Healthcare in Belgium
Access to comprehensive, quality healthcare services is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability and premature death, and achieving health equity for all in a Country.
Understanding the basics of healthcare in Belgium
Firstly there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few (commercially run for-profit) private hospitals.
Secondly is the insurance coverage provided for patients.
Finally, industry coverage; which covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in universities and hospitals.
Improving access to health care services depends in part on ensuring that people have a usual and ongoing source of care (that is, a provider or facility where one regularly receives care). People with a usual source of care have better health outcomes, fewer disparities, and lower costs.
This is what makes the healthcare system of Belgium unique:
To benefit from the healthcare system in Belgium, you have to join a health insurance fund (mutuelle/ziekenfonds). The majority of these funds are linked to the country’s political parties but they are accessible to everyone. You can choose from 20 Christian, 13 socialist, 10 liberal, seven independent and seven neutral funds from all over Belgium.
Contributions are withheld from your income if you are a salaried worker; the self-employed need to register with the social security fund of their choice. All funds charge the same amount, as they act as intermediaries between the National Institute for sickness and Invalidity Insurance and its members. This state system provides basic
healthcare reimbursements for hospital, doctor and chemist costs – for example, 50-75% of the cost of a consultation with a doctor or specialist. While hospital and pharmacy expenses are deducted when you pay, doctors’ fees usually need to be paid in full and then the invoice sent to the insurance fund for reimbursement.
When you register, there is a six-month waiting period before you can be reimbursed for any medical costs, though people who are entitled to benefits in another EU country are covered during this period. Once insured you receive a SIS (social identity) card, but these will gradually be replaced by an electronic identity card from next year.
You can opt for an additional insurance. This covers repayments for non-urgent care in hospital, the costs of glasses, dental care, vaccinations and registration at a sports club. Alternative or complementary treatments such as homoeopathy, acupuncture, osteopathy and chiropractic are also recognised as reimbursable by the Belgian Ministry of Health, if the practitioner is a qualified doctor. The content and cost of this insurance varies for each fund.
Data mining to power the health system
Belgium has an enormous wealth of digital data. The possibilities and ideas exist to become a new “mining” country. Obviously, it is not likely nor desirable that all existing real-world evidence data collected in health organisations are used for such smart systems. In health minister Maggie De Block opinion, it is necessary to explain to citizens what the added value of data for our society is and how it is a form of responsible citizenship. However, we should never collect data without their informed consent to use real-world evidence data for scientific research or optimal screening programs.
Health experts more and more integrated within the health care system
Generally speaking, health care is organised in three layers:
First line: the primary care function that is provided by physicians (GPs), emergency services and Emergency Rooms in hospitals. Polyclinics provide non urgent first line care (such as diagnostic or follow up of patients).
Second line: acute and immediate care provided by hospitals for patients requiring technical interventions (surgery, technical diagnostics etc.) and acute curative care.
chronic or long-term care: is provided by rehab-clinics, service-flat care providers, old-age homes and home-care services.
Financing the system: a common challenge
Every wage-earning worker or employee in a factory, office, working as house personnel (maids, chauffeurs etc.), and anyone working in Belgium is registered to a central system as well as the unemployed. The self-employed, such as shopkeepers, innkeepers, lawyers, and doctors are also registered.
Workers are paid a daily or monthly wage their gross salary. From that gross salary, their employer has to deduct a certain amount (approx 13%) for social security and another (approx 20%) for taxes. The employer has to pay these amounts directly to the Social Security Services and the Inland Revenue Service (employers make these payments for the employee and deduct these payments from his wage). On top of the gross salary, the employer has to pay an employer's contribution for social security of approx 15–22% to the Social Security Services. Failing to make these payments regularly and on-time is closely monitored and often causes failing businesses to be taken to court for failing to comply with their social security and fiscal obligations towards their workers. This reduces the risk for workers when they remain unpaid or when their contributions are not paid for them.
The Self-employed have a system in which they have to declare their earnings and based on their earnings a contribution is calculated which is roughly 20%-22%, but they are not covered like workers. People can opt into the system through this self-employed scheme. The government forms its tax earnings finances in part the social security system. This is a wealth re-distribution mechanism, because the contributions are incremental, this means that the more someone earns the more this person will contribute. Moreover, for health services, the compulsory health insurance and the refund system is the same for everybody (corrected for the lowest incomes) : i.e. for a consultation at the GP everybody pays the same and gets the same refund (irrespective of their income).
A complementary systems
There is a complementary system of health insurance offered by the mutualities (extended hospital cover and travel cover), available to all mutuality members, and there is private insurance with commercial insurance companies for extended care (hospital and aftercare) and for travel care.
Covering healthcare costs
Consultations with GPs or specialists in their private practice
patients pay a fee for the consultation (approx 20-€25 for a GP) and for any medical acts (e.g. dental care at the dentist) (s)he may perform directly to the doctor, in return the patient gets a receipt that lists all the medical acts performed, and if necessary a prescription for medication.
the patient gives this receipt to his mutuality, and they refund the patient in part (depending on the patients status), average patients get about 75% refunded
some patients have a special social security code; they pay only €1 to the doctor, and do not receive a refund receipt. The doctor is paid directly by the mutuality (3rd payer system)
the patient takes his prescription to a pharmacist, paying only part of its price; for each medication dispensed the supplier is paid a supplement by the social security services. In some cases the medication requires extra checks and such medication is often free to the patient, although very expensive. Each sale of the medication is tracked, and the supplier paid by the social security services directly.
2. Consultations at hospitals (polyclinic)
patients see a doctor at the hospital polyclinic just link in their private practice.
some patients pay the hospital as they leave and get a receipt for their mutuality, just like in a private practice; however many patient come in for follow-up consultations after a medical intervention or hospitalisation. The hospitals send the bill to the mutuality (3rd payer system) and patients get invoiced for their personal part.
3. Hospitalisations and medical interventions
patients are hospitalised and they have to pay weekly advances for their medical expenses (usually 50-€100 per week).
all consultations and interventions, medications etc. are directly invoiced to the mutuality and to and insurance cover the patient may have (3rd payer system)
they receive an invoice for their personal part, which is often in part refundable by their complementary insurance.
patients who suffer accidents might never have to pay any medical expenses, as accident insurers are often charged immediately, once responsibility is established.
