West connects with care Looking after each other. In , quality healthcare is a Table of contents universal right. However, the system 01 Basic models of healthcare systems P04 differs from other countries with 1. Free market economy model 2. Beveridge model a mixture of public and private 3. Bismarck model options, which is why it’s important 4. National health insurance model to know what services are available in and how you can 02 The Belgian healthcare system P06 1. Who can access healthcare in Belgium? access them. 2. Healthcare costs 3. Health insurance 4. How to register for healthcare in Belgium as an expat 5. Private healthcare 6. Doctors and medical specialists 7. Women’s healthcare 8. Children’s healthcare 9. Dentists 10. 11. Health centres and clinics 12. 13. Mental healthcare 14. Other forms of healthcare available in Belgium 15. In an emergency 16. Characteristics of the Belgian healthcare system

03 West Flanders, P18 International Ambassador 1. AZ Sint-Jan 2. AZ Groeninge 3. AZ Delta 4 - Basic models of healthcare systems Basic models of healthcare systems - 5

01 Basic models of healthcare systems

1 3

Free market Bismarck model economy model – Financed jointly by employers and employees through – Out-of-pocket expenses payroll deductions

– Used in the USA (however, 10% of the population – Health insurance plans have to cover everybody and doesn’t have any insurance) as well as in most can’t make a profit developing countries – Healthcare providers are often private

– Refund and pay-in-kind system

2 – Used in Belgium, Germany, and the Beveridge model

– Funding is provided from general 3 resources (by means of )

– Infrastructure, healthcare policy and National health management are the government’s responsibility insurance model

– The NHS in the UK is an example – Canada uses a combination of the Bismarck of the Beveridge model and Beveridge models 6 - The Belgian healthcare system The Belgian healthcare system - 7

1 Who can access healthcare in Belgium?

Healthcare is accessed through health insurance to subsidised public healthcare. People who don’t in Belgium. If you live and work in the country, you have access to subsidised public healthcare, must register for social security in Belgium and however, must take out private insurance to cover make health insurance payments to have access any health treatment they have.

2 Healthcare costs

Belgium spends 10% of its annual GDP on Public healthcare in Belgium is funded by a healthcare expenditure, according to 2016 figures combination of health insurance and social (https://www.healthybelgium.be/-report 2019). In security contributions. Residents have to pay for fact, this places it ninth out of all EU and European the remainder of unsubsidised care. Free Trade Association (EFTA) countries.

Health insurance funds cover:

02 The Belgian – 50-75% of the costs for doctors, hospitals, and clinics

healthcare – Approximately 20% of prescription costs

system – Basic dental costs

– Maternity costs

Unemployed residents, pensioners, students, and people with disabilities are entitled to the same subsidies as the working population. Employees receive The Belgian healthcare system is one of the best regional , Walloon, and German-speaking automatic cover for their children as well as any dependent spouses. in Europe. It is divided into public and private communities all have their own administrative sectors, with fees payable in both. The public healthcare divisions. Their responsibilities include system is funded by mandatory health insurance preventive health (e.g., Kind en Gezin/Child and which allows residents to access subsidised Family), care for disabled persons, homecare services such as doctors, care, dental and elderly policy (planning and facilitating), care, maternity costs, and prescriptions. mental healthcare, primary care, healthcare Both federal and regional governments are professions, and quality procedures in hospitals. responsible for healthcare in Belgium. The federal Belgium ranked fifth in the 2018 Euro Health state is responsible for social security and Consumer Index (published 2019-02-25) with the funding of healthcare, as well as providing “perhaps the most generous healthcare system advice on health policy and monitoring the in Europe”. However, Belgium scored lower than situation via the Federal Public Service for Health, the top-ranking countries in terms of outcomes. Food Chain Safety and the Environment. The 8 - The Belgian healthcare system The Belgian healthcare system - 9

3 5 6 Health insurance Private healthcare Doctors and medical

As part of the social security enrolment months after joining a health insurance fund, Private healthcare in Belgium runs alongside specialists process, all employees and self-employed unless you are able to prove that you paid public provision. Some doctors, dentists, and people must register and contribute to a health sufficient social security contributions in your specialists provide both public-funded and Most doctors in Belgium work within insurance fund in Belgium (mutuelle in French home country. If you hold a European Health private treatment. This means it is important to the public Belgian health insurance or ziekenfonds in Dutch). Residents are free Insurance Card (EHIC) you can use it until check upfront what your public insurance will scheme, while some combine this to choose their own health insurance fund. you register with a health insurance fund. cover if you don’t have private coverage. with private appointments or work entirely in the private sector. Health insurance contributions are 7.35% You can compare quotes from Belgian health To use private healthcare in Belgium, you will of gross salary (3.55% from your salary and insurance funds to select a provider. Companies need to take out private medical insurance or You can choose your own general 3.8% paid by your employer). Self-employed providing international health insurance pay the full costs. Most private health insurers practitioner (GP) in Belgium, although if workers pay the full 7.35% themselves. coverage to expats include: Allianz Care, require you to pay your medical costs upfront they work in both the public and private Cigna Global, Globality Health, and Partena. and then make a claim for reimbursement. sectors make sure it’s clear which service It is important to note, however, that you may you want. Patients usually pay the doctor not qualify for reimbursements for the first six As public healthcare in Belgium is subsidised upfront and then get a refund later from rather than free, many residents choose to their insurer. It is also possible to see take out private insurance to top up their public a medical specialist without a doctor’s coverage and give them access to private referral, but it will be cheaper if you do 4 healthcare treatment. so through your GP/family doctor. How to register for healthcare in Belgium as an expat

In order to access healthcare in Belgium, your employer will do this for you. If not, expats need to register for social security visit your nearest social security office. then select a health insurance fund. Often

Expats must provide some documentation:

– Valid ID such as a passport

– Residence permit

– Proof of address such as a recent utility bill

Once registered, you will receive a social security card (eID, formerly known as Carte SIS) to take to the health insurance company of your choice. Healthcare charges are then reimbursed by your health insurance fund. 10 - The Belgian healthcare system The Belgian healthcare system - 11

7 Women’s healthcare

To confirm a pregnancy in Belgium, first visit your working in both public and private practices; your GP. In the , antenatal care is GP will be able to give you advise on your choice. carried out by doctors alongside gynaecologists Contact the Office de la Naissance de l’Enfance and obstetricians in private practices. Kind en (ONE) for detailed advice and information. Gezin (Child and Family), the Flemish welfare Contraception is available over the counter in agency for children and families, offers free advice Belgium, including emergency contraception. and support to pregnant women and families with Terminations are legal up to 12 weeks after children under three years old. conception and can be carried out at family In the French community, antenatal care is mainly planning centres and hospitals. carried out by gynaecologists and obstetricians

8 9 Children’s healthcare Dentists

Residents with health insurance can access Belgian dental care is included under the either free or subsidised healthcare for their public healthcare system, where patients can children in Belgium by registering your child claim reimbursements for check-ups and basic with your GP. Support is provided by the regional treatments. However, most dentists work privately, agencies Kind en Gezin (Flanders) and ONE and treatment not covered under basic health (), which provide services such as: pre- insurance can be expensive. 11 natal support, medical check-ups and screenings For this reason, many people in Belgium take out by a paediatrician, free vaccinations, weight private dental insurance to cover these costs. and measurement to monitor development, You need to have at least one annual check-up to Health centers and clinics hearing and eye tests. The vaccinations program maintain your public health coverage. includes shots for diseases such as polio, Belgium has primary care centres (maisons Family Planning Centres (FLCPF) are Belgium’s diphtheria, tetanus, whooping cough, measles, médicales in French or wijkgezondheidscentra version of family clinics, providing information and mumps, and rubella (MMR). in Dutch) where different healthcare providers services on sexual and maternal health in Wallonia and professionals operate. These include and . However, there are no family planning GPs, nurses, and physiotherapists. Patients centres in Flanders. An alternative is Sensoa, 10 can register with a centre to access services which provides expert advice on sexual health, covered by public health insurance. relationships, and other topics. Hospitals 12 In Belgium, there are public and private you need, such as a towel and soap. Although your hospitals, university hospitals, and polyclinics. health insurance should cover the costs of the As with GPs, you can arrange to see a specialist medical treatment you receive while in hospital, Pharmacies of your choice at any Belgian hospital but you still have to pay a fee for daily hospital care. check if they are covered by your insurer You can also walk into ‘emergency outpatients’ In Belgium, a (pharmacie in French or Non-prescription medicines aren’t refunded, but to ensure you can claim a refund. for immediate treatment; although, as in apotheek in Dutch) is recognisable by the green those prescribed by a medical professional are. For inpatient stays, most hospitals charge a daily other countries, you shouldn’t use this as a neon cross outside. They are usually open from You have to pay for prescription medicines when fee, which is dependent on your circumstances GP replacement. You may have to pay a non- Monday to Friday and often on Saturday mornings you collect them from the pharmacy, minus the (e.g., unemployed people pay less), and the length refundable small fee if you use emergency services too, as well as offering a rotating emergency set percentage payable by the insurer. Some of your stay (daily fees are drastically reduced after without a referral. service on Saturday afternoons, Sundays and medications are reimbursed fully, while others only the first day). You may also need to take things out-of-hours. up to 20%. 12 - The Belgian healthcare system The Belgian healthcare system - 13

13 15 Mental healthcare In an emergency

Despite the fact that Belgium has a lower than mental health issues than in many countries. average number of mental health professionals Around 4% of adults report having used a per capita, there is generally less stigma around psychologist which is above the EU average. The Belgian emergency numbers are:

– Medical service: 112

Mental health services are available through public, private, – On-call pharmacy: 0900 10 500 / 070 66 0160 (fees apply) and voluntary sectors in each region. They include:

In any life-threatening situation, call the If necessary, an ambulance will take you to – Mental healthcare centres which provide counselling, pan-European emergency number 112 (or 114 the nearest hospital. However, be aware day-care and residential care hearing assisted), free of charge from any that you will typically have to pay for this phone. When you call, the operator needs to service, unless you have special or private know the type of emergency, the address, health insurance that covers this. – Psychiatric hospitals for people with ongoing mental and the number of people in danger. health conditions

– The Community Help Service, a charity organisation offering support and advice, including counselling

14 Other forms of healthcare available in Belgium

In Belgium there are both complementary and by a qualified professional. Private companies alternative (CAM) therapists. According to will usually cover alternative medicine, but a 1998 study, around 40% of the population not as part of the basic package. You will said they had used complementary therapies have to pay for the additional coverage. at least once, with the most popular Belgian medical schools don’t teach treatments being homeopathy, acupuncture, alternative medicine, therefore students osteopathy, phytotherapy, and chiropractic. need to gain qualifications at specialist However, while public health insurance doesn’t schools and colleges. All therapists should officially reimburse these treatments, some belong to a regulatory body or association, treatments may be covered if they are carried out e.g., the Belgian Acupuncture Federation. 14 - The Belgian healthcare system The Belgian healthcare system - 15

16

Characteristics of Consultation on prices the Belgian healthcare system and rates

– Biyearly: conventions between healthcare insurance companies and healthcare providers (doctors) A mandatory federal Comprehensive – Comprehensive nomenclature which caregivers can choose to join, i.e., health insurance based on cover of costs an NIHDI doctor will charge a fee in line with the NIHDI nomenclature solidarity and regional extras (NIHDI = National Institute for Health and Disability Insurance) – Wide range of healthcare services – Focus on financing care programs as coordinated collaboration among healthcare professionals is necessary, especially for patients with chronic diseases that require – Coverage for people who are and facilities complex treatment, e.g., care pathways for type 2 diabetes and chronic renal impairment unemployed, live on social – Sufficient specialists welfare, , etc. – No waiting lists – Self-employed people are insured – A wide care package is covered for minor risks (outpatient care)

A personal patient contribution Reasonable overall Therapeutic freedom expenditure for – The co-payment system aims to discourage the unnecessary use of healthcare resources – Belgium is in the middle group of the – Risk of overconsumption – While this is a threat to the equal access to essential care, vulnerable groups OECD rankings (e.g., ) can use compensation mechanisms and there are maximum invoice amounts – However, the situation is changing: – However, personal contributions are rather large in comparison to other in 2010, 10.5% of GDP was spent on OECD countries healthcare compared to the OECD average of 9.7% of GDP

Free choice of healthcare provider Growing expenditure on healthcare

– Patients can choose freely between healthcare providers, health insurance funds, – An ageing society means that fewer people now work, and they are responsible hospitals and insurance companies for an increasing number of older people – Advantages: increased accessibility, competition in the market, and quality of service – There are growing expectations about the quality and ease of access – Disadvantages: it can be difficult to monitor patients to healthcare – Actions to overcome this disadvantage include: – Expensive new technologies (chemotherapy, HIV inhibitors, MRI scanners, etc.) • GMD (Global medical record) ensures a better exchange of information between doctors – Increasing wage costs aren’t followed by increased productivity and lowers costs by 30% for patients when consulting a GP – Personal contributions are rather large in comparison to other OECD countries • Lower co-payments for the cost of specialists after a GP referral – Unexpected situations, including the COVID-19 pandemic 16 - The Belgian healthcare system The Belgian healthcare system - 17 18 - West Flanders, International Ambassador West Flanders, International Ambassador - 19

03 West Flanders, International Ambassador

AZ Groeninge www.azgroeninge.be As part of our bilateral cooperation with the Chinese province of Zhejiang, both provinces have developed a healthcare strategy to improve their healthcare system. AZ Groeninge is a dynamic hospital with 1,049 beds spread over two campuses in Kortrijk: the Kennedylaan campus and the Reepkaai city campus. The strategy focuses on: More than 2,800 staff members and approximately 300 doctors strive to – Study trips for medical students and doctors provide high-quality, safe, accessible, professional and integral care to in West Flanders and Zhejiang all patients while respecting each individual’s uniqueness. – Guest lectures and work seminars by and for doctors in Zhejiang

– Observation traineeships for doctors from Zhejiang in hospitals in West Flanders

In order to be able to realise these actions, the province of West Flanders has set up a structural cooperation with three hospitals: AZ Sint-Jan, AZ Groeninge and AZ Delta. AZ Delta , , The AZ Sint-Jan Rumbeke, and Brugge-Oostende www.azdelta.be www.azsintjan.be AZ Delta strives to be a leader in high-quality healthcare. The hospital’s 4,000 employees, AZ Sint-Jan offers innovative tertiary healthcare including 385 active doctors, strive to for everyone. The hospital tradition spans eight continually innovate and improve their centuries with its first hospital ward dating healthcare services and processes back to around 1150. The hospital has 1,221 beds across their four campuses: Menen, spread over three locations: the Sint-Jan and Brugsesteensweg Roeselare, Rumbeke, Sint-Franciscus Xaverius campuses in and Rembert Torhout. The hospital has and the Henri Serruys campus in . 1,403 beds. More than 300 doctors and 3,000 members of support staff are committed to providing highly specialised and accurate care to over 300,000 patients (hospitalisations, outpatient admittances and consults). Let’s connect ...

Province of West Flanders Department of international relations and European programmes

Koning Leopold III-laan 41, 8200 Bruges West-Flanders Belgium, Europe [email protected] T 0032 50 40 32 53 www.west-vlaanderen.be/connectwestflanders