INTERNATiONAL DIGEST OF HEALTH LEGISLATION, 1999,50 (3)
III. HEALTH CARE FACILITIES AND SERVICES
BELGIUM. Crown Order of 15 February 1999 on the qualitative evaluation of medical activity in hospitals. (Moniteur beIge, 25 March 1999, pp. 9552-9554) Beig. 99.10
This Order has been made in pursuance of the law on hospitals, as consolidated on 7 August 1987 and as amended. The following are among the principal provisions.
Chapter I. General provisions (Sec. 1) Sec. 1 reads as follows:
1. With a view to improving the quality of medical services, the care programmes referred to in Section 9 ter of the Law on hospitals, as consolidated on 7 August 1987, the services, and also the following medico-technical services and functions shall carry out an internal and external evaluation of medical activity:
1. the radiotherapy service;
2. the chronic renal insufficiency treatment centre;
3. the medical imaging service in which a magnetic resonance tomograph with integrated electronic
calculator is installed;
4. the specialized emergency care function;
5. the intensive care function.
Chapter II. Internal evaluation of the quality of medical activity (Secs. 2-4)
The provisionS of this Chapter read as follows:
2. For each of the care programmes medico-technical services, services, and functions referred to in Section 1, the chief physician of the hospital concerned shall draw up a report on the quality of medical activity.
3. (1) The reports referred to in Section 2 shall be drawn up on the basis of internal recording, in accordance with the recording model provided for in point 2 of Section 8. They shall be drawn up in the six months following the year in which recording took place.
(2) The recorded data, referred to in subsection 1, shall be the subject of an internal evaluation, on the basis of the indicators described in point 1 of Section 8 concerning the evaluation of medical activity in hospitals; this evaluation shall be carried out, on the initiative of the chief physician, by physicians who carry out activities in the care programme, service, medico-technical service, or function concerned.
4. The reports referred to in Section 2 shall be transmitted by the hospital to the college of physicians concerned, referred to in Section 5.
Chapter III. External evaluation of the quality of medical activity (Secs. 5-12)
Division 1. College of Physicians (Secs. .5-8)
Subdivision 1. Establishment (Sec. 5). Sec. 5 reads as follows:
5. Within the Ministry of Social Affairs, Public Health, and the Environment, a College of Physicians is hereby established for each medico-technical service, service, function, and care programme referred to in Section 1.
Subdivision 2. Composition and
appointment (Secs. 6-7). Subsection 2 of Sec. 6 reads as follows:
(2) Each college shall consist of physicians whose competence in the field is widely recognized by those who actually carry out the medical activity concerned. Terms of office shall be divided between physicians who carry out their medical activity in a university hospital and those who carry out their medical activity in a non-university hospital, according to the respective participation of university hospitals and non-university hospitals in the practice of the activity concerned, on the understanding that each of these two groups shall have a right of representation of a minimum of 25%.
Subdivision 3. Tasks (Sec. 8). Sec. 8 reads as follows:
8. The colleges of physicians shall be required to undertake, either at the request of the Minister
responsible for Public Health or the Minister responsible for Social Affairs, or on their own initiative:
1. the formulation, on a consensual basis, of quality indicators and evaluation criteria relating to appropriate medical practice within the care programme, the medico-technical service, the service, or the function; these criteria shall concern, inter alia, infrastructure, personnel, medical practice for the medico-technical service, service, function, care programme, or specialty as a whole, and also the results thereof;
2. the implementation of a computerized recording model and a standard report, taking into account the guidelines drawn up by the working group referred to in Section 9; 3. where necessary, carry out inspections as well as controls of the data recorded;
4. the preparation of a national annual report containing relevant data with regard to the medico-technical service, the service, the function, or care programme concerned; these reports shall be transmitted to the working group referred to in Section 9;
5. the preparation of replies to questions from a service or practitioner, concerning the evaluation process;
6. the drafting of a reporting on resource utilization; the report in question shall constitute a separate chapter of the national report referred to in point 4; and
7. the communication to hospitals and physicians of the medico-technical service, the service, the function, or the care programme concerned, of feedback from the data with regard to quality indicators, evaluation criteria, and resource utilization.
With respect to the task referred to in point 7, colleges shall receive support from the Ministry of Social
Affairs, Public Health, and the Environment.
Division 2. Structure for consultation between hospital management, physicians, and insurance agencies (Secs. 9-12). Sec. 9 reads as follows:
9. Within the structure for consultation between hospital management, physicians, and insurance agencies, referred to in Section 153 of the Law of 29 April 1996 promulgating social provisions [see IDHL, 1996, 47, 443, Beig. 96.10], a specific working group shall be set up and shall serve as the body responsible for overseeing the colleges of physicians referred to in Section 5.
Sec. 10 indicates the composition of the working group referred to in Sec. 9. Sec. 11 reads as follows:
11. The consultation structure or, where appropriate, the specific working group established by it,
shall be responsible, at the request of the Minister responsible for Public Health or the Minister
responsible for Social Affairs, or on its own initiative, for:
1. drawing up uniform guidelines addressed to the various colleges of physicians. These guidelines shall concern the working procedures and tasks of these colleges;
2. formulating, on the basis of annual reports that preserve the anonymity of hospitals and colleges of physicians, the conclusions that must be drawn concerning Federal policy with respect to programming, approval, and financing. These conclusions shall be communicated to the Federal public health authorities as well as to the health insurance bodies, each within its field of competence; and
3. transmitting annual reports, drawn up by the colleges of physicians, to the various bodies of the Ministry of Social Affairs, Public Health, and the Environment and the health insurance bodies, as well as to the competent Federal Ministries in the field of health care policy.
These reports shall also be transmitted to the chief physicians and the heads of the services, medico-technical services, functions, or care programmes concerned.
Sec. 12 charges the Minister of Public Health and Social Bencfits and the Minister of Social Affairs, in thei: respective fields, with the implementation of this Order.