Proposition 54K3226

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

General information ¶

Submitted by

MR Swedish coalition

Submission date

Sept. 10, 2018

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

health policy social security public health health insurance

Voting ¶

Voted to adopt

CD&V Open Vld N-VA LDD MR

Abstained from voting

Groen Vooruit Ecolo LE PS | SP DéFI ∉ PVDA | PTB PP VB

Party dissidents ¶

• Jan Vercammen (N-VA) abstained from voting.

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Discussion ¶

Oct. 18, 2018 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, I will allow myself to refer to the written report, but I will speak shortly afterwards.

Thank you Mr Thiery.

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. These are technical arrangements but also extremely important arrangements for the patient as well as the caregiver. I will highlight a few important elements in view of some expectations of the sector.

I will start with the provisions that directly concern pharmacists. There are legislative changes that promote pharmaceutical care. This is a highly anticipated development in the industry. The progressive orientation of a remuneration for pharmaceutical care for a patient rather than merely the delivery of a product was indeed expected. It is a measure of the “Pharma” pact. This development also recognizes the active role of the pharmacist in the healthcare system. Pharmacists have always claimed to be a little put on the side. Here, we are only reinforcing their active role.

In addition, the introduction of the budget line was also a demand of the sector. Therefore, it is a question of budgetary accountability of the sector itself.

There are changes to the distribution law. The current distribution law has revealed some gaps and, in particular, allowed transfers that have caused a lot of appeals from pharmacists. The sector was therefore faced with endless procedures in the context of certain transfers. With these project changes, we will establish new criteria taking into account demographic and geographical aspects in order to result in clear distribution criteria, which cannot be subject to interpretation. I think this approach is extremely rational. And, more importantly, I emphasize that during the discussions, we found that these provisions would not harm small structures. Therefore, this concern is no longer necessary.

The changes will make the transfer of pharmacies easier in terms of speed of procedure, which was a great hint. The amendments are supported by the Belgian Association of Pharmacists, which welcomes these provisions. I would like to thank the Minister, since all the proposals she makes are made in consultation with the sectors concerned. It is necessary to signal it.

For service providers, in general, we can point to Articles 21 and 22, which aim to establish a system of quality promotion throughout the sector. For example, kinesiotherapists were in demand. This is a considerable progress.

I think that everyone in the committee agreed on the adaptation of the legal basis, through Articles 27 and 29, in order to extend to all care providers the benefit of the granting of certain social benefits for the constitution of a supplementary pension. There was a great discussion about this. It was extremely important to review the legal basis. We were fully aware of this. It was also a request from the medical-mut. It also responds to a demand from providers who continue to work after the retirement age, which is becoming increasingly common, and who will be able to receive a premium instead of a social status.

As for positive resources or measures for the patient, there is the legal basis for eAttest, which replaces the paper certificate with an electronic certificate. It will lead to significant administrative simplification and will allow patients to have a simple and automatic refund. This was really a demand from patients. The system provided here will facilitate their task. There are many advantages for the patient in this context: lack of specific steps to be reimbursed; faster reimbursement; no risk of losing certificates or leaving the two-year deadline pass. All this is for the benefit of the patient.

A relatively significant advance concerns the allocation of the maximum to be invoiced, as income from the second year preceding the application will be taken into account, and not more from the third year. The maximum amount to be charged can therefore be granted faster to those entitled to receive it.

Finally, I refer to the legal basis for electronic prescription. I know that there has been a lot of debate on this subject, because some doctors, ⁇ of a certain age, felt hurt with regard to the problem. It was recalled that, at this stage in any case, the system remains optional, given in particular the many flaws of the eHealth system. I think that the older doctors of whom I have spoken, or the doctors who visit home or rest homes, can only rejoice in this decision.

These are the various remarks I wanted to make briefly. I think this bill is an advance in this area. We look forward to voting today. We will, of course, support you, as I pointed out in the committee.

Mr. Speaker, I will talk about my bank because I will be relatively brief. I did not want to intervene initially but I took the initiative to submit two amendments that try to address some of our concerns. We abstained from this text in the committee and we will also abstain in the plenary session. In our opinion, some elements are still problematic.

I think first of all about the prohibition of practicing third-party paying in case of abuse by the healthcare provider. This is not a new measure, but we believe it is primarily harmful to the patient, who has no knowledge of the situation before consulting his provider. You told us that the patient would in the end be reimbursed by his mutual, but the opposite would be a shame. I continue to think that we are dealing with a lack of understanding of reality. Some people do not have the opportunity to advance the full amount of their consultation or care. That’s why, I said, Mr. Speaker, I re-submitted an amendment aimed at making the paying third party compulsory for all care benefits. My group considers it inconceivable that patients, even today, postpone certain care, or even give up, because they do not know how to advance the necessary amounts.

I would also remind in this regard that, during the previous legislature, it was decided to make the paying third party mandatory for BIM and chronic patients, and this for all health benefits. The government has returned to this decision. The obligation of the paying third party was ultimately established only for general physicians, and only for the beneficiaries of the increased intervention.

In order to ensure financial accessibility of care for all, it is now necessary to take an additional step so that the third party paying becomes mandatory for all and this for the main health services. The implementation of electronic invoicing and the monitoring of health care services should enable this to be achieved under the right conditions, while avoiding potential abuses.

I would like to conclude with a few difficulties that the project still poses. Among them is the “information possibility” that we read in the text. I think it’s more about advertising. You would now allow advertising about the practice of healthcare professionals, without framework, without precise tags, with the consequences that can be imagined for patients. I also think of the changes in the status of the AFMPS, but also of the questions left unanswered regarding the legislation of clinical trials.

As I did in a committee, I also submitted an amendment regarding electronic prescription and authentic source, so that it is not limited to medicines only but is extended to other health products, and this to allow prescribers to prescribe other health products through the same procedure that they will use for medicines. This would facilitate the work of doctors and ensure comprehensive treatments for patients. I think this is a response to a demand from the ground.

I have completed the presentation of my amendments.

I want to thank you for this draft. There are many important, positive elements in the design. Let me highlight some important highlights for CD&V.

A first important point is a legal basis for reimbursement of psychological care. A few years ago, we took a first step with the law on the recognition of health care professions, namely clinical psychologists and psychotherapy. Now a second important step is being taken with the refund of psychological care. In the context of low threshold access to psychological care, we can only welcome this step.

Another important element is the anti-fraud measures, which we can only welcome. You have already shown in other files that you are willing to take steps in this regard. People who today commit fraud in a healthcare profession or within a healthcare category are not numerous, but we still see that they always do a lot of harm to a very large group of people who do well. In this sense, we find these measures positive. It is also very specific about the application of the third-party payer scheme or its fraudulent application. The draft provides for the imposition of a temporary ban. We also find that a good thing.

A third focus for us is everything that has to do with quality. Among other things, a system for quality promotion among the Chineseists is being further developed. We have a very good health care. Today, we are at the top of the OECD ranking in terms of accessibility. However, we know that we must continue to work on the quality we want to improve that ranking. Any new measure that ensures a quality test – here is that linked to a financial incentive, among others for Chineseists – is therefore a very good initiative for us.

A fourth highlight is the maximum invoice. The maximum invoice was previously calculated on the income of three years ago, which caused problems as changes in people’s income situation can occur very quickly. The deadline has now been raised to two years. We might have wanted it even shorter, but we understand it. Of course, it also has to do with taxation and the available data of a fiscal year. It is a very good thing that the deadline was brought to two years to make resource research more just and social.

I come to a final point. In the design there is a lot around pharmacists. You have agreed a multi-year framework with the pharmacists, Mrs. Minister. There are a lot of good things in it. Some elements are also implemented. For us, it is extremely important that the pharmacist within the first line is confirmed as a crucial player, especially also in terms of prevention or patient guidance.

The award of a pharmaceutical care fee is a necessary recognition of this link in our healthcare system. We also find the responsibility of pharmacies, within the framework of partial budget objectives, a good thing.

The new discharge law is also included in this bill. This is not unimportant. There has been a long demand for a new instrument. They felt the need for changes. There is currently a very large fragmentation and we believe that the choices made here, namely scale enlargement and mergers, are going in the right direction.

I would like to thank you for this bill. There are a lot of good things for us here. We will therefore gladly approve this.

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. It was so much that it was postponed. This is the proof, Mr. President, that the emergencies decreed by the government are very relative. Sometimes “bidon” reasons are invoked to try to justify them.

Madam the Minister, you can note what you want, but it was your government and your majority who had decided that this urgency was no longer really one, since this text was postponed. This was the opportunity to say it. You have taken the very bad habit of turning all your projects into urgent texts.

Then, this bill with various provisions, which is very thick, since it is more than 600 pages, deals with a bit of everything. However, certain themes such as pharmaceutical care would have required a different approach and, at least, a specific bill. Moreover, this project has neither tail nor head: it is a package full of things. However, this is not what annoys me the most.

In the committee, I have asked you three times about the nature of consultations with health actors. First, you did not answer me. Then you said to me, “Yes, yes, yes, of course, I consulted all those involved in the project.” Then, Mrs. Minister, I took my contacts and I was able to find, for example, that the Order of Veterinarians and the French-speaking Regional Council of Veterinary Doctors had not been consulted at all. They were not even aware of this bill or the first word that was in it about them. I was the one who sent the text. Do you find this normal? No, for my part, I consider that this is totally unacceptable, especially since in the commission, you yourself certified that all the actors had been consulted. This is completely false!

For other aspects, with regard to some medical unions, it is the same, you did not consult them, and some provisions appeared to them only when I passed them the text.

I consider, Mrs. Minister, that this is a famous problem of governance with a concertation that I knew was a facade. In this case, you go a little further by certifying that you have conducted a consultation while, evidence to support, this is not the case, in any case not with all the actors involved in this bill containing various provisions.

In this bill of a little bit of everything there are positive measures that I have already pointed out in the committee, in particular a part of the measures concerning the pharmaceutical pact (except for some points on which I will return in a moment), the budget framework for pharmacists, the promotion of quality ... These are points that I can point out as positive measures.

In addition to these, a number of measures pose problems to me. Some in an extremely important way and others that, in my opinion, provide insufficient guarantees compared to the commitments that had yet been made to certain health actors, in particular, or which were indispensable in relation to guaranteeing the quality of patient care.

I will stop on the one and the other, ⁇ not in an exhaustive way, but ⁇ on those that seem to me the most important, the goal being not to restart here the debate like the one we conducted in committee. I made the mistake of not asking for a second reading. I believed you when you claimed to guarantee the negotiations. After taking my contacts, I realized that was not true. It was then with regret that I realized that I should have asked for a second reading.

I will start with the pharmaceutical sector, first with regard to the law on the distribution of pharmacies. There is in terms of procedure – I have already asked you, through oral questions, about this – a situation totally unacceptable since more than 200 files of applications for pharmacy transfer are blocked and without any effectiveness. The procedures are being modified and I dare hope that they will give rise to a much more efficient path, but I continue to advocate that there is a legal deadline concrete in the bill - three months seems to me a reasonable deadline.

This is an amendment that I have called for in the committee. You didn’t want it, without any explanation. Today, some have waited for long months, if not a year, without a valid reason.

The fact that no longer guarantees a deadline in the law will allow tomorrow all possible disappearances without taking into account the point of view of the beneficiaries, i.e. pharmacists.

What still makes me concern is how you decide to authorise the exercise of certain pharmaceutical activities in extra-muros: individual medical preparation, online sale of non-prescription medicines.

Since I was in office, I have been in contact with pharmacists. I am working with those who run small offices. You present your bill as being in their advantage. Looking for motivations for your options regarding extra-wall activities, I found that this law should have been called the Newpharma law. For an operator, now acquired by Colruyt, which is not a rural or semi-rural office, one is moving away from everything that can improve the quality of patient support.

More worrying: this project does not contain any tags on the subject. However, strict guarantees would be required, in particular that these activities are subject to the same rules and controls as those provided for the activities carried out within the cadastral plot, i.e. the office to which the operating authorisation has been granted.

It is nothing! You choose, through this legal device that I will call the Newpharma law, you decide, Mrs. Minister, to clearly and strongly penalize the workshops and to favor all online devices. This is, in my opinion, a real step back for the offices.

After having had many contacts on the field, I can tell you that this finding is shared and assure you that the impacts of the device you have set up will be penalizing. Also know that a large part of the industry is landed by the decision you have made!

I come back, therefore, with the amendment I had submitted in the committee which provides – it is here, first and foremost, to ensure the quality and the interest of the patient – to subject these activities to the same rules, to the same controls, to the same requirements, regardless of where the activity of this said pharmacy is exercised.

Another point I find troubling in this bill containing various provisions: the one concerning tobacco. What a frilance on the part of the government majority in the fight against smoking!

We are constantly referring to this topic. You have major levers. In order to do this, you have the support of health actors. You are supported by the group of the National Consortium on Tobacco Control, truly at the forefront in this area. But you did not take, so to speak, any action. However, this would not have impacted the budget. It was just a matter of political will and courage.

Mr. Minister, while Belgium, having ratified the World Health Organization arrangement, committed, now ten years ago, to remove all advertising for tobacco, while, for now several years, it is urgent – you should have shown courage – to remove any possibility of escaping this ban on advertising for tobacco, you dare come here with a bill containing various provisions with a measure that diminishes the sanctions of those who do not comply with the said prohibition.

I find this strangely sad. In my opinion, this is clearly the economic choice versus the choice of patient health.

Given the number of annual premature deaths from tobacco and the number of tobacco-related cancers, I can only regret the choice your majority made on this issue. Therefore, I re-submitted an amendment to finally bring into the law the exclusion of mechanisms that today allow to escape the ban on tobacco advertising.

I now come to the care providers, the compulsory electronic prescription (e-Attest) and the harmonisation of social statutes.

The first is the compulsory electronic prescription (e-Attest). Computer bugs, Mrs. Minister, have never been as many as today. They are permanent. It is factual. I can’t imagine a single moment that you didn’t recognize it and that’s obviously your responsibility.

Nevertheless, the public authority is forced to use these electronic devices without even being able, itself, to ensure that the system works and is performing. Since the beginning of the legislature, you have not ceased to have problems. We remember the problem of software for the care of nurses and ⁇ nurses at home. You will also remember problems with PARIS software. You will remember the bugs that remain permanent today from both the PARIS app and eHealth. Very little is moving in this regard. For several years, we have been constantly questioning you on the subject. I have recently seen an attempt to use an external operator now. It is always simpler.

It does not matter who is responsible. You are a minister. The public authority, from the moment it imposes electronic devices, has the role and responsibility to ensure that they are performing and that there are no, like what nurses (especially at home) and doctors have experienced, permanent bugs that in the end directly penalize their work with patients but also directly penalize patients.

Always on the electronic prescription, I confess that I have not at all understood how you persist in not forcing software operators – that’s how I’m going to name them – to integrate all health products. Mr. Minister, I am now clearly aware of the fact that software vendors were monetizing the integration of health products into electronic prescription software. If you simply wrote it in the law, these software vendors would no longer be able to ask for financial surpluses and additional costs as they do today. I find this inappropriate and I do not understand why your majority did not want to move a minimum of lines in this regard.

I have two assumptions about this. Or you will do it in a second time. It is, in this case, a shame to have even more corrective devices in so-called laws of various provisions. Either you do not want to do it, but if that is the case, then you will still have to explain to me why you prefer so much the interests of software vendors.

Who is running the software sales platform today, Mrs. Minister? I am going to be a little confrontational, because I would like the lines to move at some point. If I’m not mistaken, it’s one of your former employees who now runs the software vendor platform. Therefore, it would be possible and easy for you to have a contact so that from this platform, there is an obligation to integrate health products into these electronic prescription software without extra costs for health actors or, on the contrary - and this thus guarantees things in a very simple way - you are in the law providing, along with medicines, health products in these software.

It is not so complicated. This is very simple legally. I have submitted an amendment in this regard. One of my colleagues also did this in the committee. Access to the authentic source for health products must be made mandatory by law.

This is something extremely simple, because it belongs to common sense. However, in your bill, as it is drafted, you persist in prioritizing economic interests at the expense of the interests of the patient and health actors.

Regarding the aspect relating to the harmonisation of social statutes, I use this to plead, Mrs. Minister, that we should not forget the Doctors Assistants Candidates Specialists (MACS). In terms of social status, they are nowhere.

As for the premium for retired health actors, you know that it was themselves, the doctors, who had pledged for the social status of active pensioners to be ⁇ ined in the form of a premium of an equivalent amount. This is in the law today.

But a bill with various provisions is a project brought by the government. Mr. Minister of Finance, I take advantage of your presence, allow me to address you. For three years the Minister of Health has promised this famous social status, this premium for active retired doctors! There is a problem with tax status. You belong to the same government. You have validated, in this government, this bill containing various provisions.

Madam Minister of Health, or you have forgotten to ensure consistency with your colleague the Minister of Finance, to settle once and for all the tax status of this premium. This has not yet been resolved, Mr. Minister of Finance. The Minister said that this was not within his powers, but within the powers of the Minister of Finance. You are here today. You are part of the same government. Everyone has approved this bill. The majority of you wanted to get it done quickly, well done. When will we have a tax status on this premium?

If I am not mistaken, Mr. De Cock recently sent a letter to the Minister of Finance. It is still foolish that, in a government, one does not know how to arrange between ministers to get effective answers. What you do on one side is a problem on the other side, at the level of tax status. To be honest, I think this is a lack of consideration and respect for doctors. It really is playing with their feet. This is a problem of poor governance. That would be a very hard decision by the Minister. Is the tax status managed? Oh well ? Fifteen years ago, it was still not.

I’m waiting to see if it’s really resolved. Having been asking for three years, we dare hope that you will resolve this situation.

As far as the veterinarians are concerned, you have certified to us that they have been concerted. Neither the Ordre des Vétérinaires – French-speaking regional council – nor the Global Veterinary Order were consulted on the chapter on antimicrobial resistance and veterinary medicine. You are planning a device that is ⁇ challenging. You set up the fact that the farmer validates the data encoded by the veterinarian. It’s a bit like asking the patient to validate the electronic record encoded by the doctor! It is quite special. But you go further since the validation by the breeder of the data encoded by the veterinarian is necessary to prove its validity. This is a form of a blow to the professionalism of veterinarians and their integrity. It was as if the veterinarian could have encoded anything. They are subject to a deontology. It is as if the breeder should control the veterinarian, who is considered a priori to be dishonest.

When you say that this is Europe, I absolutely disagree with you. Certainly, Europe – and rightly – wants to move forward with regard to the problem of antibiotic resistance and their misuse, including in animals, but another thing is to consider and concrete in the law that farmers will actually have to control the data encoded by the veterinarian.

The pompon is to have claimed that they had been consulted! They were not consulted at all. They didn’t know the word of this text, it was I who sent it to them! They also told me how much they would put this topic on the table during a planned meeting on another topic with Minister Ducarme.

It was last week. The Minister of Defense is absent. Therefore, I dare hope, Mrs. Minister, that you hold the information on this subject and that you will tell us today a little more.

With regard to the promoters of these clinics, I intervened in the committee. The formulation of the bill involves the risk that the removal of the remuneration will not be uniformly applied to them. In any case, when I had pledged in tempore non suspecto – at the time you had presented us with the original bill – that non-commercial promoters could benefit from this exemption, you had rejected my proposal. Now you are taking a small step. However, it is a pity that this possibility was not included in the original text.

As regards the obligation imposed on the doctor to no longer use the payment third party system, I am in principle in favour of this. On the other hand, I repeat it here, it seems to me that it is the patient who could be hurt by this device, not because he would not be informed of the sanction – which is not a problem for me – but because it will not be the prohibition for the doctor to be able to appeal to the third party paying. I therefore advocated for the display of information in the waiting room as is the case, for example, with regard to the status of conventional or non-conventional physician – including partially. I defended the idea that the doctor must, in this case, not write that he was sanctioned – since no definitive decision has been made in this regard, given that there is a suspicion – but despite being displayed in his waiting room that he can no longer resort to the third party paying. This information is essential for the patient.

I still have a topic to discuss, which I will return to as often as possible. When you work on a bill with various provisions, you obviously touch on a lot of themes. Last week, you were absent, Mrs. Minister, but you know that during the discussions on the State of Union, I discussed with the Prime Minister how Belgium grants without any restriction or quota of INAMI numbers to doctors and dentists who have trained at a European university.

I have long advocated against this discrimination against our young doctors and dentists who are being imposed a restrictive quota. For the twenty-third or thirty-third time, I therefore advocate for the introduction of a quota for foreign practitioners, accompanied by a quality control of studies and internships, and the knowledge of one of our national languages.

You have always closed the door to this proposal. Last week, for the first time, the Prime Minister showed himself open. I would like to work on the legal level. I have already submitted a bill for a long time. I have already repeatedly voted for your majority of the amendments that flow the principle of this quota. I reintroduce them, once again, as part of the examination of this bill containing various provisions. It is disrespectful and inappropriate for young Belgian practitioners to continue in a system such as the current one.

This is all the more urgent because President Macron – which Prime Minister Charles Michel continues to emphasize – has just decided to evolve the French government model, by abolishing all quotas for the French.

He observed, in the same way as here, that there was a discrimination of French against European foreigners. Two things one. Or you persist in saying that you want quotas for our young Belgians. If so, it is logical and normal that there are also, with quality control and knowledge of a national language, for doctors and dentists who have trained in a foreign European university. Either you consider that they can all come, and therefore your argument in favor of quotas to ensure quality of health care does not hold the way for a second. In this case, these quotas can no longer apply to our young Belgians either. It is common sense and logic.

The current system of discrimination against our youth is completely unacceptable. I therefore remit to this majority the same amendments poured into concrete, allowing the establishment of quotas for doctors and dentists trained in a foreign European university.

Dear Minister, Dear Minister, Dear Minister, I would like to thank you.

Mr. Speaker, the law containing various provisions contains a lot of technical provisions to which I will not address as extensively as the previous speaker. I will point out a few things that are important for our group and which we would like to emphasize.

For the IVDs, In Vitro Diagnostics, a basis for the refund is laid. We have already asked for this in the committee. The Minister had promised to examine that and it is now in the present draft law. We are very satisfied with this.

Even before the spread law, our group has already laid a foundation with the work of Jan Vercammen. This is also stated in the bill today. We can only welcome this.

Steps are also being taken to further electronically roll out our healthcare, which means saving the system. We also welcome and explicitly endorse this.

I think everybody feels that we are sometimes strongly lagging behind in this, which is partly due to the lack of steps by the previous government. We are pleased that there is now a recruitment movement here. The enormous paperwork that comes with health care today and the associated costs are definitely something we must continue to work on. This law contains steps in this direction.

There is also a provision on the use of antibiotics in animals. We have never put under chairs or benches – this is, of course, a shared power with Minister Ducarme – that we reserve to the KB in this regard. We consider it very important that as many steps as possible are taken to further rationalize the use of antibiotics, and especially the critical antibiotics, in animals. We also welcome further steps in the registration process.

I have already stated in the committee that we will continue to follow the figures and will see if the measures are yielding fruit.

You have already mentioned figures in the committee showing that the first steps taken have led to a decrease in the use of antibiotics in animals. We hope that this path will continue, also with regard to the critical antibiotics.

My last point is about pharmaceutical care. It is not insignificant that the new roles assigned to our healthcare providers are also honored. In this regard, we see that a foundation is laid in the pharmaceutical disciplines.

Finally, also with regard to the reimbursement of clinical psychology, as CD&V colleague Nathalie Muylle has already ⁇ , we had already taken the necessary steps in Parliament. I also refer to the resolution of my colleague Renate Hufkens. We are pleased that a foundation is now being laid and we hope that this will continue. These are the first steps, for which a limited budget is available. We hope that it does not stay there, but that an extension to, among other things, the obesity problem is possible, as we have already indicated in the committee.

Since the draft law containing various provisions on health places important emphasis on matters that we have already emphasized in the committee, we will support it.

Mr. Speaker, I would like to briefly explain my amendment to this bill. In Article 36 of the draft law, the Government intends to allow the use of English in the applications and assessment reports in the context of the possible refund of medicines, in order to facilitate an international procedure, in particular in the context of the BeNeLuxA initiative. In this regard, we naturally find it logical that, in addition to the main national languages, the use of English may be permitted. However, this is not the case with the proposed scheme, as according to the scheme documents can be delivered only in English. The Standing Committee for Languages Supervision issued a very critical opinion on this scheme on 5 June 2018.

I have included this passage in my amendment. The Standing Committee for Language Supervision is convinced that such documents, drawn up solely in English, do not provide sufficient guarantees that those documents can be sufficiently understood by all intervening parties so that they can handle those files with knowledge of the facts. I think that advice should be taken seriously by the government, so my question is why it has not been taken into account, Mrs. Minister. We are of course of the opinion that this should only be done for principled reasons.

In addition, it is of course also clear that in the context of a responsible assessment of the documents, for which only English is now permitted, the documents should also be available in their entirety in the main national languages. However, it seems to me that it is in the interest of quality health care that the documents are also available in Dutch and French, hence our amendment. Of course, I hope for your support for this, so that we could eventually approve the present draft.

Does anyone ask for the word? If this is not the case, the word is to the Minister.

Mr. Speaker, I would like to thank the members of the Chamber for their speech in the plenary session and in the committee, where the same questions were actually asked. I will therefore answer some questions, but also refer to the answers contained in the report.

Mr Pas, these are only texts exchanged within the framework of an internationally established cooperation between five countries. In that context, it is normal that the language used for the texts is English, which, however, is not permitted by our language legislation and therefore a problem for the international cooperation that we have established, hence this application.

Mr Frédéric, with regard to the third party paying, measures are necessary in case of fraud and misuse. Two measures are practically possible: no longer apply the paying third party or immediately prohibit its use as soon as abuse is found. I know that some patients will be surprised by this measure, but it is necessary to prevent fraud or prevent it from lasting.

Mrs. Fonck, the bill is urgent, as I said in the committee. It was introduced in June. But given the abundance of projects, each minister had to prioritize some of them. This project is important primarily for patients and this fact has been confirmed by various members of the committee. They also said that this project contains a number of articles in the interest of patients.

There are many improvements for patients.

Regarding the consultation of the various actors, I was told that within the AFMPS, which is responsible for this matter, there were six meetings. Of course I asked for the reports, even if you say something else.

For the extra wall pharmacies, I explained in commission that it is in the agreement that we concluded with the pharmacies. This is in favor of small workshops because they can really associate with each other to share the costs associated with individual drug preparations. It is also known that when very small offices do not have the expertise in preparation - there are numbers in this regard - the quality is not always guaranteed. The measure aims to improve the collaboration between small offices. There is also the fact that when you have to buy a robot and install it in the pharmacy itself, this is not always possible due to lack of space. This point is included in the multiannual framework with pharmacists. We will implement this agreement.

As for the procedure and the three months, I said it would be fully reviewed. The opinion of the Implementation Commission and the delegation to the Minister will be deleted. In addition, you have asked me why there were no more frequent meetings of this Implementation Commission. This is because there were too many people sick or absent and the meeting was postponed every time. The new procedure provides for a public investigation notice, an analysis of the economic viability of the surrounding pharmacies, based on objective criteria, as well as a right to be heard by the AFMPS.

We believe that this is a much faster procedure than the current procedure, and that it will provide more opportunities for pharmacists in the vicinity, willing to react and be heard. Why leave the three months when, in the procedure, the opinion of this implementation commission has been removed? Before, it needed the opinion of the commission, then the minister had three months to decide, but these two levels are suspended, and you want to reintroduce the three months.

Regarding tobacco, I explained that an agreement had been made within the government, and that I executed it like every party participating in this government agreement. Can we go further? Yes, but we will do it step by step. I am not someone who will say no after having reached an agreement within the government. I am loyal to the government. You may have a different opinion, but I am like that.

Now to the tax status. It applies to retired doctors who still perform an activity after their retirement and who receive premiums like other active doctors. It is true that they have to pay taxes. But every citizen here must pay his taxes. It is not possible to tell them not to pay, and it is not necessary to attack the Minister of Finance, for he must make sure that every citizen pays his taxes. We should not try to face us face to face. We also agree on this in the government.

Madame Fonck, you always find that you need to do something else or go further. Sometimes you find that we are going too far. I think you play your role in the opposition well, but you must still think of the patients who will benefit from all the measures decided here. There are some good measures among them.

Mr. Speaker, I would like to refer to the long discussions and the many answers found in the report.

I also remember that Mrs. Muylle and Mrs. Van Camp find many good measures in the text, including the legal basis for the refund of first-line psychological care and greater safety for the patient.

Mrs. Van Camp, you asked for numbers. I gave you the numbers that I have. We are moving in the right direction with the unhealth principle to reduce the use of antibiotics in humans and animals. It is good that you have requested the numbers and that they are now known.

I have not learned much.

I will not answer you point by point because if it belongs to me to play my role as a member of the opposition, I am above all the relay and spokesman of a whole series of field actors.

So I will explain to veterinarians that this government that has absolutely not consulted them, who has not consulted the UPV ...

The [...]

You consider that the AFMPS and AFSCA are representatives of veterinarians. Do you know what UPV is? Do you know what the Veterinary Order is? Do you know what the official coordination bodies are? The AFSCA is not the representative of the UPV; it is not the representative of the Order of Veterinary Physicians.

It is nevertheless astonishing to find yourself facing a government that swears that it consults and that, in the end, receives the documents from the opposition through Parliament. It is never seen! You should have said, Mr. Minister, that you did not organize a consultation. But not !

As for the doctors, I will be pleased to relay to them the words you have held today. It will be the same for the pharmaceutical sector, the pharmacists of the small offices. I can assure you that they won’t appreciate them very much.