Peculiarities of medical insurance and treatment in Belgium



Peculiarities of medical insurance and treatment in Belgium

Belgium has one of Europe's most generous social security systems, enjoyed by nationals and foreign residents. However, since 2012, supplementary health insurance is compulsory. 

Belgium has a universal and compulsory social security system, enjoyed by Belgians and foreigners (and their dependents). The compulsory basic health insurance program allows insured persons to join one of the country's five mutual funds or the Complementary Health and Disability Insurance Fund (CAAMI), which is responsible for managing health insurance benefits. 

Medical expenses are reimbursed according to a nomenclature which, as in France, reimburses % at a notional flat rate. For example, the standard rate for a consultation with a general practitioner is 22.22 euros, of which 75% is reimbursed by social security. 

In the case of hospitalization, the basic rate of the hospital package (not including payment for medical procedures) is 43.52 euros for the first day of hospitalization and 16.25 euros on the second day, also partially compensated by social security. This rate is degressive depending on the professional and family situation of each insured person.

European Health Insurance Card. Read here how to get preferential medical care in the EU countries.

Belgian compulsory social insurance system

As in France, reimbursement from the compulsory social insurance system is calculated based on a notional rate for each medical procedure. If the doctor consulted or the hospital visited charges more than the standard rate or additional fees, these remain entirely at the patient's expense. And they, of course, are not counted in calculating their "maximum billable amount." 

For example, the median cost of additional fees charged by Brussels hospitals for a delivery with a standard hospitalization in a single room ranges from 1,096 to 2,117 euros. 

For this reason, in particular, membership of the Caisse de mutualité implies a compulsory and simultaneous subscription to its supplementary health insurance offer. It is also possible to take out a third additional level of health insurance, this time optional, with the insurer of one's choice; some employers offer their employees group contract membership for this purpose. 

The Belgian health care system is based on a social insurance system characterized by solidarity, without risk selection. The organization of medical services provides therapeutic freedom for doctors, freedom of choice for patients, and pay-for-performance. The financing of the system is based on progressive direct taxation, proportional social security contributions tied to income, and additional financing tied to the consumption of goods and services (value-added tax).

Medical care is provided by public health services, private health care providers for outpatient treatment, private pharmacists, hospitals, and special facilities for the elderly. Hospital care is provided by either private nonprofit hospitals or public hospitals. Most specialists are self-employed in hospitals or private practice (outpatient care). General practitioners provide outpatient or primary care. Dentists and pharmacists usually work independently.

Medical insurance covers the following services, if they are included in the reimbursable services:

  • Visits and consultations by general practitioners and specialists
  • Care provided by physical therapists
  • Nursing care and home care services
  • Dental care
  • Childbirth
  • Dentures, carts, bandages, and implants
  • Hospital care
  • Nursing home care for the elderly
  • Functional rehabilitation care.

The health insurance program also covers drugs: mainline drugs, pharmaceutical specialties, and generic drugs.

Public Health

The federal government and communities regularly work together to coordinate and fund public health policies such as:

  • Screening for communicable and non-communicable diseases,
  • Vaccination programs, 
  • Health promotion programs (personal accident prevention, healthy eating promotion, tobacco, alcohol, and drug control)
  • Mental health prevention,
  • Maternal and child welfare (physical and mental health screening, new-born screening, vision and hearing screening, vaccinations).

Outpatient treatment

Outpatient medical treatment is mainly provided by private providers. Independent physicians and nurses are paid on a fee-for-service basis, and the patient has a free choice of physician. The vast majority of doctors are private practitioners. Specialist physicians may work in medical facilities (mostly hospitals) and/or on an outpatient basis. 

General practitioners rarely work in hospitals, except in maternity wards and emergency departments. In the absence of a referral system from general practitioners to specialists, every citizen has free access to specialists and hospital care, even as the first point of contact with the health care system.

Physicians (general practitioners and specialists) work in private practice or in health care facilities, such as nursing homes, where multidisciplinary teams comprised of several general practitioners, administrative and admissions staff, nurses, a physical therapist, and a psychotherapist work. They coordinate all the care the patient needs.

Inpatient care

Hospitals are private or public non-profit organizations and are classified as acute, psychiatric, geriatric, or specialty hospitals, all of which are regionally managed. Psychiatric hospitals include psychiatric asylums and mental health centres. There are two types of hospitals in Belgium: public hospitals (or Ziekenhuis) and private non-profit hospitals, also called clinics (or link).

A distinction is made between:

General hospitals, offer general surgery and internal medicine, and may also offer geriatric, maternity, paediatric, and neuropsychiatric services, as well as additional examinations such as X-rays, scans, and laboratory tests

Psychiatric hospitals, provide treatment and care for people with serious mental illness

Teaching hospitals, generally offer the same services as general hospitals, but admit patients who need highly specialized treatment. They must also contribute to the training of physicians and medical personnel, actively engage in research, and participate in the development of new technologies

Patients can choose the hospital they want, and public hospitals must accept all patients. There is no referral system between primary and secondary/tertiary care, but in practice, the decision to refer patients to a hospital is usually made by a general practitioner or private specialist.


Pharmaceutical products are distributed exclusively by private community pharmacies and hospital pharmacies. The establishment of new pharmacies is strictly regulated to control the opening of pharmacies in new areas. Only doctors, dentists, and midwives can write prescriptions for pharmaceuticals. If these products are on the positive list, they are partially or fully reimbursed by health insurance companies.

The Federal Secretary of Health is responsible for issuing marketing authorizations for pharmaceutical products. To protect public health, a pharmaceutical product must meet several requirements regarding quality, safety, and efficacy. To register a product, a pharmaceutical company must apply, either at the European or national level, to the Federal Agency for Drugs and Medical Devices. This application must be accompanied by a complete dossier containing the results of clinical trials, which establish the quality, safety, and efficacy of the product for specific indications. The Department of Health is also responsible for setting drug prices.

Long-term care

Elder care infrastructure includes comprehensive home care services, personal care, which may include assistance with meals, clothing, personal hygiene, and mobility, and subsidized security alarms as needed. The primary purpose of each home care service is to oversee the practical organization and support of home care providers and their operations. This includes assessing the patient's ability to perform activities of daily living, developing and monitoring a plan to maintain health and wellness, assigning tasks to care providers, and consulting with various stakeholders to achieve goals.

Health insurance funds medical procedures, such as nursing and physical therapy, according to several criteria, including the patient's level of dependence and resources. Communities and regions fund other services, such as family support and meal delivery.

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