In Belgium, health insurance is mandatory. Basic cover is provided by the national social security system, which is known as the mutualité or ziekenfonds.
Contributions are paid by both employers and employees and they amount to 7.35 % of each person’s gross salary. The employee must pay 3.55 % directly from their wages and employers must pay the remaining 3.8 %. Self-employed people have to pay the full 7.35% on a quarterly basis. Cover is automatically provided for unemployed dependent family members and children up to the age of 18. The unemployed, old age pensioners and people on long-term sickness benefit or maternity leave do not have to pay healthcare contributions. Foreigners immigrating to Belgium without jobs must produce proof of private health insurance in order to obtain their residence permit.
For historic reasons, some healthcare funds are limited to members of various religious, political or professional groups, but most funds are open to everyone. Each fund charges the same basic contribution as well as providing similar benefits, but some take longer than others do to make repay the fees.
People have to wait six months before they are able to claim benefits, unless they previously belonged to a health scheme as a dependant or if they were covered by a state health care plan in another EU country for at least six months before their arrival in Belgium.
People have to pay a certain amount of their medical bill themselves and they usually pay fees directly to their doctor or the hospital. They must submit their receipts for reimbursement and the money is then paid directly into the claimant’s bank account.
Most Belgians take out supplementary health insurance to cover the portion of their bill, which is not reimbursed. Many employers provide supplementary health insurance cover as an employment benefit.
The state fund covers most medical services including treatment by specialists, hospitalisation, prescriptions, pregnancy and childbirth and rehabilitation. Self-employed people are only protected for “major risks,” which include mental illness, tuberculosis, cancer, hereditary diseases, birth defects, most types of surgery and childbirth.
The Belgian system of reimbursement is complex. There are 18 categories of medical procedure and service and each one has its own reimbursement level, which can vary from no reimbursement to 100%. Some citizens like widows, orphans and those receiving certain public aid like the blind fall into a “preferred” category, which entitles them to a higher level of reimbursement. Usually though, for people who are not in a preferred group, 75% of the doctors fee is reimbursed.
Doctors are known as médecins or artsen. They are well trained and required by law to keep up-to-date with the latest medical developments.
Patients are free to register with a doctor of their choice, but registration is not compulsory. People often make “familiarisation” appointments with doctors before they enrol at their practice, so that they can determine if they like the doctor’s manner. The cost of such appointments is usually reimbursed by private health insurers.
Patients must pay GP’s and consultant doctors directly in cash or by cheque each time they visit them. Low-income patients are exempt from payment. Patients, who incur treatment charges without obtaining a referral from a GP, may not be fully reimbursed or may be reimbursed at a lower rate.
Most Belgian doctors do not employ administrative to take phone calls or make appointments, which means that they often take calls during a consultation.
Belgian doctors do not tend to discuss types of treatment or answer patients concerns. Some doctors will only see patients who have made an advance appointment known as a rendezvous or astral, others hold ‘walk-in’ consultations using a supermarket-style queuing system and some do a combination of the two. All doctors make house calls and some will only see sick patients at home in an attempt to keep their surgeries “germ-free.”
If you need a doctor out of the normal practice hours, you will have to visit a duty doctor known as a médecin de garde or de nuit or wachtdienst.
Under the Belgian national health care system, patients can make an appointment directly with a specialist without a referral from a doctor.
Hospital care is very good in Belgium, but there may be a waiting list for some non-emergency treatments and services.
There are two types of hospital in Belgium. One group is known as a hôpitaux or ziekenhuisen and can be identified by a sign showing a white H on a blue background. This type of hospital has its own staff that is in charge of all treatment once a patient is admitted. They are open 24 hours a day. Some hospitals have a separate section dedicated to the treatment of children and in some towns, this is an entirely separate hospital. Parents can often stay overnight with their child. When you arrive at a Belgian state hospital, you must provide a Belgian identification card or passport as well as s SIS (Système d’Information Sociale) card. If you do not have these documents, you must show proof of private health insurance. Patients also have to pay a deposit unless the hospital has an arrangement with the patient’s insurance company to bill them directly. Patients are also expected to settle their hospital bill weekly. Emergency patients do not have to do this until their condition is stabilised.
Women are admitted to hospital under their maiden names.
The second type of hospital is a privately owned hospital called a clinique or kliniek. It has its own medical staff, but allows a patients own GP to take charge of their treatment. Most GPs are associated with at least one or two private clinics. A GP will decide which private hospital his patient needs and this will depend on whether the type of treatment needed.
Emergencies are known as cas d’urgence or spoedgeval. Fees for ambulance journeys are not reclaimable under the national health system. Some insurers need to see a doctor’s authorisation for emergency services and hospital admissions before they will reimburse, but this is not the case with life-threatening situations. Not all hospitals have emergency facilities, and those that do are not always open 24 hours a day.
Dental care in Belgium is excellent. Citizens can choose their dentist. The state will fund dental care provided they are on the list of state approved dentists. Those with private healthcare policies may be restricted to dentists approved by their insurer.
Patients have to pay for any dental services directly and then send their receipt to be reimbursed for the costs. Many services, such as crowns and bridges, need to be approved by the appropriate health insurance company or national medical care organisation. The dentist takes care of this by submitting a schedule of proposed work.
Chemists are identified by a large green cross sign and are called pharmacie or apothem. They are strictly regulated in terms of the type of medicines they can sell. They can also be held responsible if a citizen becomes sick through a combination of drugs or through receiving the wrong drugs, even if they were prescribed by a doctor
Non-prescription drugs are priced higher than prescription drugs. Under this system, you may pay less for a packet of aspirin if it has been prescribed by your doctor. Costs for prescription drugs are reimbursed through the national health system.