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.