The healthcare system in Belgium

If you’ve just moved to Belgium, learning to navigate the healthcare system is likely top of mind, from routine doctor visits and dental care to possible emergencies. All residents who live and work in Belgium are required to choose health insurance from either the public or private sector. No matter which type of coverage you go with, Belgium has a high-quality universal healthcare system that offers greater accessibility and freedom of choice than many others in Europe.

Read on for more information on the following topics:

Overview of healthcare in Belgium

What kind of healthcare system does Belgium have?

Divided into public and private sectors across the country’s three regions (Flanders, Wallonia, Brussels), Belgium’s high-quality universal healthcare system is based on freedom of choice and accessibility.

Mandatory health insurance funds the state healthcare system and allows residents to access subsidized services like doctors, hospitals, dental treatment, maternity care, and prescription medications.

Both federal and regional governments are responsible for healthcare in Belgium. The Federal Public Service for Health, Food Chain Safety and the Environment oversees public healthcare. The regional Flemish, Walloon, and German-speaking communities have administrative healthcare divisions.

Belgium ranked 5^th in the 2018 Euro Health Consumer Index, noting that it has “perhaps the most generous healthcare system in Europe”. However, the country could perform better in medical treatment outcomes.

Who can access Belgian healthcare?

Since Belgium has a universal healthcare system, anyone who is a legal resident of the country must register for either public or private health insurance.

If you live and work in the country, you are eligible for social security and should expect to make health insurance payments from your wages. Contributing to social security will then give you access to subsidized public healthcare.

However, those who don’t have access to subsidized public healthcare must take out private insurance to cover any health treatment they have. This includes newcomers to the country who are not yet legal residents and tourists or visitors staying for a short time.

How much does Belgium spend on healthcare?

Belgium spends 11.1% of its annual gross domestic product (GDP) on healthcare, according to 2020 figures. This is very close to the European Union (EU) average of 10.9%, and places it 5^th out of 27 countries.

Who pays for healthcare in Belgium?

Public healthcare in Belgium is funded by a combination of health insurance and social security contributions. In addition, residents have to pay for the remainder of unsubsidized care.

Health insurance funds will cover:

• 50–75% of the costs for doctors, hospitals, and clinics
• 20% of most prescription costs
• Routine dental costs
• Maternity costs

Unemployed residents, pensioners, students, and those with disabilities are entitled to the same subsidies as the working population. Employees receive automatic cover for their children as well as any dependent spouses.

Belgian health insurance

As part of the social security enrollment process, all employees and self-employed must register and contribute to a health insurance fund in Belgium. This fund is called a mutuelle in French and ziekenfonds in Dutch; residents are free to select their own.

Health insurance contributions are 7.35% of your gross salary (3.55% paid by you; 3.8% paid by your employer). Self-employed workers can expect to pay the full 7.35% of their wages.

You may only qualify for reimbursements for the first six months after joining a mutuelle/ziekenfonds if you can prove you have paid sufficient social security contributions in your home country. If you hold an EHIC (European Health Insurance Card), you can use this until you register with a mutuelle/ziekenfonds.

You can compare Belgian health insurance quotes to pick the provider of your choice. Companies providing international health insurance coverage to expats include:

• Allianz Care
• Business & Expats Health Insurance
• Cigna Global

How do expats register for Belgian healthcare?

To access healthcare in Belgium, you need to register for social security. After you have done this, you can choose a mutuelle/ziekenfonds. Your employer often does this. Otherwise, you can visit your nearest social security office. You must provide a few documents, such as:

• 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 (known as eID) to take to the health insurance company of your choice. Your health insurance fund then reimburses healthcare charges.

Private healthcare in Belgium

Since Belgium has two separate healthcare sectors, doctors, dentists, and specialists can provide both state-funded and private treatment.

To use private healthcare in Belgium, you must take out private medical insurance or pay the full costs. Most private health insurers require you to pay medical costs upfront and then make a claim for reimbursement.

As public healthcare in Belgium is subsidized rather than free, many residents choose to take out a private insurance policy to top up their state coverage and give them access to private healthcare treatment.

Belgian doctors and medical specialists

Most doctors in Belgium work within the state health insurance scheme, but some combine this with private appointments. You can choose your general doctor in Belgium, although if they work in both the state and private sectors, make sure it’s clear which service you want.

Patients usually pay the doctor up front and then get a refund later from their insurer. You can also see a medical specialist without a doctor’s referral, but it will be cheaper if you do so through your family doctor.

Women’s healthcare in Belgium

Contraception is available over the counter in Belgium, including emergency contraception. Abortion is legal up to 12 weeks after conception and can be carried out at family planning centers and hospitals. See La Fédération Laïque de Centres de Planning Familial (FLCPF) for family planning centers in Brussels and Wallonia, or Luna for Flemish family planning centers.

To confirm pregnancy in Belgium, see your general doctor in the first instance. In the Flemish community, doctors provide prenatal care alongside gynecologists and obstetricians in private practices. Kind en Gezin, the Flemish children and family welfare agency, offers free advice and support to pregnant women and families with children under three years old.

In the French community, gynecologists and obstetricians work in public and private practices; your doctor can advise on your choice. See the Francophone agency Office de la Naissance de l’Enfance (ONE) for more advice and information.

Contact the Brussels Childbirth Trust (BCT) for information and advice about healthcare during pregnancy and prenatal classes throughout Belgium.

Children’s healthcare in Belgium

Those with health insurance can access either free or subsidized healthcare for their children in Belgium. You can register your child with your general or family doctor. Support is provided by the regional agencies Kind en Gezin (Flanders) and ONE (Wallonia).

Through these agencies, you can get support with the following:

• Prenatal checkups
• Medical checkups and screenings by a pediatrician
• Free vaccinations
• Weight and measurement to monitor development
• Hearing and eye tests

The vaccinations program includes shots for diseases such as:

• Polio
• Diphtheria
• Tetanus
• Whooping cough
• Measles, mumps, and rubella (MMR)

Belgian dentists

The state healthcare system includes Belgian dental care, where patients can claim reimbursements for check-ups and essential treatments. However, most dentists work privately, and treatment not covered under basic health insurance can be expensive.

For this reason, many people in Belgium take out private dental insurance to cover these costs. You must have at least one annual check-up to maintain public health coverage.

Hospitals in Belgium

There are public and private hospitals, university hospitals, and outpatient departments (polyclinics) in Belgium. As with general practitioners, you can arrange to see a specialist of your choice at any Belgian hospital, but check if your insurer covers them to ensure you can claim a refund.

Most hospitals will charge a daily fee for inpatient stays, depending on your circumstances (unemployed people pay less, for example) and the length of your visit (drastically reduces after the first day). You may also need to take things you need, such as a towel and soap. Although your health insurance should cover the costs of medical treatment you receive while in the hospital, you have to pay a fee for daily hospital care in Belgium.

You can also walk into emergency outpatients for immediate treatment, although, as in other countries, you should not use this as a replacement for a general doctor. However, you may have to pay a non-refundable small fee if you use emergency services without a referral.

Belgian health centers and clinics

Belgium has primary care centers (maisons medicales / wijkgezondheidscentra) where various different healthcare providers and professionals operate. These include general doctors, nurses, and physiotherapists. Patients can also register with a center to access services covered by public health insurance.

See the Federation Maisons Medicales (Wallonia) and the Vereniging van Wijkgezondheidscentra (Flanders) for further information.

Family Planning Centers are Belgium’s equivalent of family clinics, providing information and services on sexual and maternal health. The FLCPF provides facilities in Wallonia and Brussels. However, there are no family planning centers as such in the Flanders region. There is also Sensoa, which provides expert advice on sexual health, relationships, and other topics.

Pharmacies in Belgium

Belgian pharmacies (pharmacie/apotheek) are usually open Monday to Friday plus Saturday mornings, and have a green neon cross displayed outside.

In addition to regular opening hours, you can also find the nearest 24-hour pharmacy by entering your postal code on Pharmacie.be.

In terms of cost, non-prescription medicines are not refunded, but those prescribed by a medical professional are. You have to pay for prescription medicines when you collect them from the pharmacy, minus the set percentage payable by the insurer. Some medications are fully reimbursed, while others only up to 20%.

For further information about Belgian medicines, see the Federal Agency for Medicines and Health Products (FAMHP/FAGG).

Belgian mental healthcare

While mental healthcare is recognized as important and Belgium has a high proportion of professionals in the field, waiting times are often very long throughout the country.

Mental health services are available through public, private, and voluntary sectors in each region. They include:

• Mental health care centers that provide counseling, daycare, and residential care
• Psychiatric hospitals for people with ongoing mental health conditions
• The Community Help Service, a charity organization offering support and advice including counseling

COVID-19 in Belgium

Although Belgium still has some COVID-19 cases, most restrictions are now lifted for both travelers and those who live in the country.

For residents and tourists in Belgium, COVID-19 safety measures are implemented at the regional level rather than national. Currently, there are no restrictions in place in Flanders, Wallonia, or Brussels, but it is still recommended to wear a face mask in medical settings or very crowded public places.

COVID-19 vaccines are distributed at the regional level, so whether or not you’re due for a booster depends on where you live. See the following groups for more information on regional COVID-19 vaccine recommendations:

• Flanders: Laat Je Vaccineren
• Brussels: Vaccination-Info.be
• Wallonia: AVIQ, Je Me Vaccine
• German-speaking Belgium: Ostbelgien

Long COVID support in Belgium

Long COVID is well-documented and heavily studied in Belgium, with many resources to help those suffering from the disease find relief.

Also known as post-COVID, long COVID presents as symptoms of the coronavirus that last months – or even years – after infection. According to research by the Belgian Institute for Health, 32% of those who get COVID-19 still report symptoms six months after the illness. Long COVID is more likely to affect women than men, and the most common symptoms are fatigue, headache, memory issues, and muscle pain.

Belgium has an active long COVID community comprising smaller regional groups, usually connecting through a specific website or Facebook. Through these communities, anyone suffering with long COVID in Belgium can get the support they need and even find a doctor experienced in treating the condition.

Belgian physical therapy

Physical therapy (kinesitherapie/fysiotherapie) is a critical part of Belgian public healthcare, and you don’t need a doctor’s referral to access this treatment.

For the most part, Belgian public healthcare (PDF, in Dutch) does cover the cost of physical therapy the same way it covers treatment from a doctor or dentist.

If you’re looking for physical therapy in Belgium, the country has over 5,000 licensed practitioners accredited by the national association of physiotherapy, AXXON. You can find a physiotherapist near you through AXXON’s search feature (in Dutch).

Alternative medicine in Belgium

You can find alternative and complementary therapists in Belgium. The most popular treatments include the following:

• Homeopathy
• Acupuncture
• Osteopathy
• Phytotherapy
• Chiropractic

However, public health insurance doesn’t officially reimburse these treatments. You can also cover some treatments if a qualified professional carries them out. Private companies usually insure alternative medicine, but not as part of the basic package. You will have to pay for the additional coverage.

Belgian medical schools do not teach alternative medicine; therefore, students must gain qualifications at specialist schools and colleges. Therapists should belong to a regulatory body or association like the Belgian Acupuncture Federation.

What should you do in an emergency in Belgium?

The Belgian emergency numbers are:

• Medical service: 100
• Emergency doctor: 1307
• On-call pharmacy: 0900 10 500 / 070 66 0160 (fees may apply)

Call the pan-European emergency number 112 (or 114 hearing assisted), free of charge from any phone, for any life-threatening situation. When you call, they need to know the type of emergency, the address, and the number of people in danger.

An ambulance will take you to the nearest hospital. However, be aware that you will typically have to pay for this service unless you have special or private health insurance that covers this.

How do you make a complaint about Belgian healthcare?

Suppose you feel your rights as a patient were violated or that a healthcare provider acted in an unprofessional manner. In that case, your first step is to submit a complaint directly to that faculty or organization. This usually means seeking out a hospital or clinic’s ombudsman or complaints department.

Should you still have concerns or an unresolved issue after complaining directly to the provider, you can contact the authority regulating them. Depending on which region of Belgium you live in, you can submit a healthcare-related complaint to a different agency:

• Flanders: Zorg en Gezondheid (Agency for Care and Health) or Vlaams Patiëntenplatform (Flemish Patients’ Platform)
• Wallonia: Agence pour une Vie de Qualité (Agency for a Quality Life)
• Brussels: Federal Ombudsman Service for Patients’ Rights

Useful resources

• Federal Public Service Health, Food Chain Safety, and Environment – government agency responsible for Belgian healthcare
• Belgian Hospital Association – an official association of public hospitals across Belgium
• Belgian Social Security Office – government agency responsible for payments to social security and healthcare eligibility