A healthy new year: The Bulletin's guide to healthcare in Belgium

According to the Euro Health Consumer Index, which annually compares the healthcare systems in 36 European countries, Belgium currently has the sixth best healthcare provision in Europe.

The report described the Belgian system as “generous and focused on good service”. In recent years the system has been made more reliable, the number of hospital infections reduced and patients better informed. One point of criticism is that antibiotics are still prescribed too quickly.

To benefit from the social security healthcare system in Belgium, you have to join a health insurance fund (mutuelle/ziekenfonds). Most are linked to political parties but are open to everyone. Th e funds will generally reimburse between half and three-quarters of the bills of a doctor or specialist visit. You can also take out complementary insurance with one of the private companies, which are united by umbrella organisation Assuralia.

Because of the rising costs of the healthcare system, the Belgian government recently decided that health insurance funds and private insurers can annually adapt their tariffs.

Your first line of help is general practitioners, who either have a private practice or are attached to a clinic or hospital. There is no shortage of GPs in Belgium: according to recent calculations there is one for every 1,250 inhabitants – compared to one per 2,300 in the Netherlands, for example.

You are free to consult the doctor of your choice. Belgian doctors work with appointment systems, walk-in consultations on a first-come-first-served basis or a mixture.

They also make house calls. You can give your GP permission to hold a central record of all your medical records. For a duty doctor in Brussels, call 02 242.43.44.

Most doctors work within the health insurance scheme and have standardised prices. If they don’t, you may be charged more, so check this beforehand. After paying, you will receive a receipt outlining the treatment and cost to send to your health insurer for a refund.

To find a local doctor, the Golden Pages are helpful. Many Belgian doctors speak English, but there are several ways to make sure you’ll be able to communicate easily. Your embassy will usually have a list of doctors who work in your language, while the Community Help Service (CHS) also offers a 24/7 helpline, providing contact details of medical professionals as well as general information and anonymous support.

A helpful website is Geomed.be, where you can track down a doctor in Brussels who speaks your language. These resources will also help you find specialists covered in the following pages.

Finding a pharmacy is rarely a problem in Belgium: just look out for the green cross signs in the streets. Most are open during regular working hours. Outside these hours, call 0903.99.000 to find a duty pharmacist near you. 

Prescriptions must be paid for on collection. If you have additional cover, the pharmacist will issue a receipt for reimbursement.

People who have difficulty affording regular medical assistance are helped by their local public centre for social welfare (centre public d’action sociale/openbaar centrum voor maatschappelijk welzijn) – a public institution provided by the municipalities.

In an emergency, call 100 or 112 and an ambulance will take you to the nearest emergency centre. You will be reimbursed half of the cost of this transport.

Healthy living

It’s not just when you’re sick that you need medical intervention: here you’ll find information on dentists, opticians, dieticians, plastic surgeons and physical therapists in Belgium.

The majority of dentists work within the state health insurance system and respect the agreed fee scale that sets the level of reimbursement for basic treatment. For children, basic dental care is reimbursed completely. From spring 2016, you will have to pay 15% more for technical care – like filling and removing a tooth – if you don’t pay a visit to the dentist at least once a year. 

For specialist work, such as crowns and bridges, the dentist may ask how you will pay and offer you different quotations. There also is a large group – 31% of the dentists in Belgium according to a survey in 2010 – who work outside the state system and are free to set their own prices. There are both Dutch-speaking (www.tandarts.be) and French-speaking dentist associations (www.dentiste.be), which provide advice. To find a Dutch-speaking dentist in Flanders and Brussels at the weekend and during holidays, call 0903.399.69. If you need a French-speaking dentist in Brussels outside the working week, call 02.426.10.26.

Normally, opticians in Belgium work on the basis of a medical prescription, attributed by an eye doctor – either an optometrist or ophthalmologist. You’re advised to visit your eye doctor for a test once a year. Some opticians can also evaluate your eyesight and determine the necessary adjustments to the power of your lenses. There are about 2,000 opticians companies in Belgium.

Their number is growing because of the ageing of the population. The large chains, like Pearle, are increasingly active. Most insurance funds partially reimburse the costs of optical care, and a list of accredited opticians and optometrists can be consulted at www.opticienoptometrist.be.

The profession of dietician in Belgium is legally recognised and reserved for experts with a diploma in nutritional science. A dietician gives advice on eating healthily but also helps in cases of diseases or disorders requiring dietary advice. If you need advice because you’re ill, bring a reference letter from your GP or specialist. Under certain conditions, some health insurers partially repay your treatment.

Reimbursements are possible if you need help because you suffer from diabetes, kidney failure or obesity, for example. Dieticians can be consulted in both private practices and hospitals. The Dutch-speaking (www.vbvd.be) and French-speaking federation (updlf-asbl.be) offer online tools to find recognised dieticians.

Plastic surgery is an officially recognised medical discipline in Belgium. The medical specialists need to have the diploma of medical doctor and to have done six years of internships. The Royal Belgian Society of Plastic, Reconstructive and Aesthetic Surgery is responsible for training specialists and the continuous training of accredited practising specialists. You can track down an accredited specialist near you via their website.

There is an increasing demand for physical therapy in Belgium, partly because of an ageing population, and the number of people studying physical therapy has grown in recent years.

Health insurers reimburse treatment by recognised physical therapists, if you present a medical prescription from a doctor. For complaints such as a stiff neck or a sprain, you can get up to 18 sessions a year reimbursed at the regular tariff. For acute or chronic disorders, like post-operative disorders, you get 60 sessions reimbursed at the regular tariff. There is no limit for more serious disorders, like mucoviscidosis. Physical therapists work in private practices and in hospitals. They also make house calls.

The responsible Belgian federation has established an online register where you can find a physical therapist near your home: www.kinesitherapie.be

Alternative medicine

For those looking beyond the regular field of medicine, Belgium also has many experts in alternative health and medical practices. The alternative treatments of homoeopathy, acupuncture, osteopathy and chiropractic are reimbursable if the practitioner is a qualified doctor. The content and cost of the insurance is different for every fund, but by getting private insurance, you can get additional refunding.

In 2014, the Belgian government introduced legislation stipulating that homeopathic remedies may only be prescribed by a qualified doctor, dentist or midwife and only as an additional activity to their main profession in the healthcare sector.

Every homeopath will in the future need to have a higher education diploma in homeopathy and to be registered with the ministry of public health.

While osteopathy is increasingly popular, especially for the treatment of lower back pain and joint pain, the discipline is not yet officially recognised in Belgium. According to recent estimates, 700,000 patients a year visit an osteopath in Belgium. About 40% of visits to an osteopath are based on referrals from a general practitioner, and osteopaths also work in hospitals. About 1,000 osteopaths are connected to a professional association and the government is considering having these officially recognised for their activities which are considered “evidence-based medicine”. The federal organisation uniting the recognised professional associations of osteopaths
in Belgium, the GNRPO, has a tool to find osteopaths on its website, www.gnrpo.be

Chiropractors most often treat neuromusculoskeletal complaints including back pain, neck pain, pain in the joints of the arms or legs, and headaches. The chiropractor primarily focuses on the spine, joints and the muscles, while an osteopath has a broader approach and also concentrates on the rest of the body. The government is looking into the possible recognition of chiropractors regarding activities considered “evidence-based medicine”. Like osteopaths, chiropractors are common in Belgium. The Belgian Association of Chiropractors lists contact details of chiropractors on its website, www.chiropraxie.org

Acupuncture is a part of traditional Chinese medicine, involving inserting thin needles into the body at specific points. Acupuncturists can also apply heat, pressure or laser light to these points. It is commonly used to relieve neck pain, lower back pain, headache and insomnia. It is rarely used alone but rather as an addition to other forms of treatment. In 2011 the Belgian Health Care Knowledge Centre concluded in a report that acupuncture had at best only a light pain-relief effect. In that year, 3% of the Belgian population visited an acupuncturist. The report stated that some patients’ satisfaction with the results is a placebo effect.

Acupuncture is not yet legally recognised in Belgium. The Belgian Acupunctors Federation (BAF), the largest federation of acupuncturists in the country, is asking the government for this recognition. The BAF believes that only holders of a diploma in medicine, physical therapy, nursing or midwifery should be able to get access to the profession. On its website (www.acupunctuur-baf.be), you can find an acupuncturist in your region who meets the BAF’s expertise standards.

Much attention has in recent years gone to increased screening and guidance of both professional athletes and sports enthusiasts, especially in terms of heart screening. Most health insurance funds don’t pay back sports medical examinations when it concerns a preventive screening, but if a GP refers you to a sports doctor for a checkup, for example because of dizziness or shortness of breath during physical exercise, the funds will usually reimburse you partially.

The responsible Flemish federation (www.sportartsen.be) helps you find an accredited sports doctor in Flanders and Brussels. In Brussels, the Medical Centre in Uccle among others specialises in sports medicine.

Treatment by hypnotherapists, influencing the patient under hypnosis, can accelerate certain therapy processes. The physical and mental relaxation of hypnosis is primarily used in the treatment of anxiety, eating disorders, addiction, a lack of self-confidence, failure anxiety and phobias.

Every hypnotherapist has specific fields of expertise, for example dealing with traumas and helping to quit smoking. Certain health insurance funds partially pay pack the cost of hypnotherapy sessions. Both the Dutch-speaking (www.vhyp.be) and the French-speaking federation (hypnose-et-hypnotherapie.be) provide contact details of hypnotherapists.

This article was first published in the Bulletin Newcomer Autumn 2015