GP housecalls becoming less popular in Belgium

While the practice was once culturally well-established in Belgium, doctors are no longer paying as many housecalls.

Belgium used to be one of the countries in which home visits by general practitioners were the most widespread, reports Le Soir, with housecalls accounting for 21% of patient-doctor contacts in Belgium, compared to just 4% in the Netherlands.

But the practice has dwindled: in 2011, 1 in every 3.5 doctor-patient contacts was a home visit, compared to 1 in 5 patient contacts in 2019, a figure likely bolstered by the pandemic.

Once a common type of medical appointment for people of all ages in order to treat a wide range of conditions, now such visits are mainly utilised by the very elderly who struggle with mobility. 

“While 253 home visits were made on average for every 1,000 people under 65 in 2019, there were 1,614 for every 1,000 people aged 65 to 79, and even five times as many for people aged 80 and over,” reads a recent study from the Observatory of Health and Social Affairs in Brussels.

That means there were 7,609 home visits for every 1,000 people in their eighties, nineties or even centenarians in Belgium.

Traditionally fewer housecalls in Brussels

The overall decline is especially pronounced in Brussels, where the practice has never been as popular as it was in Flanders and Wallonia. 

In Wallonia, there are around 1,080 housecalls per 1,000 citizens and in Flanders 900 per 1,000 people. But that figure plunges to 411 visits per 1,000 residents in the Belgian capital. 

“It is true that the Brussels Region has a younger age structure than the other regions and that it’s mainly the elderly who make use of (frequent) home visits, but this fact alone cannot explain the entire difference with the other regions,” said Sarah Missine, scientific collaborator at the Observatory and co-author of the study with Dalia Fele and Gaëlle Amerijckx. 

“Indeed, this finding of lower use of home visits in Brussels is valid for all age categories. But in addition to age, the explanation lies in the postponement of care for socio-economic reasons, the loss of a privileged relationship with a family doctor, the exceptional supply of specialist doctors and emergency services in the capital and the accessibility of care institutions (proximity, public transport) for the patient.”

Like the other regions of the country, Brussels has seen the number of home visits fall considerably in recent years: -27.2% between 2011 and 2019 compared to -21.9% in Wallonia and -19.9 in Flanders. 

At the same time, the number of office visits is increasing for all regions (Brussels:+10.3%; Flanders: +15.6%; Wallonia: +16.5%), so the total number of contacts with a GP has remained relatively stable. 

“In short, patients have on average almost the same number of contacts with their GP in 2019 as in 2011, but these contacts increasingly take the form of a consultation in the practice, and less frequently the form of a home visit,” said Missine.

GP shortage in Brussels one reason for decline

One potential reason for a decline in home visits, outside of a cultural shift, is a shortage of doctors, especially in Brussels: in 2017, there were 1,468 active GPs in the Brussels Region, or 1 per 812 inhabitants. 

But the supply is not evenly distributed, and nearly every district faces a potential shortage of GPs. Complicating matters is the fact that a large proportion of Brussels' GPs will soon reach retirement age, and group practices are becoming more common than individual ones.

“All these trends can potentially influence the willingness to make (fewer) home visits,” Missine said.

Practitioners themselves have weighed in, too: commutes to patients’ homes can be time-consuming, especially in a traffic-clogged city like Brussels, and 60% of doctors believe that home visits are not always justified.

“We have had patients come to the office to ask for a visit from a doctor at home,” said Dr Els Van Hooste, president of the association of Dutch-speaking general practitioners in Brussels (BHAK). “I often say, if you can go to your hairdresser, you can go to your doctor.” 

Doctors are split almost evenly when it comes to whether or not a home visit implies a lower or higher quality of care, with some pointing to “the absence of an examination table, the lack of light, the presence of third parties or even pets” as reasons to conduct appointments in the office, according to Van Hooste.