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General methodology

The aim of this economic and societal impact study is to measure the benefits to the Brussels-Capital Region’s economy of the activity generated by CHU Brussels as an employer and, more specifically, by each of the four hospital institutions it comprises, in terms of monetary flows and jobs.

The data shown, unless otherwise stated, apply to the year 2016..

The economic and societal impacts are addressed separately in the study:

The economic impact

This is calculated in terms of monetary flows based on two elements:

  • Direct impact or local effect : a measure of the economic benefits generated in the Brussels Region by CHU Brussels and the businesses located on hospital sites, whose existence is directly linked to them (cafeterias, shops etc). For the Brussels hospital sector, these benefits equate mainly to salaries, purchases and investments;
  • Induced impact or ripple effect : an estimate of the monetary flows and jobs that are cascaded down from CHU Brussels into the local Brussels economy, with a multiplier effect, in the form of a virtuous spiral.

Multiplier coefficients of the hospital sector

Multiplier coefficients enable us to calculate the impact of final demand on production. They can be applied, in other words, to an increase in demand for healthcare, such as an increase in the number of patients, possibly correlated to demographic changes in the Brussels Region (population growth and ageing).

The calculations are based on coefficients produced by the Planning Bureau in 2015 on the basis of data from 2010, as part of an inter-regional and sectoral approach [Hospital activity - code NACE 86 A].

In this case these coefficients enable us to assess the direct and indirect benefits on revenues and employment in the Brussels Region, cascading out of the activity produced by the supply chain, to respond to the increase in demand:

  • Multiplier coefficient for revenue: the intraregional multiplier coefficient for the Brussels Region which is specific to the hospital sector is 0.71.

One million Euros of revenue generated by the hospital sector will produce an injection of 710,000 Euros into the Brussels economy.

  • Multiplier coefficient for jobs: the coefficient applied is 13.1 Full Time Equivalent (FTE) jobs for one million Euros of final demand for domestic production. This means that an investment of one million Euros in the hospital sector generates on average, directly within the sector, 9.9 FTE and also generates indirectly, in the supply chain, 3.2 FTE.

One FTE at CHU therefore indirectly generates 0.33 FTE in the supply chain

The societal impact

This is assessed with a more qualitative approach, which enables the following elements to be appreciated:

  • The volume and type of jobs created by CHU Brussels hospitals and by the businesses located on its hospital sites, within the economic fabric of Brussels;
  • The attractiveness of CHU Brussels to patients residing in the Brussels Region but also in other regions, not to mention other countries;
  • Services of general economic interest performed by public hospitals in Brussels.

Scope of the study

The study covers the economic and societal impact generated by the activities of the four public university hospitals comprising CHU Brussels, and by those of the legal entity of CHU Brussels for shared support services (in2016: legal and human resources departments).

Five “employers” (distinct legal entities) are thus involved :

  • CHU Brugmann ;
  • Queen Fabiola Children’s University Hospital (QFCUH) ;
  • CHU Saint-Pierre ;
  • Jules Bordet Institute ;
  • CHU Brussels as the coordinating structure4.

Included in “CHU Brussels staff” are contractual or statutory staff paid directly by one of these five employers (“salaried staff”), staff placed at the disposal of the employer by another employer (secondments), independent (mainly paramedics and physicians) and Interims. Students (nurses, physicians, paramedics etc.) are not included, with the exception of candidate specialist physicians in training – also called “post graduates” (PG) - who are paid and accounted for as salaried staff.

The study addresses the economic and societal impact of CHU Brussels in the three Regions of Belgium (the Brussels-Capital Region, the Flemish Region, and the Walloon Region), with a more specific focus on the Brussels Region.

Limits of the study

The study assigns no value to the indirect economic impact of CHU Brussels such as the economic benefits (hotel expenses, various purchases etc.) generated by patients, students in training and participants in any events organised by the CHU who do not reside in the Brussels Region. Such an approach has not been adopted. This first study focuses on estimating, in terms of activity, the attractiveness of CHU Brussels to patients and staff not resident in the Brussels Region5.

The following expenditure and receipts items have been ex- trapolated, wholly or partially, on the basis of objective data:

  • Training: the amount of training expenditure includes only the training costs directly reimbursed by the employer. Training costs, conference participation and other amounts spent on training by medical professionals have not been estimated and so are not accounted for.
  • Aggregate payroll of FTEs employed by businesses/ non-profit organisations located on hospital sites; we have obtained, from the majority of businesses and non-profit organisations located on hospital sites and paying staff, the number of FTE and people remunerated up to 31/12/2016. We have estimated the corresponding aggregate payroll by applying the average CHU Brugmann staff cost by the employee profile in the business/ non-profit organisation.
  • Benefits for the Brussels Region: most of these are estimates based on the application of appropriate ratios. Apart from the above-mentioned multipliers used to estimate the induced impact, some ratios have been applied to identify the direct economic benefits of CHU Brussels and the businesses and non-profit organisations located on its sites. In terms of the aggregate payroll, for example, it is the known rate for each member of salaried staff residing in the Brussels Region that has been applied. For general purchases the ratio applied to the five entities is the rate for suppliers of general purchases to CHU Brugmann whose registered offices are in the Brussels Region. For investments we have applied the rate calculated for each entity in the “top 100 suppliers 6 ” whose registered offices are in the Brussels Region. For training, we have separated the PG data - to which we have applied the rate of residence in the Brussels Region for salaried staff of the hospital concerned - from the other data (other training expenditure). For this, the rate for CHU Brugmann service providers (all services included: accounts 611 to 616) whose registered offices are in the Brussels Region has been applied to all of the data concerned.

As the data used has been rounded, some graphs display a total of 99% or 101%.

4 Taking into account the low economic and societal impact of CHU Brussels as a coordinating structure, only the data and results of each of the four hospitals are detailed in the last four sections of the report. Data on the coordinating structure is recorded in these results, at the start of the report, for CHU Brussels as a whole.

5 Other similar studies carried out in French regions have estimated this indirect economic impact to be less than 2% of the direct economic impact, or a marginal indirect impact compared to direct impact. This concerns, particularly, the Economic and Societal impact Study of CHU Limoges in the Limoges Region (2014) and the Economic Impact Studies of the Grand Ouest CHU and CHR (2014).

6 This mainly concerns, for each entity, the 100 suppliers with the highest total orders recorded in 2016 regarding investments (acquisition values).