“The current fragmentation of skills in Healthcare is nonsense” (JN Godin)

Friday afternoon, Jean-Noël Godin, director of the GBO, was interviewed by the Joint Parliamentary Commission in charge of evaluating the effectiveness of the distribution of powers following the last institutional reform. He copiously illustrated the inconsistencies arising from the balkanization of prerogatives in the health sector, before setting out some avenues to be explored to correct the situation, keeping the mantra of providing care as close as possible to the patient.

Voices are raised regularly to regret the fragmentation of skills, which does not help the performance of the health care system, or even to call for refederalisation. How many times have we not mocked in the press, during the covid crisis in particular, the “Belgian overabundance” (or rather: “French-speaking”) of ministers each holding bits of prerogative? How many times have we not called for a single command to respond effectively to the coronavirus?

Auditioned in the Senate alongside various leaders of Inami, Unessa, Aviq, Iriscare, Agentschap Zorg en Gezondheid, etc., Jean-Noël Godin did not fail to list the shortcomings of the crumbling of skills. Including, at the top of the list, the separation between curative (federal level) and preventive (federated level) which is ” counterproductive because it does not encourage the development of a real prevention policy that would lead to a reduction in curative needs “. Situation that has ” obvious negative budgetary consequences ».

The director of the GBO also qualifies as “nonsense” the fragmentation of the competences of the first line, mental health and hospitals. And to follow up on examples taken from the MG sphere: the setting of the global medical offer, the financing of services and the duty of care (enshrined in the “quality law”) fall under the federal jurisdiction. The sub-quotas are the responsibility of the Community (” with a risk of poor consideration of the specific features of Brussels which are bicommunity ») And are defined on the basis of the federal quota without taking into account the regional needs of the population. The organization of general medicine, the circles, the Impulseo funds are regionalized. ” Another example is home help: for the same patient, nursing care comes under federal jurisdiction, but family assistance comes under federated entities. »

But what does the union recommend to correct the situation? According to him, it would be wise to “ maintain interpersonal solidarity at federal state level to finance health care », So as to preserve identical accessibility throughout the kingdom for basic care (to be defined at the national level). But, at the same time, consideration should be given to bringing together, under the same authority, all that has a link with European competences on the one hand (to be created, including medicines, the regulation of health professions, etc.) and public health. on the other (including the management of epidemics). A single level of power should also be responsible for everything relating to prevention, the provision of care and its organization (in the broad sense: acute care, chronic care, accommodation establishments, etc.), and of allocation of related budgets. And the GBO to suggest in the process a rebalancing between outpatient and hospitals, ” especially in the south of the country still very hospitalocentric », And between fee-for-service and fixed-price payment. A single place could be created to coordinate policies that are not clearly the responsibility of a single public authority.

Jean-Noël Godin insists that we avoid the choice of a person between two health systems that defines who has the powers of payment of providers and reimbursement of their services ” because there would then be a choice between a French-speaking / Walloon regime and a Flemish regime with the immediate consequence of two-tier medicine ».

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