Sharp rise in hospital costs not reimbursed by insurance

There has been a sharp increase in the amount of hospital costs being paid by patients rather than mutual insurance companies, according to figures from the InterMutualist Agency (AIM).

AIM’s annual report noted that €1.60 billion in payments and supplements were charged to patients admitted to hospital for scheduled or day hospitalisation in 2024 - and not covered by mutuelles - RTBF reports.

Nearly three-quarters of that amount related to additional fees or non-reimbursable amounts. Additional fees are used in part to finance hospitals, whose underfunding has been condemned by mutual insurance companies and the hospital sector.

AIM examined hospital admission bills from 2018 to 2024, covering standard stays, surgical and non-surgical day hospitalisations, and oncology admissions.

In 2024, the total amount billed per patient exceeded €3,000 for almost 100,000 standard stays and for more than 5,100 day hospitalisations.

The agency found that access to healthcare is a major issue. Supplements and non-refundable costs are excluded from the mechanisms protecting the most vulnerable patients, such as the MàF (maximum chargeable amount) or BIM (beneficiary of increased intervention) status.

The postponement of care for financial reasons particularly affects households on modest incomes.

The fact that bill amounts are unpredictable is another negative point highlighted in the report.

The maximum percentage of additional fees (from 100% to 300% depending on the hospital) was described as failing to provide clarity on the actual amounts paid by patients and AIM noted that while 90% of Belgians have hospital insurance, patients often sign a "blank cheque", not knowing how much their treatment will cost them, without any prior estimate.

Belgium’s mutual insurance companies blame the underfunding of hospitals for the high patient bills.

“The average rate of additional fees charged per hospital stay in a private room rose from 106.1% of the Inami health insurance rate in 2022 to 112.6% in 2024, even though a ‘standstill’ applied during the same period was supposed to freeze the increase in these rates,” insurance company Solidaris said.

Solidaris described the situation as "no longer acceptable", arguing that patients "cannot continue to be used as an adjustment variable in a hospital system that lacks sufficient resources".

Additional fees charged to hospitalised patients are partly transferred by doctors to the hospitals where they work and are used to run these establishments, which Solidaris said fuelled "a logic of commodification of health".

Elise Derroitte, vice-president of the Christian Mutual Insurance Company, said there was too much ambiguity within this system.

She also pointed to chronic underfunding of hospitals as a major issue.

“If services were adequately funded and there was good planning of hospital needs, there would be no reason for patients to be responsible for financing the funding gaps in hospitals,” said Derroitte.

Philippe Devos, director-general of Unessa, a federation representing a number of hospitals, echoed funding concerns.

“Doctors give part of their remuneration to finance hospitals: of the €760 million in fees described in the report, half goes to hospitals to cover their operating costs,” Devos explained.

“In reality, this half pays the equivalent of 4,000 full-time nurses. Without these additional fees, no hospital will be able to treat patients properly or access bank loans to make the innovations necessary for tomorrow's healthcare.”

Devos said the Belgian state should compensate, but was pessimistic about that happening.

“The government has no intention of refinancing hospital care,” Devos said.

“[Health minister] Frank Vandenbroucke (Vooruit) wants to review the system to make it fairer, but without injecting a single extra euro into it. So this refinancing will not actually solve anything, as it is just a rebalancing and not an increase in resources.”

Vandenbroucke said he noted the "persistent" increase in fees and the "unpredictability" it creates for patients, and said that he regularly asked hospitals and medical organisations "how to explain that there are hospitals where additional fees are very limited, while they are very high in others".

“There is no explanation,” the minister said, adding that "additional fees must be regulated".

“Organisations representing doctors, dentists and physiotherapists will have to negotiate with mutual insurance companies on a regulatory framework. This means limits on the additional fees that can be charged.”

The minister is expecting proposals by mid-2027.

“If there are no concrete proposals based on these discussions, the government will have to make a decision,” Vandenbroucke said.

“We’re currently preparing a reform of official tariffs, i.e. what doctors will earn based on their medical services, and we are also rethinking hospital funding. Hospital funding must be adequate. It must cover the expenses necessary for the proper functioning of a hospital. We are working on it.”

Overall, Belgian patients paid €1.6 billion for hospital costs in 2024, including €455 million in regulated payments and €1.15 billion in supplements and non-refundable costs.

Supplementary charges and non-reimbursable costs account for 72% of the bill payable by the patient, an increase compared to 2018 (67% of the bill payable by the patient).

Non-reimbursable supplementary medical fees alone amount to €760 million, or nearly half of the bill payable by patients.

More than half (57%) of these costs are directly related to the choice of a private room, a proportion that is increasing.

Fee and room supplements rose sharply between 2023 and 2024, despite the freeze on the maximum percentage of fee supplements, introduced in May 2022 to stabilise these costs.

The report notes a marked increase in expenditure on single rooms, with the average rate rising from €81.20 in 2023 to €86.60 in 2024 (+6.7%).

In day hospitalisation, there are significant differences depending on the type of day, the reason for hospitalisation, the type of stay and the category of room.

For example, for day hospitalisation for surgery, the price charged to the patient will be, on average, €119 in a shared room and €1,200 in a private room.

For day hospitalisation for a non-surgical reason, the patient will pay, on average, €42 in a shared room and €941 in a private room.

If hospitalised for day oncology treatment, the patient will have to pay €18 in a shared room and €125 in a private room.

In all cases, these amounts have been rising steadily since 2019 with the biggest increases in the cost of hospitalisation in a private room, rising by 7.5% in oncology day hospitals, 8% in surgical day hospitals and 11.5% in non-surgical day hospitals.

Even for the same procedure, bills vary greatly between hospitals and even within the same establishment.