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KCE reports vol. 40 APPENDICES Physiotherapy 3
B. COUNTRY ANALYSES
1. BELGIUM
1.1 BACKGROUND INFORMATION ON THE HEALTHCARE
SYSTEM
1.1.1. Existing Coverage Schemes
The Belgian health care system is based on a statutory insurance scheme, traditionally distinguishing
between salaried workers and the self-employed. Universal coverage for all residents was officially
introduced in 1998. Complementary to the compulsory health insurance, additional coverage for
mainly outpatient care is taken by the majority of self-employed (9,6% of all insured residents in
2004). In general, private complementary insurance policies are gaining in popularity. In 2003, there
were over 13.000.000 private policies for 10.355.844 residents (1).
1.1.2. Institutional Framework
Regulation and supervision of the health care system is centralized at the federal level. Federal
authorities issue laws on health and disability insurance, hospitals, professional qualifications, etc.
They also set annual budgets and supervise health care technology control. The main governmental
body at this level is the Ministry for Social Affairs, Public Health and the Environment.
Reimbursement (and auditing) of medical care is organised by various mutualities , private not-forprofit
sickness funds. The mutualities in turn are funded by the RIZIV/INAMI, National Institute for
Sickness and Invalidity, a public body that comes under the Ministry. Mutualities and health care
providers are both represented within RIZIV/INAMI and regulate health care fees through annual
agreements.
Regional authorities (language communities) are mainly responsible for health care measures
pertaining to education and prevention.
1.1.3. Health Care Delivery
Health care provision in primary care is predominantly private and based on independent medical
practice. In general, no referral system applies to primary care in Belgium. Most doctors (GPs and
specialists alike) operate in solo practices.
Secondary and tertiary care is provided by hospitals. Most are non-profit organisations. Privately run
hospitals account for around 60% in total. A further distinction is made between psychiatric and
general hospitals, the latter comprising acute care hospitals, geriatric hospitals and specialist hospitals.
So-called university hospitals have special status on account of additional research and teaching
functions.
1.2. PHYSIOTHERAPIST PROFESSION
1.2.1. Minimal Entry Requirements
Educational requirements are set by the Ministry of Health for practicing physiotherapy at minimally 4
years of post-secondary education (master s degree). Furthermore, physiotherapists in private
practices have to satisfy general legal criteria for self-employment. Private professionals are required
to meet minimal standards regarding their working environment and medical equipment. A registered
declaration has to be filed with the INAMI/RIZIV. Physiotherapy services are covered for professionals
who enjoy additional recognition by RIZIV/INAMI.