Belgium has too many emergency departments, says KCE

Belgium has too many accident and emergency (A&E) departments, according to the Federal Expertise Centre for Health Care (KCE). Some of them should be closed, the centre suggested, and the budget and expertise spread over a smaller number of departments.

KCE carried out an enquiry into the functioning and financing of A&Es and spoke to representatives of medical staff, hospital administration and government. They also looked at how neighbouring countries organise their systems.

Belgium has an average of 1.24 A&Es for every 100,000 inhabitants, compared to 0.33 in the UK, 0.39 in Denmark and 0.54 in the Netherlands. Belgians also visit the A&E more often: an average of 290 consultations per 1,000 inhabitants in 2012, compared to 264 in the UK, 156 in Denmark and 124 in the Netherlands.

“Budget and staff for A&Es are inadequate in this country because they have to be shared among too many hospitals,” said Koen Van den Heede, co-author of the report. Almost every hospital in Belgium has its own A&E, which in cities means there is a concentration of emergency departments, often close to each other.

That proximity of A&E leads patients to make use of the departments for complaints that ought to be dealt with by a general practitioner (GP), which, the centre argued, would be faster and less expensive.

KCE also proposed that remaining A&Es should have a GP practice attached, which could be open 24 hours and handle the simpler cases. The report did not go into which departments, or how many, it thought should close.

Federal health minister Maggie De Block, herself a GP, agreed that something has to be done about the A&E situation. “Last Tuesday [22 March] showed that a well-organised, high performance emergency service has enormous value,” she said. “But that’s not an answer to overcapacity.”