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Health Systems and Policy Monitor
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Belgium
Health systems in transition
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Country overview
The Belgian health system covers almost the entire population for a large range of services. The approximately 1% of people not formally covered by the compulsory health insurance system may still access medical care through the public centre for social assistance of their municipality.
The organization of the health care system is divided between the Federal authorities (three Regions based on territory) and the Federated entities (three Communities based on language – Dutch, French and German), and local authorities (provinces and municipalities). The Federal authorities are responsible for the national compulsory health insurance, setting the hospital budget, regulating health products and activities, regulating health care professionals, and patients’ rights. The Ministry of Health (Federal Public Service Health, Food Chain Safety and Environment – Health Directorate) is responsible for the general organization of the health system. Federated entities are responsible for primary care, care for older people, mental health care, rehabilitation, as well as health promotion and disease prevention. To facilitate cooperation between the Federal authorities and the Federated entities, inter-ministerial conferences are regularly organized.
The health system is based on compulsory health insurance with social contributions proportional to income as the main financing source. The National Institute for Health and Disability Insurance (NIHDI) manages the health insurance system. To control expenditure, a real growth cap has been established since 1995 to determine the global budgetary objective of the compulsory health insurance.
The provision of care is based on the principles of independent medical practice, direct access (no gatekeeping), free choice of physicians and of health care facility, and predominantly fee-for-service payment. Reimbursed health care services are provided by both public and private institutions and individual health care providers who mainly comply with the same set of rules, enjoy the same therapeutic freedom, and offer the same services.
PACE
Progress Addressing Cancer in Europe
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