Belgium

The Belgian federal ministry is responsible for public health and social security including health care. Primary health care is provided by private general practitioners (GP), pharmacists, dentists and nurses. Both public and private primary care services are often provided even at home. Hospitals owners are either private or public entities. Most private hospitals, however, are for non-profit. Public hospitals are usually owned by the local authorities (municipalities).

The health financing is based on the Health Insurance Law that is part of broader social security code. The health insurance system is financed by contributions both from employees and employers (58%) and by federal state subsidies (42%). Every citizen can and must freely choose his own mutual health insurance company amongst the six options and the insurance company then reimburse the treatment costs based on the policy of the company. The companies often have religious or political affiliations.

In primary care patients have to pay small co-payment and in specialised care according to the fee schedule. Self employed without private insurance has to pay the full costs of primary care. Federal subsidies covers 80% of the hospital treatment costs of widows, disabled, orphans or retired one. For the rest of the patients the federal government reimburse 25% of costs based on the agreed day prices. Rest of hospital care and other medical activities are covered by the health insurance companies. Pharmaceuticals on positive list include co-payment from 0 to 85%. Other drugs are not reimbursed.

Primary health care is paid for and reimbursed by health insurance on fee-for-service basis. They do not have any gate-keeping role. Hospitals receive subsidies for major investments based on planned guidelines. Their recurrent incomes they get based on service performed based on Diagnosis Related Groups (DRG). Teaching hospitals get an extra 30% increase into the day price covered by the federal government because of the teaching status.