HOSPITAL FACILITIES - BELGIUM

INTRODUCTION

                      Belgium is a country in Europe’s northwest. It is one of Europe’s smallest and

most densely populated nations. Belgium’s healthcare is split into two sectors: public and
private, both of which charge fees. In Belgium, both the federal and regional governments are
responsible for healthcare. In Belgium, the federal minister is in charge of most aspects of
healthcare. Belgium spent 10.6% of its GDP on health care in 2011, according to the report of
the World Health Organization. Belgium's citizens benefit from a good health system as a result
of high-quality medical services. The medical laws in Germany, as well as the norms and
regulations for 1preserving hygiene and cleanliness in hospitals, will be discussed in this research
paper.

HISTORICAL BACKGROUND
                      The main elements of the Belgian healthcare system emerged after WWII when
the government-mandated public health insurance based on independent medical practice. As a
result, Belgium’s compulsory health insurance system was established in 1945. The national
institute for Sickness and invalidity insurance was established as a result of Leburton’s Law. The
following was introduced by Leburton’s Law are 
1.  Improved access to insurance coverage of all habitants of Belgium,
2. Agreement between the mutualities and the health care providers on the regulation of
their financial and administrative relationship
3. The fees scheduled by many medical acts give a price and reimbursement rate.

               Rapidly rising expenses (especially in the hospital sector) in the 1980s prompted the
government to implement a series of reforms in the early 1990s aimed at controlling costs while
preserving the system's core structure. The revisions were primarily aimed at reducing waste and
preventing exploitation; they also introduced a variety of exclusions to the fee-for-service

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https://www.expatica.com/be/healthcare/hethcare-basics/the-belgian-healthcare-system-100097/
  https://www.healthybelgium.be/en/hit

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financing regulation, as well as an increase in the maximum amount that can be borrowed. For a
variety of services, the patient is responsible for co-payments. The most contentious aspect they
did, however, set a strict ceiling of 1.5 percent for yearly maximum increase. in the costs of the
healthcare system This limit is still in place today.

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DIVISIONS OF POWERS IN HEALTHCARE IN BELGIUM

 Sub National Level

                 The health care providers ensure the population is regulated at the subnational level,
which includes both regional and community levels.

Regional
                          In the sphere of public health, there is no actual regional expertise. Regions, on
the other hand, have expertise in policy areas that are relevant to them an example- The
environment, control of the business.

Communities
                        The authorities of the communities are in charge of Formulating and enforcing
national laws Policy development and execution in the field of public health care; Managing
hospitals and delivering public health care (including to individuals with impairments); Except
for federal competencies, the policy toward invalids and the aged;
Disease prevention and public health education.

Local

                   The following tasks fall under the purview of local governments they are Health
education and preventative medicine are the responsibility of communes, according to the

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 Belgium- WHO https://www.who.int//health-laws/countries/bel-en.pdf

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general idea of local self-administration. The administrative control of public hospitals, as well
as public welfare services such as psychiatric aid and medical corps.

National Level

Federal
                 Bypassing legislation and setting the annual budget, the federal government
establishes the overall legislative framework for the healthcare system. Their responsibilities
include enacting health-and-disability-insurance legislation as health-and-disability-insurance
legislation. Insurance is still an element of the social security system, but it is now supervised.
remained the federal government's obligation.

MINISTRY OF SOCIAL AFFAIRS, PUBLIC HEALTH, AND THE

ENVIRONMENT

                    By merging existing departments within the Justice and Home Ministries on June
13, 1936, a Ministry of Public Health was established. Many aspects of health care were
transferred to localities as part of reform in 1980, and the national Ministry of Public Health and
the Ministry of Environment were amalgamated. In 1995, the Ministry for Social Affairs, Public
Health, and Environment merged with the Ministry of Social Provision to establish the Ministry
for Social Affairs, Public Health, and Environment.

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EU-CHARTER OF FUNDAMENTAL RIGHTS
   
 Article 35 - Health Care

                    This article states that according to the conditions laid down by national laws and
practices, everyone has the right to access preventive health care and the basic right to get
benefits from medical treatment. 

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upheld-by-the-court-of-justice-on-subsidiarity-and-proportionality-in-eu-lifestyle-risks-policy/
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Case Law

Swedish MatchAB V Secretary of State for Health Case C-151/17, ECLI:EU:

C:2018:241

Background and Facts 

                   Articles 1(c) and 17 of the Directive, which bans the placement of tobacco for oral
use on the European market, are the subject of the current lawsuit. Snus is a tobacco-based
product that consists of a tiny sachet put between the gums and lips for ingestion. It is commonly
used in Sweden, which is the only EU country where it is still permitted due to a concession
granted upon the country's entry into the Union. Since 1989, the EU-wide ban has been in force
and has been confirmed every year. In a challenge to the national transposition measure before a
British court, Swedish Match, one of the largest manufacturers of tobacco for oral use, argued
that the restriction of snus was unconstitutional under EU law. The New Nicotine Alliance, a
charity whose goal is to promote public health through tobacco harm reduction, has joined it in
these actions. Swedish Match has already challenged the constitutionality of this prohibition
under the prior Directive of 2001, claiming a lack of EU competence, which the Court dismissed.
Now that this issue has been resolved, the current problem centers on the exercise of
competence. Before proceeding with the case at hand, it's important to remember the EU's
competence framework for enacting public health measures, as well as the issues raised by the
first Swedish Match decision.  Because the Union lacks a stand-alone competence in public
health that would allow it to take harmonization measures, lifestyle legislation has been
implemented using Article 114 TFEU's internal market legal basis. This clause gives the EU
legislator the authority to take actions "to establish and operate the internal market." While the
Court has frequently emphasized the importance of integrating public health objectives within
internal market legislation, as required by the mainstreaming obligation included in different EU
law provisions, The Court decided in the first Swedish Match case that the EU's power under
Article 114 TFEU included the ability to impose a permanent ban on a product while retaining as
a general formula the principle that internal market measures must be designed to remove
barriers to trade between the Member States.   It's difficult to see how eliminating a product from
the EU-wide market can be deemed lowering trade barriers or even facilitating the smooth

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operation of the internal market, given that the very object of the trade is ipso facto eliminated. If
a product's prohibition does not improve trade circumstances for 4t5hat product, it does,
according to Advocate General Geel hoed, lessen the costs of enforcing laws on similar items,
thus improving their trading conditions. This justification still doesn't seem to hold water. The
prohibition of a product category is strictly a public-health policy over which the EU has no
jurisdiction. This issue pervades the current judgment, as will be demonstrated later. The parties'
arguments are based on several grounds, which translate into six preliminary ruling questions:
violation of the non-discrimination, subsidiarity, and proportionality principles, violation of
Article 296 TFEU, Articles 34 and 35 TFEU, and violation of Articles 1, 7, and 3 of the Charter
of Fundamental Rights. The Court finds no such breach, hence the focus of this analysis will be
on subsidiarity and proportionality. 

Judgment
                The referring court's first question concerns the alleged violation of the principle of
equal treatment by Articles 1(c) and 17 of the Directive. Swedish Match believes that the
restriction of tobacco for oral use is discriminatory because other tobacco products, including
smokeless tobacco, smoking goods, electronic cigarettes, and new tobacco products, are not
forbidden. The Court rejects the claim, citing objective differences between tobacco for oral use
and all other categories that could justify a treatment disparity. On the issue of proportionality,
Swedish Match contends that prohibiting tobacco for oral use is neither essential nor appropriate
for achieving any legitimate goal and that the precautionary principle cannot be used because
other tobacco products with higher toxicity are permitted. The Court begins by reiterating the
principles that govern the proportionality of EU acts – appropriateness, necessity, and respect for
the precautionary principle – before limiting its control to the presence of a manifest error,
particularly in areas requiring highly complex scientific and technical assessments. In this
context, the proportionality of the tobacco restriction for oral use must be assessed against the
Directive's dual goal of supporting the smooth running of the internal market while maintaining a
high degree of human health protection as a foundation. The Court considers the many pieces of

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https://www.cambridge.org/core/journals/european-journal-of-risk-regulation/article/ban-on-tobacco-for-oral-use-
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scientific data presented about the public health objective. 26th citation While it is clear that
tobacco for oral use is less dangerous than tobacco for smoking, it is unclear to what extent the
former could be utilized to help smokers quit. Lifting the ban would endanger those who began
using snus, particularly young people, while the benefits to current smokers would be unclear. In
this ambiguous circumstance, the Court finds that the legislator's choice was consistent with the
precautionary principle and could not be judged incompatible to preserve a high degree of public
health. The Court also finds the decision to outlaw snus as not exceeding what is essential, given
the market's potential for growth and the danger of snus, particularly for minors. It goes on to say
that the protection of one's health takes precedence above economic factors such as the snus
market's potential for expansion. In terms of the market goal, the Court deems the prohibition to
be appropriate and necessary, as lifting it would almost certainly result in a divergence in
national legislation. Finally, citing its prior decisions on the principle of equal treatment, the
Court dismisses Swedish Match's argument based on an apparent lack of consistency in the
absence of other tobacco products being forbidden. In terms of subsidiarity, Swedish Match
believes that the restriction violated this principle since it fails to take into account the unique
conditions of each Member State, in contrast to the situation for other tobacco products, where
the Member States have some choice. The Court dismisses the argument, stating that, even if the
Directive's health goal could be implemented more effectively at the national level, this would, in
any case, be incompatible with the Directive's internal market goal. The Court goes on to say that
the legislator's decision to give the Member States more leeway on other tobacco products was a
discretionary decision to harmonize tobacco in phases and that this does not show that the
Directive's goals could be met adequately by the Member States. Regarding a violation of Article
296's second paragraph, which states that "[l] legal acts shall specify the reasons on which they
are founded The Court believes that recital 32 of the Directive is sufficiently clear to allow courts
to exercise their review powers. Likewise, the Court finds no violation of Articles 34 and 35
TFEU, because the prohibition of snus is a legitimate, non-discriminatory, and reasonable
limitation on the free circulation of products. The New Nicotine Alliance's last question is based
on an alleged violation of Articles 1, 7, and 35 of the Charter by denying consumers who want to
avoid smoking a less hazardous option. Even if the substitution effect is proven and the
prohibition of snus is later found to be limiting fundamental rights, the Court believes that the
prohibition is intended to protect the right to health because it does not deprive consumers who

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want to quit smoking of all means to do so and is proportionate. As a result, there is no violation
of the Charter's articles. This decision exemplifies the perplexing position of tobacco regulation
in the current EU legal framework: it goes beyond the EU's competencies, which do not include
pure public health measures, but it also fails to adequately integrate human health concerns into
those measures, for example at the subsidiarity level. The mainstreaming responsibility cannot be
used to justify violating the Union's action limitations, but it does mean that health issues must
be appropriately integrated into internal market law once the prerequisite for such action is met.
In this case, the Court carries a share of the blame. It should not hesitate to repeal legal
provisions that do not contribute to the functioning of the internal market as long as the EU lacks
proper healthcare powers, and it should also require the EU legislator to better justify its
decisions when it appears that the national level can better protect European citizens' health or
that a given measure may not lead to a sufficiently high level of health protection. Of course,
there is a more fundamental issue with the Treaties' incoherent and deceptive constitutional
framework, which fails to properly demarcate the EU's and Member States' respective
competencies and does not entrust the Union with the powers necessary to conduct a fully-
fledged public health policy.

 
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REGULATIONS OF HEALTHCARE IN BELGIUM

                         The Belgian healthcare system is heavily regulated, not only by the federal and
provincial governments but also by the healthcare providers and mutualities themselves. The
federal government has enormous influence over the healthcare system's financing and
economics. They set the insurance premiums for businesses and employees, as well as the
amount of government assistance. They can get a vital role in the planning and funding of
hospital capital investments, as well as actively participate in hospital budgeting. They have a
veto over the process of establishing charge levels. Pharmaceutical prices are set by the Ministry
of Economic Affairs. Hospital accreditation (without which hospitals cannot be founded,
managed, or reimbursed) and doctor accreditation are likewise set by the federal government
(without which they cannot practice). Patients, third-party payers, and healthcare providers enjoy

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a great deal of flexibility under the federal regulatory framework. Patients have the option of
choosing their healthcare provider and insurer. The financial and administrative relationship
between health care providers and insurers (e.g. hospitals and mutualities) is regulated by a
system of agreements and contracts. These texts are drafted by committees made up of an equal
number of people from the healthcare 7industry and the insurance industry (who, in these
negotiations, see themselves as representing the patients). Each health profession and hospital
sector has a committee that meets regularly to discuss mutual interests. The primary goal of these
committees is to set charge amounts. The agreed fees are used to determine how much health
care is reimbursed and how much coinsurance is required. Mutuality and health-care provider
agreements only take effect if a specific percentage of healthcare providers support them. They
promise to adhere to the agreed-upon charge levels in exchange for their assistance. If no
agreement is reached promptly, or if it is rejected by a large number of practitioners, the Minister
has various options:

 To provide practitioners with an alternate draught agreement

 Charge prices for any or all of the services unilaterally

 To fix solely the reimbursement levels, leaving the fees up to the practitioners.

In this area, laws enacted in 19906 enhanced state intervention in the formation of contracts and
agreements. If budgetary restrictions for each healthcare sector are surpassed, this law establishes
remedial measures (mostly charge reductions). If the committees cannot agree on how to apply
the correct procedures, the Minister of Social Affairs has the authority to enforce them.

BELGIUM CONSTITUTION

The right to health care is guaranteed under the Constitution. The Belgian
Constitution recognizes the right to social security, health protection, and medical assistance in
Article 23(2). Several laws and decrees have added to this basic right.
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ARTICLE 23 – BELGIUM CONSTITUTION

Everyone has the right to lead a life in keeping with human dignity. These rights
include:
1. The right to employment and the free choice of occupation within the context of a
general employment policy, aimed among others at ensuring a level of employment that
is as stable and high as possible, the right to fair terms of employment and fair
remuneration, as well as the right to information, consultation, and collective
negotiation;
2. The right to social security, to health care, and social, medical, and legal aid;
3. The right to decent accommodation;
4. The right to the protection of a healthy environment;
5. The right to cultural and social fulfillment.

However, the Belgium constitution under Article 23(2) states that an individual citizen of
Belgium has the right to social security, health care, and social, medical, and legal aid to
all.

PROVISION OF SERVICES IN BELGIUM HOSPITALS

INPATIENT CARE

HOSPITALS
A hospital is defined by the Hospital Act as a health-care facility that provides
specialized exams and/or treatment in the fields of medicine, surgery, and, in some situations,
obstetrics. These examinations and/or treatments may be performed or applied at any time in a
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multidisciplinary setting, with the necessary and appropriate conditions of care and medical,
medico technical, allied medical, and logistical framework about the patients being admitted and
staying because their condition necessitates such care to treat or alleviate disease, restore or
improve their state of health, or stabilize lesions as quickly as possible.
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There are currently programs in place for reproductive medicine, cardiac pathology, oncology,
pediatrics, and geriatrics. The term "medical oncologist" was first used in the field of oncology.
making oncology a specialized field A care program is also available. As a specialist initiative
with the National Institutes of Health, a program for breast cancer was designed to develop
curative methods to Breast cancer is a disease that affects women. The children's care program
was designed with two goals in mind: to reduce the number of children in care and to increase
the number of children in care the amount of low-occupancy pediatric services to the benefit of
creating pediatric services with a greater occupancy rate, and pediatric services with a higher
occupancy rate services that provide a full range of therapeutic options, from consultation
through therapy. The same concept was used to create a geriatric patient care program. This
program includes polyclinic treatment, day hospitalization, classic hospitalization, internal and
external liaisons, and other treatment modes in the form of distinct modules. A transmural
approach in the form of care pathways should be ensured through the liaison function. In
addition, geriatrics

MEDICAL COUNCIL AT HOSPITALS - REGULATIONS

A medical council must be constituted in every hospital, according to the Hospital Act.
The hospital physicians participate in the hospital's decision-making process through this
council. The medical council provides advice to the hospital manager on five topics: general
regulations, medical activities, relationships with other hospital personnel, financial resources,
and medical techniques. This recommendation requires the management to engage an
intermediary in the event of a conflict between this opinion and the medical council's counsel in
well-defined areas. Every hospital is required by the Hospital Act to establish a so-called general
regulation. Every hospital physician's and hospital manager's rights and obligations, as well as

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his or her working circumstances, must be written down, either in an agreement between the two
parties or in a unilateral act of appointment.

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DAYCARE

Daycare is described as a planned hospitalization of a patient for a surgical procedure or a

series of diagnostic or therapeutic procedures that would normally take many days but may be
completed efficiently and securely in one day. Daycare is provided in a dedicated hospital unit
that is part of an acute hospital with a specially designed medical-technical setting. Daycare is
now available for cancer, pediatric, and geriatric activities, as well as other nonsurgical therapies.
Daycare enrollment has risen dramatically in the recent decade, from 25.4 percent in 1995 to
43.1 percent in 2004.

LABORATORY

A clinical laboratory is required in every hospital, and additional laboratory facilities can
be found outside the hospital framework. In 2005, Belgium had 267 laboratories (53 percent in
Flanders, 34 percent in Wallonia, and 13 percent in Brussels), with 59.6 percent of them being
located within a hospital. The law specifies essential organizational and technological aspects,
such as management, laboratory testing specialists, pre-analytic and analytic methods, assistant
personnel, and quality control. For approval, hospital laboratories must apply to the Minister of
Public Health. Outside of the hospital system, independent laboratories apply to the proper
community.

EMERGENCY CARE

The Emergency Medical Assistance Act defines emergency care as the immediate
provision of adapted aid to all persons who require emergency treatment for medical conditions
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resulting from an accident, a sudden disorder, or a sudden complication of an illness, using a
uniform call scheme that ensures assistance, transport, and care in adapted hospital service.

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The Federal Public Service (FPS) Public Health is responsible for recognized ambulance
services. In 2006, the government (particularly fire departments) arranged 61 services, the Red
Cross organized 19 services, 40 hospital services, and 31 private services. Communities are
responsible for non-emergency medical transportation. Each patient must be taken to an acute
care hospital's emergency department. The standards that an emergency care department must
meet are specified by the federal government. The accreditation of these departments is the
responsibility of the communities. Acute care hospitals without an emergency department must
have the ability to provide immediate relief in an emergency.

PHARMACEUTICAL CARE

Community pharmacies  and hospital pharmacies are the only places where you
can get pharmaceuticals. Belgium has 5269 community pharmacies in 2006. Since 1973, new
pharmacy openings have been strictly restricted, limiting the number of pharmacies that can start
in new locations. A ban was implemented in 1994, limiting the number of pharmacies to the
current number. The number of pharmacies per 10,000 people has increased steadily since 1988.
The limited number of pharmacies means that, while pharmacists can theoretically go into
practice after completing a five-year university course, they are frequently employed in existing
practices for a variety of reasons. Low pay or having to pay outrageous fees to purchase their
pharmacy. In recent years, a variety of steps have been implemented to reduce pharmaceutical
spending, the most important of which are described below. To update pharmaceutical policy,
the following reforms were implemented in 2000 (Vandenbroucke 2000):

 Streamlining the procedures and structures for new product approval medications, as well
as employing scientific studies to evaluate items, are already in place.

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  Ensuring the availability of new pharmacy therapeutics in Marketplace

 Promoting the use of pharmaceuticals based on scientific evidence and medical

guidelines
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Paying special attention to the price-to-quality ratios of the various options and the

 The role of pharmaceuticals in the total medical treatment provided establishing

attainable fiscal goals based on objective policy options and When the budget is tight,
recovery procedures are introduced surpassed assuring the patient's affordability.

MENTAL HEALTHCARE

The mental health care industry is made up of specialized facilities where

psychiatrists and psychologists collaborate with other care providers like nurses and social
workers to help persons with mental illnesses. The following are the five most important mental
health provisions:

1) Psychiatric facilities
2) General hospitals' psychiatric sections
3) Nursing facilities for psychiatric patients
4) Activities in support of sheltered housing
5) Mental health treatment facilities

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