What are primary care centres?Primary care centres (maisons médicales in French, also known as integrated health centres) are places where various professionals work (general practitioners, physiotherapists, nurses, social workers, caregivers, mental health professionals, etc.).
Once a patient is registered with a primary care centre, this primary care centre handles all their care. In order to cover the cost of care, they create a payment agreement with insurance companies.
Most primary care centres work for a ‘flat rate’: the patient does not pay anything for the care that is covered by what the insurance companies pay, but they are obliged to call upon the services provided by this primary care centre (with a few exceptions). If they consult other healthcare providers for care which is included in the primary care centre’s flat rate, their insurance company will not reimburse them for this care.
What is a fee-for-service consultation?In Belgium, there are two coexisting financing systems for frontline healthcare: the payment for the service (or the fee-for-service) and the flat-rate payment. When paying for services, the doctor is paid for the service provided (for example, per home visit, consultation, stitching wounds…). This system implies that the doctor is paid for each service they provide.
The payment can be made directly and in full to the doctor during the consultation. The healthcare provider gives the patient a medical statement which can then be reimbursed by the insurance company according to the standard rate (there may be a copayment that they need to pay themselves). Or the healthcare provider returns the medical statement to the patient’s insurance company who pays them directly for the part that is reimbursed for the service provided; the patient only pays the healthcare provider the copayment or a part of it, or nothing at all. It is the third-party payer system: in order for it to be applicable, the patient needs to be in one of the situations stipulated by the Royal Decree from the 10th of March 1987 determining the exceptions to the general prohibition of practising third-party payments in ambulatory work and clarified in the INAMI circular, ’O.A. n°87/150’.
N.B.: For general practitioners, whether they are authorised or not, licensed or not, can have an impact on the amount of fee-for-service financing.
What is a flat-rate consultation?Primary care centres often have a flat-rate payment system which is a system put into place across primary care centres, INAMI and insurance companies, that exonerates those who subscribe to copayments.
A contract is signed by the various organisations and the individual. In practice, the insurer pays a flat rate on a monthly basis for the individual who is subscribed, whether they come for a consultation or not. This flat rate covers consultations and home visits by general practitioners, nurses and physiotherapists, as well as the access to all preventative activities and all activities promoting health.