Demande directe (CEACR) - adoptée 1995, publiée 82ème session CIT (1995)

Part II (Medical care), Article 10, paragraph 2, of the Convention. The Committee notes with interest from the information supplied by the Government in its report on this Convention and on the application of the European Social Security Code and its Protocol, the adoption of the Royal Order of 3 November 1993 which introduces a social ceiling to cost-sharing; above a certain annual amount (15,000 francs of cost-sharing, if income is below 6,000,000 francs) households no longer share in the cost of care, which is provided free of charge for all the members of the household. This ceiling is adjusted on the basis of the income of the household and each household can benefit from it, with only medicaments being excluded from the ceiling. The Committee also notes the Royal Order of 21 September 1993 to modify the level of individual participation in the cost of certain health benefits, which includes in section 2(1) substantial increases in the levels of individual participation (with the exception of persons who benefit from supplementary insurance coverage) in the fees for certain benefits set out in the Annex to the Royal Order of 14 September 1984 enumerating health care benefits covered by compulsory health care and benefit insurance. It notes in particular, according to the information supplied by the Government, that the level of participation of beneficiaries is now set at 30 per cent (instead of the previous level of 20 per cent) of fees for consultations with general practitioners; 35 per cent (instead of 25 per cent) of fees for visits by general practitioners and paediatricians; and 40 per cent (instead of 25 per cent) of fees for consultations with specialists. However, the Committee notes that, in accordance with section 2(1) of the above Royal Order of 21 September 1993, the individual participation of beneficiaries in the fees of physicians relates to the medical acts covered by the code numbers set out in section 2(I)(A) of the Annex to the Royal Order of 14 September 1984.

The Committee requests the Government to supply detailed information on the impact of the new measures envisaged under the Royal Order of 21 September 1993 on the application of Article 10, paragraph 2, of the Convention, which provides that the participation of beneficiaries in the cost of medical care received in respect of a morbid condition shall not result in hardship.