Focus sur la planification de l'offre médicale en Belgique

Background: The planning of human medical resources has been in progress since 1996. The aim of this paper is to describe the process which occurred in Belgium and to point out its assets and limits. Methods: Literature review, analysis of the Belgian legislation at national and community (Flemish and French-speaking) level and analysis of the projection model. Results: In Belgium, planning is performed at two different levels of power. Firstly, the federal State determines the number of physicians who will access to the professional titles enabling them to obtain reimbursement of care by Health Funds. It is sustained by a supply projection type " stock and flows ", an assessment of the number of required physicians (including healthcare expenditures by age and sex) and the purpose of equalizing Dutchspeaking and French-speaking medical densities. Secondly, Communities, are responsible for training and, as such, are organizing the selection at this level: entrance examination in the North and various selection procedures (now repealed) in the South. Conclusion: Worldwide, the managers of medical planning are faced with decisions related to appropriate numbers for human resources, given population needs, use of services and professional productivity. They have to address concerns from medical surplus to shortage. The case study of Belgium provides insight of various parameters which should be taken into account for national planning of physicians. It also shows the difficulty to assess a complex future and the factors which often hinder the implementation of evidence-based decisions.