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Belgium has one of the highest doctor-to-patient ratios in the world, with one doctor for 220 inhabitants, against 300 in France, 390 in the US and 440 in the UK. Here’s how to make the most of one of the world’s best health systems.
While you will never be refused medical treatment in Belgium on the grounds that you cannot pay, the implications of getting sick with inadequate health insurance coverage can be serious.
To benefit from national health insurance and social security, you must pay contributions, either as an employee (employers automatically deduct health and social security contributions from salaries) or as a self-employed worker (indépendant/zelfstandig).
It is then up to you to shop around and join the mutual insurance association mutuelle/ziekenfonds best suited to your needs. These companies reimburse a percentage of medical costs, in line with codes fixed by Belgium’s national insurance institute, the Inami/Riziv. Some also provide complementary insurance, for example for non-conventional medicine, hospital stays in private rooms or even home carers for sick children of working parents. However, since the cost of treatment often exceeds the fixed Inami prices, you will rarely be fully reimbursed. Newcomers should also be aware that once you have signed up to a mutuelle/ziekenfonds, there is a six-month trial period before you qualify for reimbursement and other services offered by these companies.
Social security cards
All social security contributors receive a personalised social security ID card called SIS (Système d’Identification Sociale). The cards contain details such as the holder’s national insurance number, date of birth and insurance cover. They have to be presented at hospitals and chemists so reimbursement can be calculated on the spot with the patient paying the outstanding amount.
In the long term, and once doctors and dentists have invested in the necessary processing machines, SIS cards will be accepted in medical and dental practices too. In the meantime, you must give the health insurance fund a certificate given to you by your doctor or dentist, complete with a sticker bearing your personal details and provided by your health insurance fund. The deadline for reimbursement is two years from the date of issue.
SIS cards must also be presented at welfare offices for all questions concerning unemployment, disability and pension benefits.
EU nationals recently settled in Belgium who have yet to become fully-fledged members of a health insurance scheme can make provisions for medical costs by obtaining a European Health Insurance Card in their own country before arriving in Belgium.
Choosing a doctor
In Belgium you are free to choose any general practitioner or specialist, no matter where you live and without a referral. This freedom aims to benefit the patient and encourages shopping around.
Doctors may choose to be registered as part of the national health service (conventionné/geconventioneerd) or private (non-conventionné/niet geconventioneerd). The former apply prices close to those fixed by the mutual associations. Doctors, particularly some specialists, may charge significantly more for the treatment they provide. Many work as both conventionné and non-conventionné and it can be cheaper to book an appointment at the hospital they are attached to rather than their private surgery. When you call for an appointment, you may be asked which you prefer. You can also ask your pharmacist to recommend a doctor.
Before committing to treatment, especially if you need surgery, check costs because these can vary widely between doctors and hospitals. Note that the conventionné status is not always a reflection of skill: some doctors choose to be national health service doctors on principle, not because they have too few patients.
If you don’t feel your French or Dutch is up to scratch, it may be a good idea to visit your country’s consulate and embassy for a list of physicians who can speak your mother tongue. The Community Help Service’s Help Line can provide details of English-speaking doctors. If you live in Brussels, you can find a GP in your area by visiting www.mgbru.be. Otherwise, try the Q&A forum on www.xpats.com or if all else fails, see the White Pages telephone book under D for Doctors. For dentists, see the Yellow Pages.
www.chsbelgium.org, tel 02/648.40.14
Emergency services and ambulances are generally quick, and help often arrives faster than it would in a comparably-sized city in other countries. Ambulances responding to the 112 and 100 numbers take patients to the nearest facility that provides appropriate emergency care; a doctor’s approval is needed to transport a patient to a different hospital. In case of poisoning, drowning or a cardiac problem, you should request a physician to accompany the ambulance.
All chemists display a list of pharmacies open until 23.00, according to a rota system. Addresses of pharmacies open between 23.00 and 9.00 are available on www.pharmacie.be or www.apotheek.be (type in your commune’s postcode to find the nearest duty chemist) or by phone on 0900.10.500 (€0.50 a minute). If a chemist that should be open looks closed, ring the bell. For safety reasons, more and more duty chemists handle sales through security windows. Emergency medical and dental services as well as duty chemists are also listed in daily newspapers.
For hospital stays or visits to the emergency outpatients’ ward, don’t forget to take your SIS card or other proof of insurance, blood group details and information about current medication. This is particularly essential for people suffering from chronic illnesses.
Bring personal effects with you (nightclothes, dressing gown, slippers, towels, soap, toiletries) for a hospital stay, as nothing is provided. Hospital stores can be expensive, so bring your own bottled water too. The day before an operation, you may be asked to join queues for blood tests, a cardiogram, a chest X-ray and a meeting with the anaesthetist. This can take several hours. Most university hospitals allow a parent to stay overnight with a sick child for a fee, but the practice varies among private hospitals.
Belgium is one of the world’s pioneers in fertility treatment, attracting many people from abroad. Treatment is widely accessible, and university hospitals usually have the most up-to-date fertility department.
When seeking fertility treatment, you do not need a referral from a GP to benefit from national health insurance: anyone who contributes to the Belgian social security and health insurance system can recuperate some of the costs via a mutual association (see previous page). Those who do not have national health insurance can contact a fertility clinic as a private patient. One attempt at IVF now costs up to €34,200, with Belgian insurance funds offering higher reimbursements for women under 43, putting the cost for couples at a few hundred euros per attempt (to a maximum of six attempts).
There are 18 officially recognised hospital centres specialising in fertility treatment in Belgium. In Brussels they include:
Akademisch Ziekenhuis, Jette, www.brusselsivf.be, tel 02/477.66.99
Hôpital Erasme, www.hopitalerasme.be, tel 02/555.31.11
Cliniques Universitaires Saint-Luc, www.saintluc.be, tel 02/764.11.11
Pregnancy and childbirth
On the whole, Belgium favours an interventionist approach to pregnancy and childbirth. This means that you will almost certainly be closely monitored throughout pregnancy and offered numerous tests and ultrasounds. Invasive tests such as chorionic villus sampling or amniocentesis may be prescribed if your baby has a high risk of carrying a genetic or chromosomal disease such as Down’s Syndrome.
Towards the end of your second trimester, your doctor will send you to a physiotherapist for ante-natal classes. These will teach you postures as well as breathing and relaxation techniques. Physiotherapists usually help during the birth. They also hold post-natal classes to help new mothers get back into shape.
Employed women in Belgium are entitled to 15 weeks of maternity leave (19 for multiple births), one of which at least must be taken before the due date and nine after the birth. The remaining five weeks can be taken either before or after. Some women choose to extend their maternity leave with an unpaid breastfeeding leave. Those who wish to continue breastfeeding while returning to work are entitled to two half-hour breaks during the day to feed their baby or express their milk. Fathers can take up to 10 days off in the month following the birth.
For advice in English about pregnancy and childbirth, ante-natal classes or recommendations about gynaecologists and hospitals, contact the Brussels Childbirth Trust, an independent branch of Britain’s National Childbirth Trust that is a non-profit association and welcomes all nationalities. For information about breastfeeding, contact the Belgian chapter of La Leche League.
www.bctbelgium.com, tel 02/215.33.77
The choice of maternity hospital will largely be dictated by your gynaecologist, who is likely to be present at the birth. Popular choices in Brussels include the Clinique Edith Cavell in Uccle as well as the Saint-Pierre, Erasme and Etterbeek-Ixelles hospitals. Epidurals are routinely administered. After childbirth, mothers and babies spend an average of five days in hospital. Home births supervised by midwives are also becoming more common.
www.sages-femmes.be (in French)
www.bollebuik.com (in Dutch)
Most children’s vaccines are provided for free but your paediatrician will charge for the consultation. For free vaccinations go to ONE, the French-speaking community’s Office for Birth and Childhood, which organises free medical services for children aged up to six. Its Flemish equivalent, Kind en Gezin, similarly offers free vaccinations and baby-care. Daycare centres recognised by ONE and Kind en Gezin also vaccinate babies and toddlers regularly and, once the child is in school, there is a compulsory medical check-up once a year. An up-to-date vaccine record is required for all children to enter daycare and primary and secondary school.
www.one.be, tel 02/542.12.11
www.kindengezin.be, tel 02/533.12.11,
If depression happens to you, it’s crucial not to brush the issue under the carpet and to seek help.
You don’t need a referral from your GP to see a mental health professional, although it is a good idea to approach them first. They might prescribe tests that could reveal a medical cause to your problem. They may also direct you to a psychiatrist, psychotherapist or counsellor.
The English-speaking Community Help Service is a useful source of advice. They also run a telephone crisis helpline and a Mental Health Centre staffed by English-speaking professionals in Brussels’ Bascule area.
www.chsbelgium.org, tel 02/648.40.14 (crisis helpline)
33 Boulevard de la Cambre, 1000 Brussels, tel 02/647.67.80
People struggling with addiction can seek help from their local chapter of Alcoholics Anonymous or drugs helpline Infor-Drogues.
www.alcooliquesanonymes.be, tel 02/511.40.30 (in French)
www.aavlaanderen.org, tel 03/239.14.15 (contains info and links in English)
Infor-Drogues, tel 02/227.52.52, 24 hours a day (in French)
De DrugLijn, tel 078/15.10.20, Monday to Friday, 10.00 to 20.00 (in Dutch)
Some alternative, or parallel, medicine is reimbursed, but only when the practitioner in question is registered as a qualified doctor. Increasingly though, mutuelles are making exceptions to this rule and provide some reimbursement against payment of an additional fee. As it stands, the law recognises four types of non-conventional medicine: acupuncture, homeopathy, osteopathy and chiropractic.
A yearly visit to the dentist is mandatory if dental treatment is to be reimbursed by health insurance companies.
Belgium is a world-leader in organ transplants and Saint-Luc University Hospital (tel 02/764.11.11) is one of the world’s top centres. As in every country, doctors’ efforts are hampered by the shortage of organs on offer. Belgian law encourages organ donation: anyone who has lived in Belgium for more than six months is presumed, like all Belgian citizens, to consent to organ donation should they die here. Relatives have the power to veto organ donation, unless the dying person has made his or her consent explicit. If you want to clarify the fate of your organs, state your preference at your local town hall.
Doctors in Belgium are allowed to help a patient “suffering from constant unbearable physical and mental pain” to die. The euthanasia law was adopted in 2002.
For information on all aspects of health in Belgium, see the Ministry of Health’s website.
In Belgium, each commune has its social welfare centre – Centre Public d’Aide Sociale/Openbaar Centrum voor Maatschappelijk Welzijn (CPAS/OCMW).
These centres provide material, financial, social, psychological and medical assistance to individuals or families in need.
The CPAS/OCMW is responsible for palliative, curative or preventive health care services in each commune; they also run some hospitals or retirement homes. They can provide home-helps, personal services or meals to the elderly, disabled or bedridden. Childminders are provided for children whose parents are ill, or for sick children with working parents. If you have been in hospital and find you cannot afford to pay the bill, which generally arrives several weeks after your discharge and includes costs not covered by your health insurance, you should contact your local CPAS/OCMW. Telephone your commune for details.
Health insurance funds
The following are the addresses of the head offices of the main health insurance companies.
Alliance Nationale des Mutualités Chrétiennes
579 Chaussée de Haecht, box 40, 1031 Brussels
Union Nationale des Mutualités Neutres
145 Chaussée de Charleroi, 1060 Brussels
Tel 0800.30.004 or 02/538.83.00
Union Nationale des Mutualités Socialistes
32-38 Rue Saint-Jean, 1000 Brussels
Union Nationale des Mutualités Libérales
25 Rue de Livourne, 1050 Brussels
Union Nationale des Mutualités Libres
19 Rue Saint-Hubert, 1150 Brussels
74/76 Boulevard Mettewie, 1080 Brussels
Partenamut (Brussels & Wallonia)
1 Boulevard Anspach, 1000 Brussels
Partena Ziekenfonds & Partners (international community and Flanders)
1 Boulevard Anspach, Box 6, 1000 Brussels, and Coupure Links 103, 9000 Ghent
Emergency health services
Emergency medical and ambulance service:
100 or 112*
*112 is the emergency number for police, fire and ambulance in Belgium
Belgian Red Cross 24-hour ambulance service:
Anti-Poison Centre/Centre Anti-Poisons/Antigifcentrum
070/245.245 or www.poisoncentre.be
Serious burns unit/Centre des Brûlés/Brandwondencentrum
0800.15.801 (French), 0800/15.802 (Dutch)
0800.20.120 Monday to Friday, 18.00 to 21.00 (in French)
Community Help Service Helpline
02/648.40.14 (in English); 107 (in French); 106 (in Dutch)
Suicide Prevention Centre/Centre de Prévention du Suicide/De Zelfmoordlijn: 0800.32.123 (in French), 02/649.95.55 (in Dutch)
Medical services in the Brussels area:
General practitioners (on call 24 hours a day):
Dentists on duty evenings and weekends:
Pharmacies on duty:
Hospital emergency rooms
See under Cliniques in the White Pages for the hospital and emergency department nearest you