Patient classification and cost analysis of AIDS and HIV: the case of Belgium.

The study calculates inpatient costs generated at the University Hospital in Antwerp (Belgium) and outpatient costs generated at the Institute of Tropical Medicine or at the University Hospital of 213 seropositive patients without AIDS and of 48 AIDS patients, for the year 1991. Outpatient drug use other than Zidovudine was excluded. An HIV + patient has an average annual total billing cost of 2062 ECU, 43% of which is spent in hospital, 29% on Zidovudine and 28% for follow-up at the Institute of Tropical Medicine. The average cost of care for an AIDS patient is 5.5 times higher and amounts to 11,277 ECU--hospitalisation costs (8349 ECU) and costs of Zidovudine (2031 ECU) are much higher. Costs vary with the severity of illness. In comparison to 1987, costs decreased due to lower drug prices and reduced hospitalisations. Life time costs of a seropositive patient are estimated at about 35,000 ECU, based on cost calculations per CD4-class for a follow-up period from 1991 to 1993.

Pharmacoeconomic studies. Pitfalls and problems.

The literature on economic evaluation of pharmaceuticals is growing rapidly. Although there have been substantial methodologic advances, there remain serious problems and pitfalls. This presentation focuses on three aspects, i.e., use (and abuse) of evaluation studies, methodologic problems, and the quality of published studies.

The role of the sickness funds in the Belgian health care market.

This article reviews some of the salient features of the Belgian health care finance and delivery system. Special attention is paid to the role played by the third-party payers, i.e. the Health Insurance Associations (HIAs) in administering the compulsory national health insurance program. It is shown how, despite extensive government regulation, the markets for GP, specialist and hospital services exhibit fierce competition of the non-price variety. Next, the paper considers the three problems perceived to be the most pressing ones at present: (i) the problem of raising sufficient revenues to cover the public share of health expenditures; (ii) the (related) cost containment problem; and (iii) the problem of ensuring efficiency through appropriate incentive mechanisms. Finally, two recently proposed options for reform are discussed and complemented with a third proposal based on the ideas of regulated competition. It is concluded that strengthening the role of the third-party payers remains crucial in any attempt to reshape the system to make it efficient and affordable while keeping it equitable.