International Handbook of Medical Education

By Abdul W. Sajid; Christine H. McGuire et al. | Go to book overview

4
Belgium

L. CASSIERS

Belgium is a small European country whose geographic location has laid it open to foreign influences throughout its history, resulting in a long-standing outward- looking tradition. The country's population is characterized by multiple philosophical and linguistic backgrounds. Belgium has both French and Dutch- speaking populations, which has created an atmosphere conducive to competition and creativity.


OVERVIEW OF THE HEALTH CARE DELIVERY SYSTEM

Belgium s health care system is based on the principle of compulsory insurance. All individuals are required to pay a percentage of their income in social insurance contributions and must register with a sickness insurance fund. The fund reimburses individual health care expenditure according to tariffs set by the national government. The sickness insurance funds are not private insurance companies in the commercial sense. They are strictly regulated by a lengthy series of statutes, and in fact, they are, to a large extent, the creatures of (and have many de facto links with) political parties and trade unions.

The doctor-patient relationship is governed by the principle of freedom of choice. Individuals consult the practitioner of their choice, while doctors are free to charge the amount they see fit. In practice, however, the surplus of medical practitioners means that the vast majority of doctors apply the scale of charges recommended by the state in order to maintain the size of their practice. The same applies to the hospitals, which are noncommercial bodies bound to the state under detailed contracts stipulating compliance with the scale of charges.

The rates of reimbursement of health care expenditure are fixed under collective agreements between the doctors' professional association, insurance funds, and the state, one of whose obligations is to underwrite any losses incurred by the system. In essence, health care is a semi-state-run system. Individuals have freedom to choose their doctor and receive virtually free treatment with no

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