1. Medical Manpower in Belgium Numerus clausus Alain De Wever

2. Medicine

3. A. Medical planning agents in Belgium

4. Belgium Federal State RegionsCommunities FlemishFrenchDutch speaking

5. 1° Federal level Establish the number of doctors who have access to the practice in the health insurance system 1996 : Creation of the « Commission de planification » (Planning Commission)

6. 2° Communities’ level Flemish Community  Entrance exam (Decree of July 24, 1996)

7. 2° Communities’ level French community  End Bachelor examination – Third year (Decree of July 17, 1997)  End Master examination for the specialization – seventh year (Decree of July 27, 2003)  Examination at the end of the first year and at the entrance in the specialization training (Decree of July 1st, 2005)

8. 3° Difference between communities Flemish Community French Community Entrance exam Examination Number of students < quotasNumber of students = quotas

9. At the end of the first year, classification of the best students per university At the end of the seventh year, inter-universities commission  GP (43 %)  Specialists (57 %) Quotas per specialization The examinations in the French Community

10. The exam consists of 2 parts : Exam assessing the scientific knowledge (physics, chemistry, biology, mathematics) Comprehension tests (assessment of the ability to acquire & assimilate information through comprehension & restitution tests) Entrance exam in the Flemish Community

11. B. Too much doctors in Belgium ?

12. Medical density Medical acts / inhabitant Time Number Plethora 1° Past trend Fig.1 Sources : D. Deliège (SESA – UCL)

13. 2° Current trend Ageing medical population and increase of the retirement Increase of the feminization of the medical population Increase of the healthcare consumption Diversification of the medical profession (pharma industry, civil agent, professor, etc.)

14. 2.1. a Ageing medical population Ageing medical population : 55-74 / 20-54 Source : UCL – Sesa – Deliège D.

15. 2.1. b Retirements’ boom French and Dutch speaking communities Source : UCL – Sesa – Deliège D.

16. 2.2. Feminization of the profession Women doctors’ rate Source : UCL – Sesa – Deliège D.

17. 2.3. Consumption increase Due to the ageing (22 %) Due to others agents including the wealth (66 %) Source : UCL – Sesa – Deliège D.

18. Time Medical acts / inhabitant Medical density Number Plethora Shortage 3° Coming trend Sources : D. Deliège (SESA – UCL)

19. Demographic bump Feminization Working hours’ decrease (48 hours/ week – European Directive – Colla law)  Possible shortage

20. Physiotherapists

21. Restriction by the federal level of the number of physiotherapists who can work in the health insurance reimbursement system No restriction at communities’ level (training)

22. However, the French Community limits the access for the students who do not live in Belgium (30 %)  economical reasons (by lottery)

23. Examination organized by the Federal State :  Attitude test for the self-employed practice  Ability test for the self-employed practice  Knowledge test : Laws about physiotherapists’ rights and duties About the health insurance