The Belgian Health Care Reform: “Integrated Care for a better health” was approved by all responsible ministers in 2015 (federal level and federated entities). This plan aims to provide high quality care and support to all patients, at the best cost, and to improve the health status of the population (Triple Aim). In order to achieve this goal, local pilot projects were implemented all across the country following a ‘guided bottom-up approach’. In this approach, actors were given the initiative to create a project based on the local needs and context with the government acting as facilitating partner. After a conceptualization phase, 12 projects have started in January 2018 with the deployment of a specific action plan in order to achieve integrated care in their region. On the basis of the experiences during the first 18 months of implementation, some lessons learned and recommendations can already be formulated.
Policy Context And Objective
Belgium has an accessible health care with a national, compulsory health insurance (covering 99% of the population). Fee for Service, fragmented services and lack of coordination and communication lead to inefficiencies and make the system unsustainable for dealing with the future societal challenges (e.g. multimorbidity).
A legislative basis was created to allow pilot regions to test new, integrated models of care.
The Plan targets the whole Belgian population with a focus on people with a chronic disease. In total, the 12 projects cover a region of 2.52 million people (about a quarter of the Belgian population).
The first stage of implementation already highlighted different key lessons for the future design and implementation of integrated care policies in Belgium, such as:
- The underlying vision and key components of integrated care as put forward in the national plan are widely supported by all stakeholders
- The guided bottom-up approach in order to create and sustain support at the local level is valuable, but building these relationships of trust takes time
- Integration at the policy level is a key determinant for a successful change towards integrated care
- To be able to test new practices, a sufficient amount of legal flexibility is highly desirable
- Some key aspects of integrated care systems are difficult to develop through bottom-up pilot projects; e.g. sustainable multidisciplinary and transmural communication tools
- To be able to evaluate such complex system changes, extensive data are needed that are not always available yet in current practice
- Within a co-creative approach between government and field, the aspect of trust is essential:
o Clarity in the role of the government (partner and evaluator)
o Clear expectations between both parties
The early implementation stage of integrated care in Belgium highlighted different good practices as well as some strategic challenges. Also, these first experiences demonstrated the enormous support and willingness to change at the local level. Clear policy choices now need to be made in order to overcome these challenges so that the 12 pilot regions can grow to reach their full potential.
How to Cite:
Verhaeghe T. Co-creating integrated care in Belgium: first experiences. International Journal of Integrated Care. 2021;21(S1):138. DOI: http://doi.org/10.5334/ijic.ICIC20193