves our full support.

Mr. Speaker, Mrs. Minister, in general, sp.a. considers that the bill for voting today contains a number of good things.

I will give some examples, such as the earlier mentioned faster allocation of the maximum social invoice to children with disabilities. Measures that strengthen the maximum invoice logic can of course always count on our support.

There is also a first initiative to reform the Order of Doctors. I would like to ask you immediately when we can expect a real reform of the Order. The amendments to the draft law are a beginning, but they solve a number of functioning problems that currently exist with the Order are not yet really solved.

We all agree that the prohibition of supplements in two- and multi-person rooms during daytime hospitalization is a very good decision.

The SP wants to submit amendments. Ms. Detiège will talk later on the third-payer scheme, Ms. Jiroflée on the advance scheme, and I myself will now explain the amendment on the prohibition of honorary supplements in single rooms.

The bill, which is submitted for voting, will abolish the supplements in two- and multi-person rooms, but only in case of daily hospitalization. We believe that this cannot be the end point. We see that those single rooms are becoming more and more expensive and that a number of people, who are not financially so wide, have problems with the tariff insecurity.

The amendments nrs 9, 10 and 11 to the bill proposes to abolish all honorary supplements attached to a one-person room. It’s not just about the supplements for the doctors, but also about the supplements for camera material.

We see that many people choose a single room, but often those who can afford a hospital insurance are also.

We also see that efforts have been made in recent years to drastically limit honorary supplements, but those single rooms are still a pain point. However, figures show that they have a huge impact.

In 2013, a patient paid an average of 453 euros at a hospital stay, which is, of course, an average, but in a two- or multi-person room that is only 293 euros. In a single room, the average invoice is up to 1,395 euros. This represents a difference of 62%.

We also see very large regional differences. In Brussels, the patient invoice amounts to 2 322 euros, in Flanders only to 1 078 euros.

Finally, 40 % of hospitals have decided to reduce the additional costs to a maximum of 100 % and 46 % of hospitals have limited the honorary remuneration supplements to 200 %.

These supplements carry two dangers. There is class medicine, a two-speed medicine. There is a medicine for people who can pay. They usually have insurance, which the hospitals use to generate additional funds, but actually it is paid through the insurance and you know that we all pay those insurance oneself.

I know that there is a discussion in the committee on the re-registering of hospital funding. Therefore, the amendment states that this would not enter into force until 1 January 2018. After all, now the argument is often used that the one-person rooms and the honorary salary supplements balance the financial balance of the hospital. This is a perverse system.

Mrs. Minister, you said you intend to put a lot of energy into this. We hope that the re-registering of hospital funding will help this perverse system out of the world.

Mr. Speaker, Mrs. Minister, dear colleagues, this bill containing various health provisions brings together various measures that are positive measures and some of which have been expected and announced for some time. If we have co-signed several amendments with our colleagues from sp.a and PS, it is because we would have wished that this bill contained more things. With this note I will begin my speech.

It is clear that reforming the Order of Doctors in its provisions relating to the organization of the Order between the doctors of Brussels, the doctors of the Flemish Brabant and those of the communes of facility was a necessary and expected measure. Will the chosen option withstand all the tests? It is to be seen, but I think this proposal had been matured with the representatives of the doctors.

We regret that there is no and we do not have the possibility to exchange between policies on a deeper reform of the Order of Doctors, knowing that a whole series of elements are to be corrected, corrected, reoriented in terms of its composition, in terms of transparency of decisions and in terms of the distribution of tasks that belong to it, with sometimes situations of judge and party and conflict of interests in the positions that members of the organs of the Order must take.

You told us that the Order Council was finalising a document and that, probably, in September, it would present proposals for reforms. I really hope that the majority present here will accept – and you too, Madame the Minister – that from that moment on, we can have exchanges with the representatives of the Order in order to finalize these changes in a draft or a bill.

With regard to hospitals, we can only welcome the extension to day hospitals of the prohibition of supplementary in common room and two beds. I also welcome the measure aimed at better informing the patient about the costs he will have to bear.

That said, it is regrettable that the reflection has not been extended to all the rooms of the hospitals. Indeed, it is known that some of the latter find a parade to the limitation of supplements by transforming all their rooms into individual rooms to be able to request supplements. It is therefore necessary to continue the reflection as part of a fundamental reform of the financing of hospitals, which is being prepared.

In my view, it would be appropriate to inform the hospitals concerned that, as part of a funding reform, a measure to ban the supplement in single room could be or will be taken. This would allow this reform to be considered in a more positive or more comprehensive way.

Furthermore, the automatically paying third party for patients who benefit from preferential rates is currently limited to general practitioners as well as to other professional categories such as nurses and nurses. We appreciate the fact that you program the expansion of this automation and the establishment of a tool that allows for proper operation, the recording of benefits, their recording as well as to ensure the insuredness of patients. Consequently, the measure aiming at a leveling between the categories of specialists or care providers is, in my opinion, a good measure.

The measure aimed at extending automaticity, without necessarily having to use the presentation of the identity card when the patient has a comprehensive medical record, is also an essential positive measure. In this regard, we still have a huge job to provide so that general practitioners are in possession of the medical record of each of their patients allowing them to have a holistic view of the health of the latter, and so that the general practitioner is considered as the referent health provider. This will avoid unnecessary use of medications and/or specialised second-line care.

It is true that, in an optical perspective of generalization and automaticity, it would have been interesting that the automatic character and the third party paying generalize to all patients and be applied more widely than only to general practitioners.

We accept the fact that things must work technically, but we also need to enter into a dynamic that makes this automation truly automatic, and accessible to a majority of patients, especially for first-line care.

You now allow patient platforms to be present in the KCE Board of Directors. This is a good thing, and it was included in the reform on skills transfer. This was also a wish of the KCE. You give them additional means so that they can fulfill their missions of representation and presence. It is very important to recognize them in their functions and give them the means to function. These patient platforms will be expected to connect with patient associations. We know that it takes time. In order for them to spend enough time, subsidies are needed. I think what is proposed corresponds to their wishes and needs.

I highlight the positive side of the announced measures, including the paying third party and the prohibition of supplements in the rooms, but there was way to go further and act more and better in the area of accessibility to care for all and especially in terms of first-line care and quality hospital care.

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. I’m not going to list all of them, but I’m going to list three of them that are very important to me.

The first concerns living graft donors. I consider this to be a first step. Recognize it, a whole series of important brakes explain that today, the number of donations of transplants from living donors is still significantly lower than it could be if these brakes were removed.

The second element I find positive is the provision regarding technologists in medical imaging and medical laboratory. This is a question I have discussed several times in the previous legislature. I imagine that a work was subsequently carried out by the INAMI as well as by the Association of Technologists and the hospitals concerned. There was a solution, and I am pleased because the situation on the ground was not easy. This will keep experienced and quality technicians who, themselves, train the young technicians who enter the services.

The third point that I think is important is financial transparency of health care.

In addition to these elements, this bill raises a number of questions. First, hospital financing agreements continue to be penalized and reduced, even as a reform of hospital financing is being developed.

In my opinion, the additional reduction of the packages for patient admission within the ten days within the same hospital is not positive. This sometimes represents significant budgets for hospitals. Remember that for the patient, not being re-admitted if there is a complication after his leaving the hospital or timing one or two more days to not be within the period of ten days, is obviously not beneficial from a qualitative point of view. I think you will be able to understand it.

Then, another element that I am concerned with and which will need to be considered in the future is the compulsory third-party paying scheme, namely the aspect of the administrative overload and that of the effectiveness of the refund to caregivers and in particular to doctors, who are most concerned. No one can say today that everything will work perfectly.

I will conclude my speech by addressing the problem of the Order of Doctors. I would like to apologize because I have to go to the Ministry of Finance. If you intervene recently, I may not have time to go back and forth to hear your answer.

With regard to the Medical Order, we are talking about a technical problem. This is not at all the case! In fact, this bill confirms a choice that does not date from today. It is about dividing the Brussels doctors by connecting them to an order. This project thus prepares for a division of the Order of Doctors on a community-to-community basis rather than on a regional basis.

An order of Brussels doctors could have been envisaged by simply saying that "in the sense of this law the Brussels Region must be considered as a province". This is what the State Council indirectly suggests in its opinion. This is not the choice you made. You have opted for the division of the Order on a community basis.

Furthermore, this bill ends the possibility for peripheral doctors to choose to register for the common order in the Wallon Brabant. This represents a very clear retreat for French-speaking doctors from the periphery.

Finally, the draft law, and the State Council noted it, is contrary to linguistic laws insofar as it does not amend provisions incompatible with the requirement of full bilingualism of services whose activity extends to municipalities of Brussels-Capital. However, both orders have an activity that extends to Brussels-Capital as they address Brussels doctors.

It is true that we are not in favour of the whole chapter relating to the Order of Doctors, since it facilitates both the division of the Order of Doctors on a community-to-community basis, it reduces the rights of French-speaking physicians of the periphery and, finally, it disregards the language laws. Here are the various points I would like to discuss here.

Madame Fonck, Mr. Thierry wants to question you.

Mrs. Fonck, I understand well your community argument regarding the Order of Doctors. Nevertheless, I have a little concern about understanding what you’re moving forward with.

You have your vision for the future; we’ve discussed it in the committee and I’m not going to repeat the debate here. However, how do you explain that the decision made here, that this agreement, not affecting absolutely the rights of French-speaking doctors located in the periphery, was signed with the National Council of the Order of Doctors, involving a number of French-speaking doctors living in the periphery? You are not going to tell me that these doctors have consciously agreed to a decision that might go against their interests! You should explain it to me!

Mr. Thiery, you are referring to the agreement of the Order of Doctors.

Mr. Minister, I told you that I had contacted the Order. You told me that I had done my job. This is also the right of every member. The work must be taken seriously. At least we agree on this point. Furthermore, when I questioned you, you acknowledged that the discussions that had taken place with the Order of Doctors were informal.

Mr. Thiery, I will answer you very simply, rather than making a long explanation. I have presented it in a reasonable way, but I will give you an example. A doctor who, today, works in Woluwé-Saint-Pierre, who, after the entry into force of this law, would no longer work in Woluwé-Saint-Pierre, but in Crainhem, will no longer have the possibility of being part of and being registered in a Franco-speaking order. This is a very precise example that I can multiply to infinity.

The whole majority stated that there was no worry, because current doctors saw their rights preserved, but new doctors who move to the level of their place of activity will no longer enjoy the same rights as today. I call this a downturn compared to the French-speakers of the periphery.

I hear your argument. You still need to see the consequences of the words you have just said. Article 36 of the Decree of 6 February 1970 states: “Any doctor who does not understand or does not sufficiently understand the language of the provincial council on which he depends may, from the beginning of the instruction and at the latest before the hearing, request his referral to a provincial council using the other language.”

If this is not a guarantee of the right of everyone and ⁇ of doctors, I do not understand! Therefore, I sign up false in relation to what you are trying to make it seem like a retreat, while ultimately, although nothing is perfect, in no way will it harm the doctor in his function.

I will not eternalize. Each of them exchanged their arguments. I understand that mr. Thiery is, in these aspects, embarrassed by the surroundings. But the reality is as I described it. Indeed, where today doctors could register to a French-speaking order, this will no longer be the case tomorrow!

I’m embarrassed about the surroundings, there’s room. If there is a person who is ⁇ aware of the problem at the peripheral level all the confused areas, you have that person in front of you! Obviously we will not agree. But what I ⁇ ’t like is that, through Ms. Fonck’s intervention, some believe that we are leaving the French speakers from the Brussels outskirts to the Dutch-speaking side. This is not the case! Of course, there are adjustments and of course, there are obligations! This will be done in the interest of everyone’s rights.

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. From today on, a limited extension of that scheme applies, with general practitioners obliged to apply the system for people with an increased reception. This has helped about two million people, but the question is why you don’t go for all the eleven million people in this country.

The draft law containing various health provisions now provides for a transitional period until October. At the same time, the mandatory nature of the extension of the third-payer scheme is considered equally smoothly. The reason for this is that the software for MyCareNet has not yet immediately got installed everywhere with the doctors. This is a practical problem that is being solved. I would therefore like to reopen the discussion principally and substantially.

It is courageous of Minister De Block that she sets out on the mandatory nature of that extension against a few contradictory physician syndicates. It was not ⁇ uplifting to hear the spokesman of the Belgian Association of Medical Syndicates (BVAS) on the radio last night say that he does not want to be dependent on the health fund for his cents. The doctor in question wants, in other words, like usual cash money from his patients. He is sure of his money. To be honest, I find such statements unworthy of the profession of a doctor. What about sick patients who really need to pay attention to their money while neglecting the care of their health?

I have also cited in the committee that a recent study on primary care commissioned by the European Commission shows that in Belgium approximately nine hundred thousand people postpone a visit to their general doctor because they cannot pay for it. These figures are shocking for a country that we still consider to be prosperous. The survey revealed that Belgium scores poorly at the European level when it comes to accessibility of care. We are in the 20th place of the 31st. This is not something to be too proud of. In addition, the costs increase if one has to postpone a necessary doctor’s visit. After all, the condition will worsen, which will increase the cost of healing the patient in most cases.

We have made our request for a generalization of the third-payer scheme several times. I really don’t think we’re standing crying in the desert, because today the Flemish Patients Platform, the Network Against Poverty and the Family Union once again urge to generalize the third-payer system.

Also the chairman of the largest party in this hemisphere has declared on the family day of his party that he is tired of the old-fashioned hassle with stickers. Maybe he can help us approve our amendment tomorrow? With this bill, there is once again an excellent opportunity to immediately implement the third-payer scheme for everyone. In this way, the bad adhesive leaves can disappear.

If the design is talking about software problems that need to be solved in order to regulate the mandatory third-payer scheme for people with increased compliance, then frankly I do not understand why after the software has been finalised the system cannot be generalized. I have never heard a conclusive argument from the Minister on this subject. A number of colleagues from the majority continue to say that this would lead to overconsumption in healthcare. I am glad that not only sp.a but also Minister De Block finds this argument foolish. No one goes to the doctor for his pleasure, no one.

Let us stop dividing patients into boxes and let us finally work on a uniform, unambiguous and correct way of paying for health care. This will make our healthcare more accessible. In this way, people in need of medical assistance can also get this help effectively, regardless of how much money is in their portfolio at that time.

Remember, dear colleagues, that here we are not asking for additional intervention from the government. We simply ask that the patient should no longer rush this amount. The introduction of the third-payer system is a modernization of the current system. The doctor should not be afraid of whom he assigns the scheme, because it just applies to everyone. There was also a lot of administrative stress removed from the treating doctor. They no longer need to worry about the income of their patients. He may have to wait for a refund through the RIZIV, but that will be a maximum of one month. There are even 14 days. What hell does that mean? In any case, the fee will be paid as soon as possible, and the doctor and his family can count on the income of the patients they have treated the month or week before.

Dear colleagues, in the third-payer system, the patient only pays the brake fee and the rest of the fee is settled directly between the RIZIV and the doctor. For the general doctor, this means that one will have to pay a maximum of 6 euros, for the specialist, that is 12 euros. This allows anyone who needs medical care to effectively pay for it. What does it actually help if the amount is repaid, if one cannot put it on the table at first?

For all these reasons, we have amendment no. 6 from the Committee on Public Health submitted again, together with colleagues from the PS and Ecolo-Groen. Let’s just introduce this generalized third-party payment system now.

Hopefully you think of all the patients who deserve quality care without having to get stuck in a financial pit. Let us, colleagues, bring about a real, revolutionary change in healthcare, a change that benefits everyone.

I will talk about my bank. I will address the point that justifies my intervention, which is the vivid concern expressed to my party or to myself by several French-speaking doctors of the six facilitated communes. I understand this concern. They had a certainty, that they belonged to an institution that guaranteed them language rights because they were with Brussels. Now that they are no longer, in addition to the symbolic once again of the split of what makes the link between the periphery and Brussels, there is the risk for the newly registered that, becoming minorities in an order and in a council that will be provincial, they do not see their linguistic rights scrupulously respected.

We must not be naive. We know how the language laws are interpreted in the north of the country. We know what the will of some Flemish authorities, even ordinary ones, is. I have testimonies for other liberal professions of how peripheral French speakers are treated when they are minorities in their order. And so here, the split between Brussels and the periphery, once again, causes damage in terms of linguistic rights.

It would have been so simple to say that for the six municipalities with facilities, freedom of choice was left. I have no problem in saying that the Flemish of Brussels have the freedom to register in the language order of their choice. It is of course! Whether they are registered through the Provincial Council of the Flemish Brabant, I have no problem with this. But the parallelism of rights is so simple! What is granted to the Flemish of Brussels, why not grant it to the French speakers of the periphery? This is such an elementary rule of know-how and mutual respect! This is not the choice made by the majority. It is true that the MR could not resist because he did not have the will. They wondered if there were no reforms of a community character, here is one of a community character by the weakness of the MR.

I would like to make a brief speech following what has just been said. I would have a fairly simple solution to solve these community problems related to the Order of Doctors. It is to purely and simply remove this anachronic order because when you look a little at how it works, you realize that when patients really have concerns and submit them to the Order of Doctors, there is little chance for them to be treated. These patients do not even know what happens to their complaint.

On the other hand, this Order is still there vigorously to react as soon as the medicine of money is challenged. The doctors of the PTB are systematically attacked by this Order of Doctors, because we do not recognize this corporatist order that has no other functions than to defend economic interests where there would be to defend medical and social interests. This is why the doctors of the PTB, who have created medical houses throughout the country where free medicine is practiced, systematically refuse to pay contributions to this anachronic order. For the PTB, the best place for this Order of Doctors is the garbage. This would avoid such problems and discussions.

We will not argue about this for a long time. I understand that the opposition, in some way, has the desire to try to raise a community problem where there really is no one. I would just like to remind that the Order of Doctors itself, in perfect knowledge of the cause and with doctors who participated in the negotiations, made it clear that given the way things were presented, there was no risk to incur in their head.

Of course, the parliamentary debate is democratic and all the world can express itself but it is interesting to refer to those who are directly concerned and therefore to the Order himself. This element is fundamental in relation to the interpretation that could be made by the one or the other in order to attempt the relevance of the community debate, which is absolutely not the envy of the majority.

Mr. Speaker, I honestly wonder where, from his point of view, Mr. Maingain sees problems. He will undoubtedly have read the State Council’s opinion on the bill. That advice ensured that the preliminary design was modified and that the actual bill was formulated differently, so that the facilities, French and Dutch-speaking, indeed continue to count in the facility municipalities.

We submitted amendments to Articles 28, 81 and 92 of the bill, just to abolish the facilities and return to the wording in the preliminary draft. However, it must have been intended that the ten regional services of the Medical Assessment and Control Service operate unitaryly and that only the service for the Brussels Capital Region operates in two languages.

There is also no clarity about facilities for non-speakers. Those are simply ⁇ ined, while everyone knows that the facilities at their introduction were considered temporary. Other languages living in Flemish-Brabant or Waals-Brabant have had enough time to adapt. Therefore, it is indeed intended that the orders in the provinces of Flemish and Waals-Brabant function uniformly. However, this is not the case in the present draft law.

In my reply to Mr Maingain I have therefore immediately explained our amendments, with the aim of returning to the wording of the preliminary draft and explicitly referring to Article 33 of the Language Act, so that the language legislation is indeed applicable.

Ms. Minister, in your draft you speak, among other things, about the advances that, except for urgent care, can be requested within the limits agreed in the Agreement Committee.

Hospitals, doctors and other healthcare providers regularly ask for an advance from patients, before any examination, medical treatment or admission takes place. However, patients perceive that advance as very unpleasant. Nevertheless, when they are admitted to the hospital or have to undergo treatment, they are already very concerned and have all sorts of questions. At this point, they are faced with the financial side of the matter.

A study involving debt aid providers and debtors, among others, found that asking for advances is absolutely not an exceptional practice. In addition, the problem makes it feel even more sharp for people who have less financial breadth. Medical problems are hard for them anyway and the advance is that they must immediately, even before the treatment has taken place, find out how to gather the money for it.

Another study shows that in mid-2010 two-thirds of general hospitals requested an advance for a stay in shared and double rooms. In two out of three cases, the maximum was requested. Therefore, this is clearly not a marginal phenomenon, colleagues. According to our group, the advances are a limitation of the constitutional right to health care.

The system of advances is also unacceptable in the context of poverty reduction and combating the health gap. Thus, the thresholds are much too high for those who have it less wide. In our vision, the system of advances even smells a little like class medicine. It is unthinkable that in this way people with modest incomes are hunted to the OCMW hospitals.

Therefore, we already wanted to introduce a ban on advance payments, both during day and overnight recording. Payment in our proposal would only be possible after a treatment. Therefore, we also today, following your draft, Mrs. Minister, submit two amendments in the same sense. In the amendment, we propose to simply prohibit advances. It would make the health gap a little smaller.

Thank you, Madame Jiroflée. I no longer have requests for intervention. The floor is for the Minister.

Mr. Speaker, we have been standing in the committee for a long time on the issues contained in this draft law containing various provisions and there has already been a lot said about this.

Overall, I believe that most provisions are good for the patient. There is also a demand for greater transparency in hospitals, about how they are financed.

There is a discussion about the third-payer scheme, which goes too far for one and not far enough for the other. We will return to this later. It is within the framework of the government agreement that the third-payer scheme enters into force today for the people with a preferential scheme, a small two million patients in our country. However, it also states that there will be an evaluation in the light of the accessibility and affordability of health care for the patients and that there may be an extension in a step plan after the evaluation.

I answered the questions of Ms. Fonck on the Order of Doctors in the committee. I just want to say to Mr Maingain, whom I have not seen in the committee, that to his great disappointment, a pragmatic solution has been chosen, in which French-speaking and Dutch-speaking doctors are assured of their rights to be treated in their language role. It is a pragmatic solution. There has been no community discussion within the Order, so I must say to Mr. Maingain that times are changing and that the branch on which he sits is literally and figuratively breaking down.

Mr. Van Hees, about the solution you propose to the problems that the Order has after the sixth state reform and after the division of the judicial district, in particular to abolish the Order immediately, I am not surprised. However, I think this would not be wise, not because the Order is there for the doctors, but because there must be a discipline college within the Order of doctors, precisely to protect the patient if he feels missed by a doctor who has treated him.

Mrs. Detiège, on the question of extending the third-payer scheme, I have already answered Mrs. Jiroflée in the committee. You are asking to abolish and prohibit advances. However, this is already being taken into account, because when patients enjoy a preferential scheme, the advances are already much less. Those who ask for a room alone will have to pay larger and also more frequent advances. So I do not think that this affects the health gap, on the contrary. However, you think it can be remediated.

Mrs. De Coninck, you ask when the general reform of the Order will be realized. Well, it is actually up to the Order itself – as it is stated in the government agreement – to submit a proposal for reform to Parliament. We have now only made it possible to re-elect the Order of Doctors. Since mid-May, the mandates have expired and by election new mandators can be installed, which also provides legal certainty in terms of the patient’s rights to be defended within the Order of Doctors.

Overall, it is a positive draft law containing various health provisions, which means a whole step forward for patients.