[Belgian medical houses: a post-68 accident or an enduring mode of organization?]. / Les maisons médicales belges, un accident de parcours post-soixante-huitard ou un mode d'organisation inoxydable ?

The names of health houses vary from one country to another and according to the specific organizational history of healthcare provision. Yet their current mode of organization and the type of services which they make available to the public largely tend to converge. One of their shared objectives is for health houses to constitute "a first line" of health and healthcare provision, amidst a general crisis of general medical practice but also among paramedical workers. Past and current experience in Belgium indicates that it is possible to ?make users happy' and to facilitate access to quality healthcare services for the most underprivileged sectors of the population. Recent studies argue that certain group practices may prove to be efficient, especially in terms of medical prescriptions. Defining the most appropriate mode of remuneration is a central issue, and while capitation is not altogether flawless, it appears to have enabled the adoption of a wide range of "virtuous" practices resulting in a harmonious whole that ensures high standards of healthcare provision. Belgian medical houses also reflect the preferences of young healthcare professionals. In Belgium, 20% of GPs under the age of thirty currently work in these organizations. If different causes are liable to have the same effects, it is because the GP profession is in crisis and is undergoing profound and significant changes, but also because multidisciplinary houses are the least unsatisfactory solution for overcoming current difficulties.

[Towards Unity for Health" criteria applied to medical centers in Belgium]. / Les critères du concept "Vers l'Unité pour la santé" appliqués en Belgique aux Maisons médicales.

OBJECTIVE: To describe the Belgian medical centers' experience against TUFH criteria. To identify convergences, strengths and weaknesses, and suggest explanations. To present current dynamics in medical centers. METHOD: Literature review on legislation, history, mode of operations and evaluations. OUTCOMES: The convergence of the Belgian medical centers' experience with TUFH criteria is striking, particularly regarding the use of a reference population and territory and the use of health information. Capitation fee encourages health personnel to change attitudes. The Belgian federation of medical centers should play a greater role in the education of health personnel. Partnership is widely practised. Impact measurements are favourable but should be generalized. CONCLUSION: The convergence between the TUFH approach and the one used by the Belgian medical centers, particularly in their integrated health centers has been demonstrated by use of TUFH criteria. While still a small fraction in the spectrum of health services in Belgium, though in steady progress, it is believed that integrated health centers should remain places for experiment on health care to help the entire system to reform.