Solicitud directa (CEACR) - Adopción: 1996, Publicación: 85ª reunión CIT (1997)

Part II (Medical care), Article 10, paragraph 2, of the Convention. In its previous comments, the Committee noted that, under the terms of the Royal Order of 21 September 1993 to modify the individual share in the cost of certain types of health care, the level of individual cost-sharing by beneficiaries for consultations, visits and opinions by general practitioners and specialists had been raised substantially.

In its report, the Government confirms that, in the case of visits and consultations by doctors, beneficiaries have to pay a share of the cost and that the average rate of the cost-sharing per beneficiary, for all categories of beneficiaries, calculated on the basis of the amounts actually paid in respect of cost-sharing by patients and registered by the INAMI for this type of care, amounted to 26.77 per cent in 1995. However, it states that the category of the most economically vulnerable beneficiaries (VIPOs) have to pay a share of 10 per cent of the cost of the benefit or a flat rate. It also refers to the social and fiscal "franchises", which permit the reimbursement to the insured person of the surplus of cost-sharing paid over a period of one year in excess of the limit established for the various categories of insured persons; these reimbursements represented an overall amount of around 2,400 million in 1995.

The Committee notes this information. It also notes that, according to the report, the rise in cost-sharing by insured persons resulted in 1995 in a transfer of around 7,500 million more to be covered by beneficiaries. In this context, the Committee recalls, in particular, that in the case of beneficiaries who do not fulfil the requirements set out in the legislation to benefit from either a preferential personal rate for the cost of medical care, or social and fiscal "franchise" measures, the rate of cost-sharing, according to the type of benefit, attains between 30 and 40 per cent of the level of the fees established for consultations, visits and opinions from general practitioners and specialists, which appears to be high. Furthermore, even in the case of beneficiaries who are entitled to a social or fiscal "franchise", the rate of their share of the cost of medical fees depends on the amount of the medical expenses incurred above the corresponding annual ceiling. In this situation, the Committee hopes that the Government will continue to supply detailed information on the measures that have been taken or are envisaged, in accordance with Article 10, paragraph 2, of the Convention, to ensure that the sharing by beneficiaries in the cost of medical care received in respect of a morbid condition is so designed as to avoid hardship.