Sir, – Correspondence about our prospective universal health insurance scheme has pointed to its probable non-affordability and negative reference has been made the Netherlands. Has any attention been given to the case of Belgium?
There insurance is provided by several non-profit-making mutual societies ( mutuelles ). Every resident must be insured and has a free choice of mutuelle . The monthly contribution is paid in equal shares by the insured person and his or her employer. It covers the individual and dependents, and is calculated pro rata on the level of earnings. The unwaged have their contribution paid entirely by the state. Thus the system is designed to ensure that the mutual societies have adequate resources.
In operation, the insured person pays directly for treatment and medicines and then claims reimbursement from his mutuelle on the basis of an authenticated receipt. However, through a national institution (the INAMI), encompassing the medical professions, the hospitals, the pharmacies, the mutuelles and the state, precise maximum prices are periodically negotiated and fixed for every known form of treatment or care. Each treatment is accorded a number which has to be inscribed on the receipt given to the patient. A significant point is that those maximum prices ( charges conventionnées ) are much lower than those demanded in Ireland.
The patient has a free choice, at every stage, of GP, specialist or hospital. All are in abundant supply. Perhaps the Belgian system is worth a glance in the current discussion. Yours, etc,
DAVID M NELIGAN,
Silchester Road,
Glenageary,
Co Dublin