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Belgium - Health Service
In Belgium the emergency number 100 is available for emergencies requiring the fire brigade or an ambulance, and 101 is the number to call for urgent police assistance.
Both 112 and 100 numbers will result in the call being answered by the same operators. There is a 112/100 centre in every province of Belgium which will answer the calls from that particular area. Calls to 112, 100 or 101 are appropriate if the police, fire service or medical staff are required for a situation which is currently in progress or has just happened, especially where threat to people and property is involved. The operators deal with over 6 million calls each year to these emergency numbers, but one in four of the calls are not about emergency situations.
Ambulances are run by the hospital, the fire service or private companies as determined by local arrangements, with the Red Cross providing further ambulances to supplement existing services during large scale events. An ambulance will normally be staffed by a driver and a paramedic. For particularly serious situations a Medical Emergency Response vehicle (MERV) will be sent, staffed by a doctor and nurse from the accident department at the local hospital and by a driver.
Life expectancy in Belgium is 81.1 years, and lies in 21st place on the global ranking just below the UK and just above Finland.
Coronary heart disease, lung cancer and stroke are the leading causes of death in Belgium, reflecting issues of lifestyle within the country:
• The typical Belgian resident will spend about 80% of their time indoors and heavy car use is normal, which affects the activity levels of the general population.
• 1 in 4 residents regularly smokes cigarettes; the use of e-cigarettes by persons aged over 16 years only became legal with a royal decree in 2016.
• 1 in 12 residents in Belgium suffers from diabetes; this is higher than the 1 in 16 diagnosed in the UK and close to the 1 in 10 of the US. Mostly this is due to Type 2 diabetes affecting most developed nations around the world, but there are increasing numbers being diagnosed with Type 1, especially amongst the young.
Publicly funded healthcare and social security is run by the federal government, delegated to the independent private, public and university practitioners and institutions as appropriate via the three regional community authorities. Like many other countries, Belgian organises its medical healthcare system into primary care for non urgent first line care, secondary care for immediate and emergency treatment, and chronic or long-term care for individuals requiring daily help and care on an ongoing basis.
The 2015 Euro health consumer index compiled by industry analysts Health Consumer Powerhouse concluded that Belgium has probably one of the most generous healthcare systems in Europe, although it only holds fifth place in the index because medical treatment outcome rates could be improved.
The social security card (SIS Card) was introduced in the 1980s, issued to everyone who was entitled to social security protection. It was a plastic card the size of a credit card, and displayed an individual’s unique social security number. In 2014 the SIS Card was updated to become a plastic ID Card, known as the Belgium EID Card, which now contains the individual’s social security information on a card chip.
Every adult in Belgium who works as an employee has a social security deduction made to each wage payment in addition to the tax deductions; the employer pays these amounts, which are based on percentages according to wage levels, over to the Social Security Services and Inland Revenue Service respectively. The employer also makes a contribution to the social security services, again based on a percentage according to the employee’s wage levels. Failure to make social security payments is a criminal offence. Self employed workers must officially declare their earnings; they will be advised of the Social Security contributions to make should they choose to opt in to the system. People registered as unemployed will receive social security credits.
The healthcare system in Belgium is mostly publicly funded. The social security fund is used to pay for treatment of individuals via a mutuality. Every citizen who has not chosen to opt-out of the Social Security health system will choose a mutuality, pay for treatment as required and then claim a percentage refund from the mutuality, with the social security system then reimbursing the mutuality for the cost of the refund in addition to a contracted management payment to cover the organisation’s running costs.
In practice this means a patient will pay roughly €25 to visit the GP, then on submission of their receipt will receive 75% as a refund. It will be the same when visiting the dentist. Those patients who are registered with a specific social security code just pay €1 and do not receive a refund.
Each General Practitioner (GP) or physician will be self employed and running a practice they own, sometimes on a group basis. They form local arrangements with other GPs to ensure their clients can access primary care 24 hours a day 7 days a week even during holiday periods.
Patients attending a hospital consultation will pay as they leave and be given a receipt for their percentage refund. Follow up consultations will be billed directly to the social security scheme with the patient’s part being charged for their portion.
If patients are hospitalised, they pay weekly advances for their medical expenses, which may be up to €100 a week. They pay their individual portion, which may be later refunded to some extent, whilst the rest is billed directly to the scheme.
Unlike the UK, doctors working in hospitals will often be self employed and running their own practice. Exceptions include neurosurgeons, radiologists and researchers.
Hospitals generally specialise between those providing general non surgical care, including maternity wards and emergency departments, acute hospitals which are often linked to universities, and hospitals providing geriatric care for elderly people requiring medical treatment.
Belgium takes mental health seriously and provides 68 hospitals throughout the country to provide a range of services from secure detention for treatment to group therapy sessions for day patients.
The government financially supports the production and distribution of healthcare products to be used by universities and hospitals in their research programmes.
In 2016 two hospitals in the Belgian cities of Ostend and Liege introduced robots to their reception desks in the paediatric and geriatric departments. Known as Pepper, the 140cm humanoid assistant attached to a wheeled unit can recognise the human voice in 20 languages and identify whether it is speaking to a man, woman or child.
Medication from pharmacists will be paid for by the patient to a set limit, with the social security system paying the rest. Drugs and medications can only be sold by a pharmacist, including painkillers and acid stomach remedies which many countries allow to be sold by shops and supermarkets without prescription. The pharmacy based in a hospital only serves the medical staff on behalf of patients. All companies which produce and distribute medicinal products are licensed and required to maintain strict stock control procedures.
Only a few private hospitals operate in Belgium, catering to the luxury end of the healthcare market; the majority of hospitals are funded by the state. However, a number of premium based insurance systems are available. An independent ombudsman service oversees the health insurance system, to ensure termination of the insurance and other issues are all dealt with fairly; they may refer cases on to the government’s arbitration service.
If you are a British citizen you are entitled to use a European Health Care card whilst on holiday in Belgium. This will allow you to access health care services in Belgium, pay the fees required, and receive an 80% refund from the National Health Service on your return. However, the National Health Service is a residency based system, so even if you are a British citizen you are no longer entitled to receive NHS services if you move abroad. Your EHIC becomes invalid as does your right to treatment in the UK. Access to healthcare via the social security system (through your new employer) or a private health policy are essential and should be arranged in advance of moving to Belgium.
In 2006 smoking was banned from workplaces and restaurants across Belgium, and since 2011 it has been illegal to smoke in bars and nightclubs. Tobacco advertising and sponsorship are prohibited. But one in four adults regularly smoke and smoking is not banned from outdoor public areas, so bars, restaurants and cafes will often have an outside area dominated by customers smoking cigarettes.
Belgians tend to have liberal attitudes to personal freedoms, as long as the behaviour of an individual does not adversely affect others. On 1st June 2003 it became the second country in the world to legalise same sex marriage. In the same year, anyone over the age of 18 was permitted to possess up to 3 grams of cannabis, which is deemed sufficient for personal use.
In 2002, Belgium legalised euthanasia by lethal injection for competent adults and emancipated minors. In 2014 the law was extended to allow death by lethal injection for a child of any age who was close to death. In 2015 almost 2,000 people chose to die this way in Belgium, which caused some hysteria in the foreign press but less in the country itself. More than twice as many people choose euthanasia in the Netherlands, one of Belgium’s neighbouring countries. The majority of residents in Belgium declare themselves to have Christian affiliation, especially Catholicism, and most schools are run by religious institutions, but attendance at church on a Sunday morning is low across the country, and their views on important moral issues is much more relaxed than might be expected. There are strict rules governing each request for euthanasia, although some cases do generate discussion as people’s individual circumstances sometimes raise further questions.
Euthanasia has not ended suicide in Belgium; in fact it occurs at a higher rate than in many neighbouring parts of Europe, with 14.2 suicides per 100,000 inhabitants each year. Belgium’s development of a suicide prevention public policy and strategy is recent, and is aimed to coordinate services and personnel so that successful prevention can become the norm.
The Samaritans is a not for profit organisation which distributes food on a weekly basis to the homeless in Brussels. It is not to be confused with the suicide support line operated in the UK and US.
The Community Health Service offers mental health services to expats living in Belgium. They run a confidential and anonymous phone line open 24 hours a day, seven days a week. Phone 02 648 40 14 or visit www.chsbelgium.org if you are in crisis or need to access English speaking mental health services for yourself or your family.
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