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Belgian doctors' freedom to be guaranteed

The Belgian association of doctors' syndicates has called the proposed law a "declaration of war on medical staff" and a "threat to the quality of care," and it is threatening to go to the European Court of Justice and to cancel the national agreement between doctors' associations and the sickness funds that sets fees for medical services.

The law gives the minister powers to force doctors to retire by cancelling recognition of professional qualifications after a certain time--for example, when the doctor is 65 or 67. Without this recognition doctors cannot work in the social security system in Belgium or any other state in the European Union. The minister will also have the power to set quality and quantity norms. These could include setting the time that doctors should spend with patients and the maximum list size. Doctors who disregard the norms and quality evaluation could have the recognition of their qualifications withdrawn.

The Belgian association of doctors' syndicates accepts that there are too many doctors in Belgium, where some general practitioners see fewer than five patients a day, and that the current total of 33000 could be reduced by between 4000 and 6000. But it denies that forced retirement will solve the problem, which it sees as an infringement of doctors' individual rights. The association fears that setting norms will endanger patients and deter new research and technology by obliging doctors to treat all patients the same. It also fears that the norms could be used to ration care, citing a recent proposal by the body administering sickness funds not to refund the cost of implanting heart defibrillators in people aged over 65 years.

Mr Colla denies interfering with clinical freedom and has said that he will consult with the medical profession. Although he has agreed that the law cannot be put into practice without the agreement of all parties, he said that a final decision had to be taken at a political level.--TONY SHELDON, freelance journalist, Utrecht

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