Proposition 54K3402

Projet de loi relative à l'intervention de l'assurance obligatoire soins de santé dans les frais du transport en ambulance organisé dans le cadre de l'aide médicale urgente.

General information ¶

Authors

CD&V Nathalie Muylle
MR Damien Thiéry
N-VA Valerie Van Peel
Open Vld Dirk Janssens, Ine Somers

Submission date

Nov. 28, 2018

Official page

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Subjects

health policy emergency aid social security transport of patients health insurance

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Discussion ¶

Jan. 10, 2019 | Plenary session (Chamber of representatives)

Full source

I am referring to the written report. I will speak later on behalf of my group.

Mr. Speaker, colleagues, my best wishes for 2019 and good health.

We have worked well in the public health committee in the last few weeks and the result is here today. This law proposal concerns a number of technical adjustments that, however, require some explanation.

In recent years, a major financial injection has been given in the urgent medical care, namely 12 million euros in 2016 and 35 million euros in 2018.

Minister De Block started simultaneously with the reform of the financing of the urgent medical care. That reform was necessary because since the 1964 law no major changes have been made and the sector had become structurally underfunded.

With this bill, a new funding system comes into effect. There are two important components.

First, each patient receives a uniform, transparent and legible invoice with a flat rate of 60 euros per ride. The uniform rate means that the distance from the ride of an ambulance car no longer affects the costs for the patient. Today, the patient pays an average of 65 euros. If the ambulance does long journeys, the bill for the patient can be very high. The expensive bills for ambulance services are, therefore, part of the past with the new regulation.

Second, the ambulance services will receive a more solid and correct financing, which should lead to a viable system of urgent medical care throughout the territory.

The new financing model will refine the current flat-rate model and consists of a model consisting of two grants. The first is a permanent allowance based on a point system aimed at covering personnel costs. The second concerns an activation allowance aimed at compensating for non-transported journeys and providing for a geographical correction for interventions in rural areas.

I will leave this here, Mr. President, because I have understood that other co-inventors will also speak.

It should be clear that this is a long-awaited text that serves the interests of all patients. I think this is a very good bill. I ask for the support of everyone with conviction.

Mr. Speaker, I will make a brief speech from my bank. I have had the opportunity to speak extensively on this issue in the Health Committee.

Mr. Minister, dear colleagues, as it has been said, being taken urgently by ambulance to the hospital can happen to everyone and at any time with a cost often extremely large for the person who has benefited from the care and, this, despite an intervention of the health insurance, especially since, so far, obviously not every citizen was accommodated at the same sign, depending on whether he is more or less away from the place of departure of the ambulance and the hospital to reach. Thus, the amounts of the interventions varied greatly from one patient to another with sometimes mirobolant bills at the key and the astonishment in the patient’s head who was eventually seen claiming several hundred euros simply for being transported to the hospital, which is still not a trip for pleasure.

You know, Madame the Minister, that for a long time, the Socialist Group has been advocating for the revision of the system and the financing of emergency medical assistance as a whole, to reduce the costs for patients, but also to allow for adequate financing of the areas and ambulance services. Your government, then a majority and not a resignant, was committed to it. This took some time. The reform was announced. Information was communicated through the press. It is always nice for a parliamentary to find out the reforms he should vote for in the newspaper! A principle of solidarity through which each patient should pay the same amount, regardless of the distance travelled, was put on the table. This is the subject of the text submitted to us. Some elements such as the planned package have evolved. We talked about 45 euros, then 60 euros today without finally having the Parliament, so far, associated with this important work.

And then, all of a sudden, last December, here is the urgency being asked – we are often confronted with these urgency requests – to examine the text that occupies us. It is a text that purely and simply removes the intervention of health insurance for urgent ambulance transports and that purely and simply removes these ambulance transports from health services. This is an issue that I have already discussed in the committee and which is a problem for me. In view of the urgency, it was necessary, according to the former majority, to vote quickly because the reform was to enter into force on 1 January. When you take it in December to implement a legislation on January 1, you can actually consider that you are in an emergency or you do your job a little late!

You asked us for it, while we had not received any assurance at that time as to the effective implementation of the reform. Furthermore, you could not clearly tell us where the execution orders were, although the consequences may be significant and harmful to the patient in terms of costs, since he would not have been able to benefit from the package and would have been deprived of the refund.

Mr Minister, where are we? The execution orders would have been published. This is a good news. However, have all rescue areas and rescue services been adequately informed of the new billing conditions as well as the new financing criteria? As a result of the contacts that have been taken, it appears unfortunately that is not the case everywhere.

Furthermore, are we assured that everyone will be adequately funded – this is the fundamental question – without transfer of charges?

(The tumble)

I feel like my intervention is passionate about the CDH...I can no longer hear myself talk. If you wish, there is a room below where you could hold a group meeting.

So I said that it was worth asking whether we can be assured that all services will be financed properly, without transferring charges to the municipalities. In this regard, the responses given in the committee have not been sufficiently accurate.

It is undeniable that with this reform, not many patients will pay less, while others will pay a little more. In any case, I remain convinced that this flat-rate amount of 60 euros, which will no longer be the subject of any refund, remains too high for many of our fellow citizens.

It is therefore regrettable that the proposal presented to us today now completely closes the door to any refund for patients of emergency transport by ambulance. We also regret that this text definitively removes ambulance transportation from the list of health benefits. They will therefore no longer be included in the maximum to be charged, which limits patient healthcare spending when their medical expenses reach a certain amount during the year.

Mr. Speaker, Mrs. Minister, I repeat, my group fully supports the establishment of a flat-rate financing system in which each citizen will pay the same amount when he is taken care of urgently by an ambulance. However, due to the questions still unanswered about the reform itself – which we have been waiting for four years – and given the amendments made by the proposal itself, my group will abstain – as was the case in a committee.

This is a very important issue, even though it is a very technical issue. It underlies a reform that is in the patient’s interest and is included in the government agreement.

The budget for emergency medical assistance increased by virtually three points. I mean by this that it grew from 25 million to 73 million between 2014 and 2019. As you may have understood, the aim of the current reform is to improve the emergency transport of patients following the simple call to 112. As previously stated, from 1 January, a package of 60 euros will be applicable to absolutely everyone. It does not matter from where the ambulance will come to pick up the patient, and the number of kilometers it will have to travel to bring him to the hospital. This is obviously extremely important, especially in rural areas where it was well known that a major problem existed, and that the amounts to be paid for some patients exceeded several hundred euros. Rural areas and peripheral areas around major cities are directly affected and upgraded by this flat amount of 60 euros, regardless of where the ambulance comes from.

We gave another example. Two people living in the same street sometimes had to pay significantly different amounts simply because the ambulance came from a different region. The system here is uniform, equal for all patients. It is more appropriate for the patient.

The message I address to you, Mrs. Minister, and I address to all those who will one day be affected by a call to 112 in case of emergency, is as follows. Once again, we understood the problem faced by a number of patients. These patients remain at the centre of the debate, as they have always been since the beginning of this legislature. They will all be returned to the same level and will be able to benefit from exactly the same low-cost services, since, combined with all averages, the price of 60 euros remains much lower than the vast majority of amounts previously paid.

We will, of course, support this bill with all our hearts.

Dear colleagues, I thank you for all your presentations. I only received questions from Mr. Frédéric.

The reform was prepared by the FOD Public Health in consultation with the National Council for Emergency Medical Assistance, supplemented with representatives of the insurance institutions. Insurance institutions receive the invoice information so that they have the necessary instruments to control.

The years 2019, 2020 and 2021 are a transitional phase. During that period, services that would receive fewer resources as a result of the new financing system will receive compensation. That compensation is calculated at the end of the year. It should allow services to adapt to the new financing rules.

A new administrative system AMBUREG was introduced in early 2019. Its data may serve as a basis for further refining and improving the financing system and for supporting programming policies.

Already in 2018 all services received a higher permanent subsidy than in 2017, regardless of their activity and their organizational model. This means that some services received more in 2018 than they would receive in the final financing model. This also allows them to install a buffer.

For this purpose, the 35 million euros allocated to me were used. In the previous years, there was already an injection of 12 million euros in the permanent budget. Overall, the budget was thus tripled.

You also asked how far it is with the royal decrees.

You ask me if the royal arrests were taken. They did, because they did not require the adoption of a new law. They are taken in enforcement of the 1964 Act on Emergency Medical Assistance. Two royal decrees were taken on 21 December, one on billing and the other on subsidies; as well as two ministerial decrees at the end of the year, one for permanent subsidies and the other for subsidies for service activity.

Two newsletters from SPI Public Health, one in August and the other in December, were communicated to all services. You say they didn’t see them all, but I still checked today that they were all contacted by mail.

The citizens were informed by their mutuality. Postcards and posters are available in the waiting rooms of general physicians.

You say that the maximum amount to be charged is not taken into account. However, this has never been the case. Before, even though there was a 50% intervention by the INAMI, this was not within the maximum to be charged. We have changed nothing.

I agree with you that in the future it will be necessary to take targeted measures for certain vulnerable categories. This can still be done. With the registration data, we will be able to refine the measurements. I agree with you that in some cases, older people do not need an emergency ambulance. I am open about this. For most people, emergency medical assistance is occasional. But some people need it more.

Yes, in Inami, it’s easier now. The amount that was planned by the latter was transferred to the SPI Public Health. This is how we will really do a reform in the interest of citizens who need urgent medical assistance. We have been talking about it for a long time.

You say there were articles in the press. I can tell you that in most cases it was information that didn’t come from us, whether it was the amounts or situations described as the fact that the patient should pay the 60 euros or the fact that we didn’t inject money and made savings. This information was false. We never communicated because we were still negotiating with the ambulance services and with the SPI Public Health.

I really pledge for everything we are doing here because everything else is already underway.

All provisions stipulating that the RIZIV meets in ambulance transport are removed from the Coordinated Law on Compulsory Insurance with the current legislative proposal. The necessary budgets have already been transferred to the FOD Public Health. I would like to have the members of the House put their shoulders under it, because I think it is a very good thing for all citizens who urgently need an ambulance.