Abstract
The public health insurance funds are a unique player in the healthcare landscape. Belgium has seven public health insurance funds that operate the reimbursement system of health care services covered by the compulsory health insurance for their members and the payment of a replacement income in case of long-term illness. Public health insurance funds are present throughout the lifespan of their members, from birth to death, they are companion and point of contact for crucial moments in life at all ages.They play a key role in the rollout and implementation of key aspects of integrated care.
Not only are they responsible for the health care reimbursement, they are the guardians of the health insurance finance as well as the administrator. They are in control of the recognition and follow up of patients in incapacity for work and guide those patient in return to work and rehabilitation and reintegration. They have lots of experience in finance mechanisms and regulation within health care.
Next to their responsibilities in reimbursement, there’s also an important social service. The social workers are there to familiarize people with care, the organization of home care and to facilitate all preconditions to make this possible, but also to determine the severity of care and to open up as many social benefits as possible for those who are entitled to it. The public health insurance funds also generate data which they can use to evaluate the health system, provide for scientific research but also use to enhance population management and to weigh on decision- or policy makers.
After a short, interactive part, we will explore these different roles and demonstrate how they contribute to integrated care. Not only from the perspective of the public health care insurance institutions, but also from the perspective of collaboration amongst formal care givers surrounding one patient and from the perspective of several informal care givers. By using various testimonials, we let informal care givers share their experience and needs about integrated care.
Despite the long history, many actors in Belgium are insufficiently aware of what exactly these different roles are. It is the task of the public health insurance funds to continue to fully focus on this and to participate in initiatives that can realize integrated care. Therefore, at least one good practice will be discussed from one of the 12 integrated care pilot projects in which the funds, together with the other care actors and the government, are looking for innovative actions to make integrated care possible.