How is public health insurance and universal coverage organized in the healthcare system of Belgium?

In 2015 Belgium had a nominal GDP of €410 bn, with an economic growth rate of 1.4%. Belgium’s healthcare expenditure as a percentage of GDP is 10.6%. This is within average range for central and northern European nations. In comparison, the Netherlands spends 10.8% of GDP on healthcare, Sweden spends 11.9% and France spends 11.5%.

In terms of GDP per capita, Belgium spends €3858,25 per capita, compared to €3779,6 in France or €4,224 in the Netherlands. Around 78% of healthcare costs are financed publically and 22% is sourced privately.

5 public health insurance schemes

All working citizens in Belgium are obligated to contribute social security payments and to join a health insurance scheme (mutualité in French, and mutaliteit or ziekenfonds in Dutch).

Approximately 99% of the Belgian population is covered by the social security system.

There are 5 major health insurance schemes in Belgium, that all operate not-for-profit. They are the following (including the approximate number of employees and members):

  • Christian (6514 employees, 4.66 m members)
  • Liberal (109 employees, 360,000 members)
  • Independent (11,300 employees, 2.15 m members)
  • Neutral (600 employees, 800,000 members)
  • Socialist (2864 employees, approximately 3.15 m members)

These public insurance providers are often directly linked to corresponding labor unions.

The requested monthly contribution asked by one insurance provider compared to another does not vary immensely. This contribution is around €7.80 per month per person. The providers attempt to differentiate themselves by offering additional services, like holiday or family deals, or separate insurance plans for particular dental or other specialty healthcare needs.

The competition is high between the 5 providers and this market is closed to newcomers.

Federal Institute for Illness and Disability Insurance (RIZIV/INAMI)

The Federal Institute for Illness and Disability Insurance (RIZIV in Dutch, INAMI in French) supervises the payments and tariffs of the healthcare reimbursements and coverage. In Belgium, a set – though continuously revised- nomenclature and codification scheme is used to categorize and price various diagnostic and curative procedures and the materials used in each process.

RIZIV’s responsibility to manage codification and prices can have a very direct impact on the procedures and materials that will be applied, and also, how the care provider himself will codify the treatments that he/she applies. If a procedure being used is not catalogued, then the care provider may see himself forced to use another code in order to receive reimbursement.

A new product or procedure cannot always clearly fall under an existing codification (due to being innovative or unprecedented) and it can require some time before a rational price and tariff can be provided for it in order to integrate it into the public healthcare insurance system.

Products and treatments can apply for inclusion into the catalogue with RIZIV. The requirements for inclusion are described in further detail in this report’s section on Purchasing Processes and Decision-Making (in the TforG report; National Landscape and Healthcare Outline of Belgium).

Insurance coverage

Within the RIZIV frame, the 5 insurance providers contribute collectively to discussions around patient fees, care coverage, and regulation. It is said that these discussions facilitate a balance between the insurance schemes, the care providers, the social partners, and the government.

The insurance scheme providers offer compensations for the following:

  • Consultations at a GP’s and healthcare specialist’s
  • Treatments by physiotherapists
  • Care by nurses and services for home care
  • Dental care
  • Childbirth
  • Prosthesis, wheelchairs, bandages and implants
  • Hospital care
  • Care in senior residences
  • Rehabilitation
  • Homeopathy, acupuncture, osteopathy and chiropractic care are also recognized in Belgium as reimbursable alternative treatments.

Care path reimbursement

Under certain health conditions, primarily chronic conditions, a care path is delineated contracting 3 different parties: the patient, the GP and the specialist. Currently such a care path exists for diabetic patients and for kidney-insufficiency patients. Very specific conditions define the care path patient; for example, the diabetic patient type 2 with one to two injections per day or with maximum oral treatments (where insulin is under consideration) will have to consult the GP at least twice a year and the specialist at least once a year.

During the duration of the contract, the patient will have all the GP consultations fully reimbursed, and two consultations with a specialist (dietician, podiatrist or diabetes educator) partially reimbursed. By creating a care path the patient has a greater guarantee that the GP and specialist will work in close coordination for the treatment and follow-up of the illness.

A supplier of chronic illness medicine can apply with RIZIV for inclusion in the care path reimbursement.

Private and additional health insurance

Some people in Belgium choose to take additional insurance policies to cover them for healthcare services that are not included in the public insurance packages. This can be done with the health insurer they are already subscribed to or with a different private entity.

Typical complimentary insurance covers include the following:

  • Non-urgent hospital admittance
  • Purchase of lenses and glasses
  • Some types of dental care
  • Some vaccinations
  • Daycare for children when ill
  • Medical care abroad

Reimbursement infringements

Sometimes there are cases where care providers deliberately or accidentally request more reimbursement than they are entitled to. In 2015, this averaged €11.6 m in reimbursement infringements.

Close to half of this amount was voluntarily paid back to RIZIV after the faulty care providers were notified of their overcharging.

34% of these infringements were in the home-care sector, 13.5% were amongst doctors-specialists, and 9.4% were in hospitals, care-facilities and elderly care centers.

 

For further quantitative and qualitative information on the Belgian healthcare system and the macroeconomic climate, please look into our Business intelligence platform or order the Belgian Healthcare Scan incl. Surgical Procedures Volumes (all specialisms) – product license containing volumes of 984 surgical procedures in 13 specialisms.
Other licenses to our business intelligence platform depending on your needs are also available.

Want to learn more about or speak with our market expert?

Leave your details here and we will contact you on the same day.