Proposition 55K0346

Projet de loi modifiant la loi relative à l'assurance obligatoire soins de santé et indemnités, coordonnée le 14 juillet 1994, en ce qui concerne l'affichage des tarifs par les dispensateurs de soins.

General information ¶

Authors

Vooruit Jan Bertels, Karin Jiroflée, Gitta Vanpeborgh

Submission date

Sept. 16, 2019

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

display health care profession health expenditure consumer information health policy health care health insurance

Voting ¶

Voted to adopt

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

Abstained from voting

N-VA LDD

Contact form ¶

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Discussion ¶

Oct. 21, 2021 | Plenary session (Chamber of representatives)

Full source

The rapporteur is Ms. Hennuy, who refers to her written report.

The proposed legislation has already taken a fair path in the committee. It has already returned several times.

The N-VA advocates communicating clearly to the patient how much a treatment will cost. Our patients need to know what they are doing. Today is Cancer Day and we all wear a yellow ribbon to show our support to our patients. Nothing is worse than getting a difficult diagnosis, seeing his entire life overwhelmed and then worrying about how much the treatment will cost and whether one can pay for it. Clearness towards the patient is a message that we support.

Our group has also taken a number of initiatives to ensure that a patient does not face surprises when undergoing treatment. When a patient goes to a conventional doctor and is referred for further examination, he must be guaranteed that the convention will also be respected for the follow-up examinations. This is a very important step, because when patients are referred by one doctor to another doctor for an anatomo-pathological examination, for example, and those who do not speak by the doctor themselves, they need to get clarity about how much that will cost and know whether it is guaranteed that the research will also be conducted under the convention if that possibility exists.

If that is not the case, if there is no possibility of convention with a healthcare provider to which the patient is referred or if the specialist in question is not conventioned, it is up to that healthcare provider to communicate very clearly with his patient and to make it clear to him that the convention is not guaranteed in the referral.

The proposed legislation has already taken a fair path in the committee. It has already returned several times.

The N-VA advocates communicating clearly to the patient how much a treatment will cost. Our patients need to know what they are doing. Today is Cancer Day and we all wear a yellow ribbon to show our support to our patients. Nothing is worse than getting a difficult diagnosis, seeing his entire life overwhelmed and then worrying about how much the treatment will cost and whether one can pay for it. Clearness towards the patient is a message that we support.

Our group has also taken a number of initiatives to ensure that a patient does not face surprises when undergoing treatment. When a patient goes to a conventional doctor and is referred for further examination, he must be guaranteed that the convention will also be respected for the follow-up examinations. This is a very important step, because when patients are referred by one doctor to another doctor for an anatomo-pathological examination, for example, and those who do not speak by the doctor themselves, they need to get clarity about how much that will cost and know whether it is guaranteed that the research will also be conducted under the convention if that possibility exists.

If that is not the case, if there is no possibility of convention with a healthcare provider to which the patient is referred or if the specialist in question is not conventioned, it is up to that healthcare provider to communicate very clearly with his patient and to make it clear to him that the convention is not guaranteed in the referral.

In the proposal that was put to the vote here, we had a number of comments. We have made this very clear in the committee and I will repeat it again.

The biggest mistake we can make is to leave or question vulnerable patients, who are already struggling, through an exhaustive, long list of prizes in the unknown. If that list is suspended, it will not always be easy for the patient to deduce from which nomenclature and how many treatments he needs. Some treatments are reimbursed every eight turn, while others are reimbursed every eighteen turn. The patient should be able to evaluate this very clearly. However, the more vulnerable the patient is, the more difficult it is for him to find out from a list how much it will cost him.

I also commented on the maximum invoice. By including in the list whether one is eligible for the maximum invoice or not, you can meet that in part, but not always. So we remain concerned that that list, with which we symbolically want to make clear to the patient that we are transparent, is nothing more than a symbol when the communications of the healthcare provider do not follow it. That is why we have once again submitted an amendment which makes it very clear that the communicating gap of the healthcare provider with the patient should be guaranteed at all times, so that the patient is clearly informed.

A second note from our N-VA faction is about the reference to the most common practices. We have submitted an amendment that you have not accepted. The prices should be displayed, but it should be clear to the healthcare provider what the government means with the most common benefits.

In the proposal that was put to the vote here, we had a number of comments. We have made this very clear in the committee and I will repeat it again.

The biggest mistake we can make is to leave or question vulnerable patients, who are already struggling, through an exhaustive, long list of prizes in the unknown. If that list is suspended, it will not always be easy for the patient to deduce from which nomenclature and how many treatments he needs. Some treatments are reimbursed every eight turn, while others are reimbursed every eighteen turn. The patient should be able to evaluate this very clearly. However, the more vulnerable the patient is, the more difficult it is for him to find out from a list how much it will cost him.

I also commented on the maximum invoice. By including in the list whether one is eligible for the maximum invoice or not, you can meet that in part, but not always. So we remain concerned that that list, with which we symbolically want to make clear to the patient that we are transparent, is nothing more than a symbol when the communications of the healthcare provider do not follow it. That is why we have once again submitted an amendment which makes it very clear that the communicating gap of the healthcare provider with the patient should be guaranteed at all times, so that the patient is clearly informed.

A second note from our N-VA faction is about the reference to the most common practices. We have submitted an amendment that you have not accepted. The prices should be displayed, but it should be clear to the healthcare provider what the government means with the most common benefits.

We have proposed to draw up those lists together with the trade unions. You did not follow that proposal and we continue to regret that very much.

We have already conducted this discussion extensively. The N-VA is absolutely in favor of the spirit of the proposal. We therefore hope that we will be able to vote with you, that you review our amendment thoroughly and that we can still introduce it. A patient who sees only a list is, as far as I am concerned, an insufficiently informed patient. There should be clarity from the caregiver to the person sitting in front of him. After all, uncertainty is really the enemy of any sick person sitting in the waiting room.

Our health care system must be at the heart of our concerns. I said this recently in the context of current issues. This is what we, the Socialists, repeat with strength and conviction. We have always defended its quality but also its accessibility. Vooruit’s proposal goes in this direction and I would like to thank our colleagues for this excellent and indispensable initiative.

This proposed legislation is concrete for patients. It is concrete now. A clear display of the main benefits at the different care providers will finally allow the patient to know what to expect when he will have to open his portfolio and pay for his care.

Transparency is primary. My group has taken many initiatives in this direction. I recall, for example, the establishment of the admission form, the obligation to see clear information on the websites of hospitals, the obligation also to have in each hospital a contact person from which the patient can obtain the useful and personalized information on the details of the invoice that will be applied to him.

Transparency is also the obligation for care providers to clearly inform whether they are or are not conventioned, in whole or in part.

Today, a step further towards this clarity and transparency is taken by allowing the patient to know in advance the rates that will be applied by the provider of care he wishes to consult through a mandatory display of the most common benefits. This is a step further towards the protection of the patient as he often finds himself lost in the face of the cost of some of the usual services he needs. And who can say with certainty that he knows what the amount he will pay tomorrow? At least not me! Not often the relatives I close, not often the fellow citizens who often have this fear of the bill, to have bad surprises and sometimes financial disasters.

The fact of not knowing can also lead to dramatic consequences: the postponement for fear of the necessary care, or worse, their cancellation and renunciation. This is what we must absolutely avoid, dear colleagues!

With this text, the patient will therefore know in advance how much this or that service costs, what amount it will be reimbursed and what will be the possible supplements; in short, what he will have to pay out of his pocket when crossing the door of the doctor.

We have proposed to draw up those lists together with the trade unions. You did not follow that proposal and we continue to regret that very much.

We have already conducted this discussion extensively. The N-VA is absolutely in favor of the spirit of the proposal. We therefore hope that we will be able to vote with you, that you review our amendment thoroughly and that we can still introduce it. A patient who sees only a list is, as far as I am concerned, an insufficiently informed patient. There should be clarity from the caregiver to the person sitting in front of him. After all, uncertainty is really the enemy of any sick person sitting in the waiting room.

Our health care system must be at the heart of our concerns. I said this recently in the context of current issues. This is what we, the Socialists, repeat with strength and conviction. We have always defended its quality but also its accessibility. Vooruit’s proposal goes in this direction and I would like to thank our colleagues for this excellent and indispensable initiative.

This proposed legislation is concrete for patients. It is concrete now. A clear display of the main benefits at the different care providers will finally allow the patient to know what to expect when he will have to open his portfolio and pay for his care.

Transparency is primary. My group has taken many initiatives in this direction. I recall, for example, the establishment of the admission form, the obligation to see clear information on the websites of hospitals, the obligation also to have in each hospital a contact person from which the patient can obtain the useful and personalized information on the details of the invoice that will be applied to him.

Transparency is also the obligation for care providers to clearly inform whether they are or are not conventioned, in whole or in part.

Today, a step further towards this clarity and transparency is taken by allowing the patient to know in advance the rates that will be applied by the provider of care he wishes to consult through a mandatory display of the most common benefits. This is a step further towards the protection of the patient as he often finds himself lost in the face of the cost of some of the usual services he needs. And who can say with certainty that he knows what the amount he will pay tomorrow? At least not me! Not often the relatives I close, not often the fellow citizens who often have this fear of the bill, to have bad surprises and sometimes financial disasters.

The fact of not knowing can also lead to dramatic consequences: the postponement for fear of the necessary care, or worse, their cancellation and renunciation. This is what we must absolutely avoid, dear colleagues!

With this text, the patient will therefore know in advance how much this or that service costs, what amount it will be reimbursed and what will be the possible supplements; in short, what he will have to pay out of his pocket when crossing the door of the doctor.

I would also like to say that this text is the fruit of constructive work among the members of the majority. We took the time to ask for many opinions from field actors at the different stages of the course of this text. A considerable work has also been done to make this measure practically feasible. For the patient, it must be an easy access to clear and understandable information, and for the provider, it must be an easy to undertake action that will not require too large administrative burden.

In short, this is a great step forward: coupled with the latest decisions made by the INAMI General Council in the framework of the 2022 care budget, it aims to allow for a generalization of the third party paying and can only be beneficial – I am convinced – to all patients.

Health is our most precious asset, as I said before. We repeat it constantly and we will repeat it again and again. It is a creed for us, socialists, with this constant willingness to defend our healthcare system as a whole, its quality, accessibility and transparency.

I would also like to say that this text is the fruit of constructive work among the members of the majority. We took the time to ask for many opinions from field actors at the different stages of the course of this text. A considerable work has also been done to make this measure practically feasible. For the patient, it must be an easy access to clear and understandable information, and for the provider, it must be an easy to undertake action that will not require too large administrative burden.

In short, this is a great step forward: coupled with the latest decisions made by the INAMI General Council in the framework of the 2022 care budget, it aims to allow for a generalization of the third party paying and can only be beneficial – I am convinced – to all patients.

Health is our most precious asset, as I said before. We repeat it constantly and we will repeat it again and again. It is a creed for us, socialists, with this constant willingness to defend our healthcare system as a whole, its quality, accessibility and transparency.

Mr. Speaker, colleagues, the proposal, to which Mr. Depoorter also referred, has indeed been returned several times. It has also gone back and forth several times during the previous legislature. It has already laid on the table and admitted, I was there in the previous legislature but a cool lover of it. This was mainly due to the fear that colleague Depoorter also talked about in relation to transparency.

We all know that the tariff structures are very complex. I remember the example I gave a few years ago, and that I found in my notes: the services of ophthalmology have 1,161 nomenclature numbers, gynecology more than 800. I thought the following. If all this is to be displayed in the waiting room, with all the different tariff structures (refund, own share, convention status, the maximum supplements), then one risks the opposite effect. Such a display should not make the net less transparent and discourage patients. This is exactly what we want to avoid with this proposal. We all know that there is a clear problem with accessibility and transparency and that we need to take a number of measures to improve it.

During this legislature, we have engaged in a lot of consultations with our colleagues, also on the basis of the opinions, and there has been a great support to do so. I think there are a number of meaningful guarantees in the text that make it possible to take that step. It is intended that a model of display is developed, together with the actors of the field, such as the Insurance Committee, where both mutualities and doctors representatives are sitting at the table, and also always in consultation with the agreement committees.

As regards the discussion on the conventional benefits, I assume that this is elaborated in a sound manner, also taking into account what the most common benefits are.

After all, benefits can be described in a waiting room in such a way that no cat understands what it is about. The parties involved in the development of the model will have to ensure that everything is done in a simple, clear and understandable way for the patient and that in this regard even the most common benefits are displayed fairly easily. They are now very easy to consult. From a number of specialists, it can now be perfectly consulted on the websites of a number of organizations what the patient must pay today, what the own share is and what the maximum supplements are. Therefore, it is important that the exercise is done with the stakeholders.

I also indicated in the committee that for CD&V the penalty would have been heavier. I have also been clearly in this. If one goes through the trajectory with all partners and then comes to a model, the agreement in this regard must also be honored and adequate sanctions should be built in.

However, the proposal is not about sanctioning. It is about informing. It is important that we anticipate a first step here.

Have we reached a final point? No, we do not have it. Ms. Depoorter is right when she states that it is not a story of just posting or placing all the info on a website. It is much more than that. It is the responsibility of many people, today primarily the healthcare providers themselves, but also of many actors in the field to provide the information on the subject, including through hospitals or social services of hospitals. We know all the actors in the field. Therefore, it is not a story of just a poster and the case is finished.

The proof of the pudding is in the eating. We must take that step. We need to see what this step leads to. The exercise presented here today is only a first step, but a first step that deserves our support, especially since it is a first important step in terms of transparency and greater accessibility.

Will an evaluation be needed? This will ⁇ be the case. Per ⁇ we need to adjust? I suspect yes. However, this first step is sufficient for us to support this proposal.

Mr. Speaker, colleagues, the proposal, to which Mr. Depoorter also referred, has indeed been returned several times. It has also gone back and forth several times during the previous legislature. It has already laid on the table and admitted, I was there in the previous legislature but a cool lover of it. This was mainly due to the fear that colleague Depoorter also talked about in relation to transparency.

We all know that the tariff structures are very complex. I remember the example I gave a few years ago, and that I found in my notes: the services of ophthalmology have 1,161 nomenclature numbers, gynecology more than 800. I thought the following. If all this is to be displayed in the waiting room, with all the different tariff structures (refund, own share, convention status, the maximum supplements), then one risks the opposite effect. Such a display should not make the net less transparent and discourage patients. This is exactly what we want to avoid with this proposal. We all know that there is a clear problem with accessibility and transparency and that we need to take a number of measures to improve it.

During this legislature, we have engaged in a lot of consultations with our colleagues, also on the basis of the opinions, and there has been a great support to do so. I think there are a number of meaningful guarantees in the text that make it possible to take that step. It is intended that a model of display is developed, together with the actors of the field, such as the Insurance Committee, where both mutualities and doctors representatives are sitting at the table, and also always in consultation with the agreement committees.

As regards the discussion on the conventional benefits, I assume that this is elaborated in a sound manner, also taking into account what the most common benefits are.

After all, benefits can be described in a waiting room in such a way that no cat understands what it is about. The parties involved in the development of the model will have to ensure that everything is done in a simple, clear and understandable way for the patient and that in this regard even the most common benefits are displayed fairly easily. They are now very easy to consult. From a number of specialists, it can now be perfectly consulted on the websites of a number of organizations what the patient must pay today, what the own share is and what the maximum supplements are. Therefore, it is important that the exercise is done with the stakeholders.

I also indicated in the committee that for CD&V the penalty would have been heavier. I have also been clearly in this. If one goes through the trajectory with all partners and then comes to a model, the agreement in this regard must also be honored and adequate sanctions should be built in.

However, the proposal is not about sanctioning. It is about informing. It is important that we anticipate a first step here.

Have we reached a final point? No, we do not have it. Ms. Depoorter is right when she states that it is not a story of just posting or placing all the info on a website. It is much more than that. It is the responsibility of many people, today primarily the healthcare providers themselves, but also of many actors in the field to provide the information on the subject, including through hospitals or social services of hospitals. We know all the actors in the field. Therefore, it is not a story of just a poster and the case is finished.

The proof of the pudding is in the eating. We must take that step. We need to see what this step leads to. The exercise presented here today is only a first step, but a first step that deserves our support, especially since it is a first important step in terms of transparency and greater accessibility.

Will an evaluation be needed? This will ⁇ be the case. Per ⁇ we need to adjust? I suspect yes. However, this first step is sufficient for us to support this proposal.

Mr. Speaker, with the bill proposed today, all healthcare providers will be obliged to include the rates of their most common care services in their practice and on their website in the course of 2022.

For the PVDA, this is a step forward. We support the bill. When it is good, it must be said, whatever we do. We support the proposal.

This morning I saw in a local Facebook group of citizens of my neighborhood a message appearing from someone who had an appointment with the dermatologist in a particular street, where there was no ban contact. That person asked if someone knew how much there would be paid. Therefore, it is important to give more clarity to patients. These tariffs must be known in advance.

Ms. Vanpeborgh, you stated in the committee that it effectively addresses the scare of people because they do not know what care costs. In this way, they will not face surprises afterwards. This proposal is therefore effectively a positive intermediate step for us, but it does not change the problem itself of the often too high prices for consultations and care services. In my practice I see that people are very aware of the prices of some treatments and therefore postpone a visit to the dentist or family doctor. The figures on health care discharge for financial reasons are ⁇ disturbing, despite the fact that we are a wealthy country. Recently, ACV Puls conducted an interview with the household aid services. 80% of them said they delayed doctor visits. Only 20 percent said they would not do that. One respondent said that every expense should be weighed. Each invoice paid that person in discs, and he or she did not have the means to go to the doctor himself. That money was put aside for the moment when one of the children became ill. That is the reality.

According to the PVDA, the best and structural solution against that fear of unexpectedly high bills and health care is to make the consultations with the general physician free. Therefore, we have a bill on the table in Parliament. The PVDA and Medicine for the People have not only campaigned for this for years, but also put it into practice every day. We therefore advocate for a mandatory generalization of the third-payer scheme across the entire first line. Today the lines move, as the ban on the third-payer scheme will soon be lifted. This is a step in the right and right direction towards a more universal approach. The problem with this, however, is that the doctor can still decide whether to apply the third-payer scheme or not.

Mr. Speaker, with the bill proposed today, all healthcare providers will be obliged to include the rates of their most common care services in their practice and on their website in the course of 2022.

For the PVDA, this is a step forward. We support the bill. When it is good, it must be said, whatever we do. We support the proposal.

The third-payer scheme consists in that the person pays only the brake money and not the part he or she receives back from the health fund.

Selective measures can be counterproductive, as they can lead to stigma, in which patients entitled to the third-payer scheme do not dare to go to their doctor if he refuses to apply that scheme. During the hearing in the Health Committee, including on the bill aimed at allowing patients to consult with the general physician without money, too much arbitrariness was accused when the physician decides whether or not to apply the scheme. By generalizing the third-payer system, arbitrariness and stigmatisation are avoided.

I would therefore like to quote from yesterday’s press release of the Flemish Patients Platform: “In a next step we would like to see at the Flemish Patients Platform that the third-party payer scheme is applied automatically. Now every healthcare provider must decide for himself whether to apply the third-party payer scheme or not. Therefore, patients will need to ask to apply the system. This creates a threshold again. An automated arrangement would really increase the financial accessibility of health care.”

Alleszins advised the Belgian Anti-Poverty Network display. I quote: “As long as the generalization of the third-payer scheme for all first-line medical services is not a reality on the ground and as convention is not mandatory, we propose to require all healthcare providers to inform patients about whether or not to apply the third-payer scheme.” However, you pointed out that this made the bill more complex and that the discussion should remain separate. I do not agree with this. Although the lifting of the ban on the third-payer scheme is a positive step, without an obligation to the third-payer scheme there is room for more arbitrariness and confusion among patients. It is perfectly feasible to include in the poster model whether the doctor applies the third-payer scheme or not. For us, this is the same discussion.

Mr. Minister, in the Standard of 18 October, you also said that you would like to examine whether an extension of the mandatory application is desirable. Therefore, we also see movements in this area and we find that very positive.

This morning I saw in a local Facebook group of citizens of my neighborhood a message appearing from someone who had an appointment with the dermatologist in a particular street, where there was no ban contact. That person asked if someone knew how much there would be paid. Therefore, it is important to give more clarity to patients. These tariffs must be known in advance.

Ms. Vanpeborgh, you stated in the committee that it effectively addresses the scare of people because they do not know what care costs. In this way, they will not face surprises afterwards. This proposal is therefore effectively a positive intermediate step for us, but it does not change the problem itself of the often too high prices for consultations and care services. In my practice I see that people are very aware of the prices of some treatments and therefore postpone a visit to the dentist or family doctor. The figures on health care discharge for financial reasons are ⁇ disturbing, despite the fact that we are a wealthy country. Recently, ACV Puls conducted an interview with the household aid services. 80% of them said they delayed doctor visits. Only 20 percent said they would not do that. One respondent said that every expense should be weighed. Each invoice paid that person in discs, and he or she did not have the means to go to the doctor himself. That money was put aside for the moment when one of the children became ill. That is the reality.

According to the PVDA, the best and structural solution against that fear of unexpectedly high bills and health care is to make the consultations with the general physician free. Therefore, we have a bill on the table in Parliament. The PVDA and Medicine for the People have not only campaigned for this for years, but also put it into practice every day. We therefore advocate for a mandatory generalization of the third-payer scheme across the entire first line. Today the lines move, as the ban on the third-payer scheme will soon be lifted. This is a step in the right and right direction towards a more universal approach. The problem with this, however, is that the doctor can still decide whether to apply the third-payer scheme or not.

Nevertheless, the point of the Network against Poverty is clear: as long as the third-payer scheme is not generally mandatory, we believe it is necessary for the doctor to display whether he applies the scheme or not. That is why we are presenting our amendment again today and we hope that they will follow us, which is, in our view, a logical addition. It is very important for the patient to know whether the third-party payment scheme will be applied or not.

The third-payer scheme consists in that the person pays only the brake money and not the part he or she receives back from the health fund.

Selective measures can be counterproductive, as they can lead to stigma, in which patients entitled to the third-payer scheme do not dare to go to their doctor if he refuses to apply that scheme. During the hearing in the Health Committee, including on the bill aimed at allowing patients to consult with the general physician without money, too much arbitrariness was accused when the physician decides whether or not to apply the scheme. By generalizing the third-payer system, arbitrariness and stigmatisation are avoided.

I would therefore like to quote from yesterday’s press release of the Flemish Patients Platform: “In a next step we would like to see at the Flemish Patients Platform that the third-party payer scheme is applied automatically. Now every healthcare provider must decide for himself whether to apply the third-party payer scheme or not. Therefore, patients will need to ask to apply the system. This creates a threshold again. An automated arrangement would really increase the financial accessibility of health care.”

Alleszins advised the Belgian Anti-Poverty Network display. I quote: “As long as the generalization of the third-payer scheme for all first-line medical services is not a reality on the ground and as convention is not mandatory, we propose to require all healthcare providers to inform patients about whether or not to apply the third-payer scheme.” However, you pointed out that this made the bill more complex and that the discussion should remain separate. I do not agree with this. Although the lifting of the ban on the third-payer scheme is a positive step, without an obligation to the third-payer scheme there is room for more arbitrariness and confusion among patients. It is perfectly feasible to include in the poster model whether the doctor applies the third-payer scheme or not. For us, this is the same discussion.

Mr. Minister, in the Standard of 18 October, you also said that you would like to examine whether an extension of the mandatory application is desirable. Therefore, we also see movements in this area and we find that very positive.

Nevertheless, the point of the Network against Poverty is clear: as long as the third-payer scheme is not generally mandatory, we believe it is necessary for the doctor to display whether he applies the scheme or not. That is why we are presenting our amendment again today and we hope that they will follow us, which is, in our view, a logical addition. It is very important for the patient to know whether the third-party payment scheme will be applied or not.

First and foremost, I would like to thank all my colleagues for the enriching debates in the committee and again today. The arguments put on the table here are important and deserve an answer.

I will go back in time. When I became a member of Parliament less than a year ago, this proposal was one of the first to arrive on my desk, and I wondered how it was possible that such a text had never been adopted before, while it seemed to me obvious that all healthcare providers would give patients clarity about their convention status and the rates they apply. I accepted the 11 amendments. They were very educational. One learns where the gaps are: with one medical union and with other organizations. On this basis, the majority submitted a number of amendments, which we explained in the committee. When discussing them, we also promised to submit them for advice to various agencies to verify whether we were right. We have done that too. In the second consultation round, we received eleven opinions, all of which were positive, with the exception of the advice of one medical syndicate, in particular BVAS-ABSyM. That can and should be said. Here and there, there were also concerns and suggestions. I would like to repeat them, because they also come back in some of the concerns of previous speakers.

First and foremost, I would like to thank all my colleagues for the enriching debates in the committee and again today. The arguments put on the table here are important and deserve an answer.

I will go back in time. When I became a member of Parliament less than a year ago, this proposal was one of the first to arrive on my desk, and I wondered how it was possible that such a text had never been adopted before, while it seemed to me obvious that all healthcare providers would give patients clarity about their convention status and the rates they apply. I accepted the 11 amendments. They were very educational. One learns where the gaps are: with one medical union and with other organizations. On this basis, the majority submitted a number of amendments, which we explained in the committee. When discussing them, we also promised to submit them for advice to various agencies to verify whether we were right. We have done that too. In the second consultation round, we received eleven opinions, all of which were positive, with the exception of the advice of one medical syndicate, in particular BVAS-ABSyM. That can and should be said. Here and there, there were also concerns and suggestions. I would like to repeat them, because they also come back in some of the concerns of previous speakers.

Some said that the bill is good, but that it does not solve everything. Complementary actions are needed. I also emphasized this in the committee, Mrs. Depoorter. We work step by step and the story is not yet over. I also pointed out in the committee the importance of a public campaign, which must finally come out to inform the public about the convention status. We use that word here, but that is not always evident in the world beyond. Mrs Depoorter, you also complained that the hospital bills are still not transparent. Indeed, we do not solve this problem; we must continue with it. I am convinced that we should make the public health markers.

We also need to make people aware of their rights. In 2022, the Patient Rights Act will be 20 years old. This is a great time to further strengthen the rights of patients. It should be made clear to the people that there is not only the third-payer scheme, but that many other statutes can also bring reductions on healthcare costs.

Another consideration was – I return to a comment made by Mrs. Muylle and Mr. Creyelman – that the fine should have been a little higher. The amount was raised from 125 to 1,000 euros in the original proposal. We have been talking about this for a long time, but ultimately decided to keep the fine at 125 euros. Healthcare providers will have to display their rates and convention status online or in the waiting room, allowing for the first time a visual check. At the same time, they will be punished for the supplements they dare to ask. In the future, the penalty may still be increased.

As requested in a consultation, we have excluded pharmacists from the scheme. They are reimbursed via the RIZIV and, in addition, they must – you ⁇ had a point there – label everything and that is tightly controlled.

This strengthens me in the thought that control should also be possible in this case, both by the Economic Inspection and by the Service for Medical Evaluation and Control of the RIZIV.

We have long discussed that poster model, about whether it is up to us to determine the definition of the most common provision and to say how the list should look. We talked about it with the professional groups and in the end it was very clear that we had to leave it to them. In the agreement committees of the RIZIV all those professional groups are represented and I am confident that they will be able to say which is the most common provision and will be able to develop a legible model.

I have already said that we must give them the necessary time. If the bill is approved, then we should ask the minister to ask all those agreement committees to do their job and develop such a poster model. We must give them a reasonable time. At the moment, I think of a year, but we need to evaluate that halfway and make a state of affairs to see if it works and where it needs to be updated. This is also a very important given.

I would like to return to the comments made here by the colleagues. Let me start with you, Mrs. Merckx. You said it’s okay, a step forward, but that those healthcare costs still remain a concern. I share your opinion. There is the budget for health care approved by the RIZIV, namely 45 million for dental care, as well as the deployment of the oral hygiene practitioners, who are now finally recognized and can facilitate the work of the dentists. In addition, there is also the maximum invoice, where the threshold is reduced to 250 euros for the vulnerable families.

Some said that the bill is good, but that it does not solve everything. Complementary actions are needed. I also emphasized this in the committee, Mrs. Depoorter. We work step by step and the story is not yet over. I also pointed out in the committee the importance of a public campaign, which must finally come out to inform the public about the convention status. We use that word here, but that is not always evident in the world beyond. Mrs Depoorter, you also complained that the hospital bills are still not transparent. Indeed, we do not solve this problem; we must continue with it. I am convinced that we should make the public health markers.

We also need to make people aware of their rights. In 2022, the Patient Rights Act will be 20 years old. This is a great time to further strengthen the rights of patients. It should be made clear to the people that there is not only the third-payer scheme, but that many other statutes can also bring reductions on healthcare costs.

Another consideration was – I return to a comment made by Mrs. Muylle and Mr. Creyelman – that the fine should have been a little higher. The amount was raised from 125 to 1,000 euros in the original proposal. We have been talking about this for a long time, but ultimately decided to keep the fine at 125 euros. Healthcare providers will have to display their rates and convention status online or in the waiting room, allowing for the first time a visual check. At the same time, they will be punished for the supplements they dare to ask. In the future, the penalty may still be increased.

As requested in a consultation, we have excluded pharmacists from the scheme. They are reimbursed via the RIZIV and, in addition, they must – you ⁇ had a point there – label everything and that is tightly controlled.

This strengthens me in the thought that control should also be possible in this case, both by the Economic Inspection and by the Service for Medical Evaluation and Control of the RIZIV.

We have long discussed that poster model, about whether it is up to us to determine the definition of the most common provision and to say how the list should look. We talked about it with the professional groups and in the end it was very clear that we had to leave it to them. In the agreement committees of the RIZIV all those professional groups are represented and I am confident that they will be able to say which is the most common provision and will be able to develop a legible model.

I have already said that we must give them the necessary time. If the bill is approved, then we should ask the minister to ask all those agreement committees to do their job and develop such a poster model. We must give them a reasonable time. At the moment, I think of a year, but we need to evaluate that halfway and make a state of affairs to see if it works and where it needs to be updated. This is also a very important given.

I would like to return to the comments made here by the colleagues. Let me start with you, Mrs. Merckx. You said it’s okay, a step forward, but that those healthcare costs still remain a concern. I share your opinion. There is the budget for health care approved by the RIZIV, namely 45 million for dental care, as well as the deployment of the oral hygiene practitioners, who are now finally recognized and can facilitate the work of the dentists. In addition, there is also the maximum invoice, where the threshold is reduced to 250 euros for the vulnerable families.

You say that this is not enough yet and Ms. Depoorter asks what is done for families who are just out of here. This is how you can see where the differences are, but it is good that something happens. Mrs Depoorter, I am the chairman of a special committee in my home town and also there people can apply for financial support for care, even if they do not have the status of vulnerable family or individual. Efforts are actually being made.

This brings me to the third-payer system. In the committee, I have proposed not to involve this now, because it makes things even more complicated. In fact, I have heard arguments for not upgrading the third-payer system now. The discussion on this subject is not yet fully clarified, although there is fortunately movement in the case. You know our position. We strongly support a compulsory third-party payment scheme for children and young adults. During the hearings, this view was widely supported. However, we are not yet completely out of it, which is precisely the argument to conduct the discussion about it separately. With the movement coming up, it’s worth looking at it separately.

Earlier this afternoon I interrogated Minister Kitir. We can come up with and write out a lot of bills here, but we need to see if there is also monitoring. For the third-payer scheme, monitoring and follow-up are also very important. If we see that it does not go as we expect, we can and must take our responsibility and adjust.

Mrs. Muylle, on what you commented about the sanction, I have already answered that it could be stronger.

Mrs. Depoorter, I now come to your comments. Majority or opposition, I think it is important that we listen to each other and learn from it. You had three concerns.

You say that this is not enough yet and Ms. Depoorter asks what is done for families who are just out of here. This is how you can see where the differences are, but it is good that something happens. Mrs Depoorter, I am the chairman of a special committee in my home town and also there people can apply for financial support for care, even if they do not have the status of vulnerable family or individual. Efforts are actually being made.

This brings me to the third-payer system. In the committee, I have proposed not to involve this now, because it makes things even more complicated. In fact, I have heard arguments for not upgrading the third-payer system now. The discussion on this subject is not yet fully clarified, although there is fortunately movement in the case. You know our position. We strongly support a compulsory third-party payment scheme for children and young adults. During the hearings, this view was widely supported. However, we are not yet completely out of it, which is precisely the argument to conduct the discussion about it separately. With the movement coming up, it’s worth looking at it separately.

Earlier this afternoon I interrogated Minister Kitir. We can come up with and write out a lot of bills here, but we need to see if there is also monitoring. For the third-payer scheme, monitoring and follow-up are also very important. If we see that it does not go as we expect, we can and must take our responsibility and adjust.

Mrs. Muylle, on what you commented about the sanction, I have already answered that it could be stronger.

Mrs. Depoorter, I now come to your comments. Majority or opposition, I think it is important that we listen to each other and learn from it. You had three concerns.

Your first concern is the communication with the patients. You are right when you say that a poster doesn’t solve everything. I share your concern. In principle, it is assumed that all healthcare providers are informed. In this regard, I want to reassure you. It has nothing to do with your amendment, but two days ago I accidentally received in my mailbox a judgment from the Court of Cassation, a press release, dated September 6, 2021, against the vzw Emmaüs. The court makes it very clear that the healthcare provider must, on its own initiative, inform the patient of the financial consequences of a provision. With right and reason. This judgment, together with our proposal, makes the amendment substantially superfluous. I believe in it, and it is also stated in the Court of Cassation. There is a great sense of responsibility among the healthcare providers.

The bill, the amendments and sub-amendments that we have written have been reviewed ten times by various advisory bodies. Sometimes I was surprised by those advice, but they were important. A number of times, for example, we have been hit by the RIZIV because we did not use the right legal terminology. This is also important.

It is not that I do not share your concern, but I do not accept this amendment because it is not written on the basis of an opinion and it is also not submitted for advice. I now know from experience that this is very important.

I have answered all comments and concerns. I did this with great respect, because it learns a lot. I would like to end with a thank you to all those who have contributed to this, including all those who have debated in the committee. This has enriched me incredibly. I have become smarter by doing so and it has convinced me even more, Mrs. Depoorter, that this is not the end point. It is a starting point, a first step forward and we must continue with it. I hope that all parties will eventually approve this bill.

Mr. Speaker, dear colleagues, my group fully shares the objective pursued by this bill, namely to improve the transparency of medical tariffs. Unfortunately, the proposed approach does not seem convincing enough.

I explain it. Our colleagues in Vooruit, of course, are quite right to worry about the fact that many doctors do not comply with their obligation to indicate their convention status. I also believe that too many patients do not understand what this convention status means and what it implies for their portfolio. If we could start by enforcing existing obligations, adopting a pedagogical language and prioritizing the dialogue with the patient, that would already be a very good thing.

However, moving to a price display appears to us to be more complex. This information is already available at mutual companies or on the official website of the INAMI. The complexity of the tariffs is thus such that the information by display may be falsified, for example depending on whether, or not, a preferential tariff is benefited; not counting the impact of the overall medical record, or even, of a possible journey of care.

Summarizing all this on a poster, in a waiting room, without further explanations, without a reading grid, seems to us to be ineffective. I hear well that the authors of the proposal aim here at the most common services, and therefore a understandable display, but without specifying them. Therefore, we should not create in the patient’s head expectations that could not be fully met for everyone.

Some arguments leave me confused. I quote an excerpt from the report, in which Ms. Jiroflée explained, at least with regard to the most common benefits, since that’s what it’s about: “Their display could partly dispel the patient’s fear of receiving a high bill; this fear leading to underconsumption of health care.”

I allow myself to resume this argument because if the patient is already in the waiting room of his doctor, it means that he has already decided to get treated, which makes us think that the information must rather come up, to trigger consultation.

In addition, getting treated also involves a downstream treatment cost, unknown at this stage in the waiting room, so that a frank and transparent dialogue with the doctor is more logically required.

Finally, I share other reservations that have been expressed by some colleagues, such as fees supplements, which today penalize patients.

Your first concern is the communication with the patients. You are right when you say that a poster doesn’t solve everything. I share your concern. In principle, it is assumed that all healthcare providers are informed. In this regard, I want to reassure you. It has nothing to do with your amendment, but two days ago I accidentally received in my mailbox a judgment from the Court of Cassation, a press release, dated September 6, 2021, against the vzw Emmaüs. The court makes it very clear that the healthcare provider must, on its own initiative, inform the patient of the financial consequences of a provision. With right and reason. This judgment, together with our proposal, makes the amendment substantially superfluous. I believe in it, and it is also stated in the Court of Cassation. There is a great sense of responsibility among the healthcare providers.

The bill, the amendments and sub-amendments that we have written have been reviewed ten times by various advisory bodies. Sometimes I was surprised by those advice, but they were important. A number of times, for example, we have been hit by the RIZIV because we did not use the right legal terminology. This is also important.

It is not that I do not share your concern, but I do not accept this amendment because it is not written on the basis of an opinion and it is also not submitted for advice. I now know from experience that this is very important.

I have answered all comments and concerns. I did this with great respect, because it learns a lot. I would like to end with a thank you to all those who have contributed to this, including all those who have debated in the committee. This has enriched me incredibly. I have become smarter by doing so and it has convinced me even more, Mrs. Depoorter, that this is not the end point. It is a starting point, a first step forward and we must continue with it. I hope that all parties will eventually approve this bill.

In conclusion, dear colleagues, as we do not wish to compromise the approach taken by a negative vote while we are not sufficiently convinced to express a positive vote, abstention therefore seems to us to be the most appropriate vote.

Mr. Speaker, dear colleagues, my group fully shares the objective pursued by this bill, namely to improve the transparency of medical tariffs. Unfortunately, the proposed approach does not seem convincing enough.

I explain it. Our colleagues in Vooruit, of course, are quite right to worry about the fact that many doctors do not comply with their obligation to indicate their convention status. I also believe that too many patients do not understand what this convention status means and what it implies for their portfolio. If we could start by enforcing existing obligations, adopting a pedagogical language and prioritizing the dialogue with the patient, that would already be a very good thing.

However, moving to a price display appears to us to be more complex. This information is already available at mutual companies or on the official website of the INAMI. The complexity of the tariffs is thus such that the information by display may be falsified, for example depending on whether, or not, a preferential tariff is benefited; not counting the impact of the overall medical record, or even, of a possible journey of care.

Summarizing all this on a poster, in a waiting room, without further explanations, without a reading grid, seems to us to be ineffective. I hear well that the authors of the proposal aim here at the most common services, and therefore a understandable display, but without specifying them. Therefore, we should not create in the patient’s head expectations that could not be fully met for everyone.

Some arguments leave me confused. I quote an excerpt from the report, in which Ms. Jiroflée explained, at least with regard to the most common benefits, since that’s what it’s about: “Their display could partly dispel the patient’s fear of receiving a high bill; this fear leading to underconsumption of health care.”

I allow myself to resume this argument because if the patient is already in the waiting room of his doctor, it means that he has already decided to get treated, which makes us think that the information must rather come up, to trigger consultation.

In addition, getting treated also involves a downstream treatment cost, unknown at this stage in the waiting room, so that a frank and transparent dialogue with the doctor is more logically required.

Finally, I share other reservations that have been expressed by some colleagues, such as fees supplements, which today penalize patients.

In conclusion, dear colleagues, not wanting to compromise the approach taken by a negative vote while we are not sufficiently convinced to express a positive vote, abstinence seems to us, therefore, to constitute the most appropriate vote.