For the past few weeks, doctors have been subject to more frequent and intense checks. Mutual health funds now have access to information concerning healthcare providers and their patients, whatever mutual fund those patients are affiliated with.
Among the data transmitted are the type and number of consultations, as well as the content of prescriptions. The aim of this new measure is to be able to spot possible abuses and better combat fraud.
A doctor interviewed on condition of anonymity understands the need to monitor problematic practices, but believes they remain in the minority. “We really feel a bit, if you like, betrayed because yes, there are inevitably healthcare providers who unfortunately set bad examples, but they are exceptions”.
Medical situations that can be difficult to interpret
The practitioner is concerned in particular that numerous consultations or large numbers of prescriptions could be deemed problematic without taking account of the situation of the patients concerned.
She refers in particular to the link between deprivation, certain lifestyle habits and chronic conditions, which may require more regular medical follow-up. “The lower the socio-economic level, the greater the risk of problematic alcohol consumption, smoking, which are also linked to chronic conditions that will also need more regular follow-up, more medication, more antibiotics too”.
The question doctors are therefore asking is how these data should be interpreted: can a high level of medical activity be linked to patients’ specific needs rather than to abusive practice?
Mutual funds want to identify anomalies
At the Intermutualist Agency, access to this information has been welcomed. Marianne Hiernaux says the data will first allow mutual funds to carry out their usual tasks, especially in relation to reimbursements.
But they should also make it possible to identify behaviour that appears unusual in the statistics. “With this data, we will be able to manage all our basic tasks, all the reimbursement tasks for patients or providers, but we will also be able to detect certain statistical anomalies such as overprescribing, overconsumption”.
The statistics identified are then passed on to INAMI. The body can then carry out certain checks and, in some cases, establish findings of fraud.
Doctors agree in principle, but with reservations
From the Belgian Group of General Practitioners, the objective of limiting costs and abuses is not rejected. Lawrence Cuvelier nevertheless stresses the need to defend both budgets and all doctors. “We must defend budgets and defend all doctors. We cannot defend things that ultimately cost everyone money”.
The GPs’ representative also believes part of the answer lies in better educating patients, particularly when it comes to requests for tests or medication. “There is patient education to be done, not only about medication. Every day, we have to fight by saying that the blood test will be of no use, this scan will be of no use. It is not easy”.
These new rules come against an already tense backdrop between the federal Health Minister, Franck Vandenbrouck, and doctors. Some could go on strike in the coming weeks.