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Hospital supplements in Belgium: Price variation and regulation


  • Lecluyse, Ann
  • Van de Voorde, Carine
  • De Graeve, Diana
  • Schokkaert, Erik
  • Van Ourti, Tom


Objectives Although there is a comprehensive public health insurance system in Belgium, out-of-pocket expenditures can be very high, mainly for inpatients. While a large part of the official price is reimbursed, patients are confronted with increased extra billing (supplements). Therefore, the government imposed various restrictions on the amount of supplements to be charged, related to the type of room and the patient's insurance status. We investigate how prices are set and whether the restrictions have been effective.Methods We use an administrative dataset of the Belgian sickness funds for the year 2003 with billing data per hospitalisation and hospital characteristics. Boxplots describe the distribution of several categories of supplements. OLS is used to explore the relationship between hospital characteristics and extra billing.Results There is a large and intransparent variation in extra billing practices among different hospitals. Given the room type, supplements per day are smaller for patients qualifying for protection, confirming that the regulation is applied quite well. However, because of their longer length of stay this does not result in lower supplements per stay for these patients.Conclusions Currently the price setting behavior of providers lacks transparency. Protective regulation could be refined by taking into account the longer length of stay of vulnerable groups.

Suggested Citation

  • Lecluyse, Ann & Van de Voorde, Carine & De Graeve, Diana & Schokkaert, Erik & Van Ourti, Tom, 2009. "Hospital supplements in Belgium: Price variation and regulation," Health Policy, Elsevier, vol. 92(2-3), pages 276-287, October.
  • Handle: RePEc:eee:hepoli:v:92:y:2009:i:2-3:p:276-287

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    References listed on IDEAS

    1. Herbert C. Northcott, 1982. "Extra-Billing and Physician Remuneration: A Paradox," Canadian Public Policy, University of Toronto Press, vol. 8(2), pages 200-206, Spring.
    2. McKnight, Robin, 2007. "Medicare balance billing restrictions: Impacts on physicians and beneficiaries," Journal of Health Economics, Elsevier, vol. 26(2), pages 326-341, March.
    3. Mitchell, Janet B. & Cromwell, Jerry, 1982. "Physician behavior under the medicare assignment option," Journal of Health Economics, Elsevier, vol. 1(3), pages 245-264, December.
    4. Epp, Michael J. & Vining, Aidan R. & Collins-Dodd, Colleen & Love, Ernie, 2000. "The impact of direct and extra billing for medical services: evidence from a natural experiment in British Columbia," Social Science & Medicine, Elsevier, vol. 51(5), pages 691-702, September.
    5. Pauly, Mark V., 2000. "Insurance reimbursement," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 10, pages 537-560 Elsevier.
    6. van de Glind, Irene & de Roode, Stanny & Goossensen, Anne, 2007. "Do patients in hospitals benefit from single rooms? A literature review," Health Policy, Elsevier, vol. 84(2-3), pages 153-161, December.
    7. Glazer, Jacob & Glazer, Jacob & McGuire, Thomas G., 1993. "Should physicians be permitted to 'balance bill' patients?," Journal of Health Economics, Elsevier, vol. 12(3), pages 239-258, October.
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