Thursday, October 21, 2010

Medical care in Belgium

Earlier I posted on liability and medical issues. Here I want to explain how the Belgian medical system works from the point of view of a patient. If you go racing in Belgium, sooner or later you will come in contact with the medical system and it is a good idea to know what to expect before that happens.

You need not worry about the quality of care. It is generally agreed that Belgium has one of the best healthcare systems in the world, and I can personally attest -both as physician and patient- that medical care in Belgium is every bit as good and a whole lot more convenient and less expensive than in the US. As a matter of fact, I try to take care of most non-emergency medical and dental issues my family faces whenever I visit Belgium. You also need not worry about language issues as most medical personnel speaks English fluently.

Contrary to what you might think, healthcare in Belgium is not socialized medicine and both private and state supported care is available. Many Belgians have both. The whole issue is totally transparent to the patient. You go see the doctor, pay your bill and get reimbursed later. Here is a key difference with the US: when you go see a doctor in Belgium, bring cash (not credit cards or checks) and be prepared to pay at the end of your visit. You can inquire about fees beforehand if you like but usually these are very economical and you won't experience sticker shock.

There are two key reasons why healthcare is cheaper in Belgium. One is the absence of what I consider a huge, largely ineffective and super-expensive system of liability and medical malpractice. Malpractice in Belgium is largely unheard of and in most cases limited to physicians refusing to help people when they should have done so. It is not there to dole out huge sums of money for supposedly bad treatment. Yes people make mistakes in Belgium, but these are easy to handle without involving another paid (legal) professional and a hugely expensive legal system. I see it as plain common sense.

The second reason is that the reimbursement system is very streamlined and doctors do not need clerical help or office staff to run their practice. Some have staff but most don't.

When I worked as a general practitioner in Belgium, I rarely spent more than fifteen minutes a day taking care of reimbursement issues and I never had office staff. I answered my own phone and I, like most other GP's, did house calls when requested. When I closed the office door at night, the work was done, except for emergency calls.

Here is what happens: when you are very ill, call a general practitioner - any general practitioner - and have them come to your house or hotel. Be prepared to pay in cash. Doctors will visit day and night and cannot refuse to come when you indicate a serious problem. You may have to wait but when you indicate a serious issue or potentially serious issue, they are obliged to respond quickly.

Be aware though that calling a doctor at night is a whole lot more expensive than visiting one during the day. You can also go to an emergency room or call an ambulance but note that emergency care in Belgium is not set up to replace your doctor and anything that can be handled by a GP will be sent there. Don't go to the emergency room unless the issue is potentially life-threathening.

If you are involved in an accident or witness an accident, call "100" and an ambulance will be dispatched. Emergency care will never be refused, regardless of whether you have money or proof of insurance or lack thereof. You will always be treated and you will be treated the same way as everyone else. Nobody will worry about payment until you are ready to leave the hospital at the end of your stay.

At the end of a visit or house call, pay the doctor or dentist and he or she will give you a slip with a reimbursement code. What happens next depends on your coverage method. If you are working in Belgium and a member of the state's health coops (called mutualiteit or mutuelle), you will attach a sticker (you will receive stickers in the mail if you are a member) to the slip and collect the reimbursement at your coop. You are free to join any coop you like and although these are either religiously or politically affiliated, your reimbursement money is the same regardless. It is set by law and governed by the code the doctor gave you. If you have private insurance you will submit the form to your insurance company.

If you live and work in Belgium money will be deducted from your wages and you will have an SIS card (a credit card like ID card) that identifies you as a beneficiary. Always take this card with you when you seek medical help but once again nobody will refuse emergency care if you don't have your card.

The doctor will also give you a prescription slip (either for medication or additional care).  You have to take your drug prescriptions with your SIS card to a pharmacy. There are pharmacies (apotheek) everywhere and they can be identified by a green cross. Pharmacies are independent businesses and they are never found in supermarkets or other chain stores. There are no drugstores in Belgium. All medications, even over the counter medications are sold in a pharmacy and dispensed by a trained apothecary.

Doctor's offices and pharmacies are usually (but not always) located in the practitioner's residence. Most GP doctors and dentists have walk-in hours everyday, where you can just go in without an appointment. Hospitals may have a walk-in clinic for key specialists.

You need to go to the pharmacy or send someone there as prescriptions are never called in. Pharmacies are open during regular business hours and there is a rotation for after hours and weekends. The rotation is published in the local newspaper or displayed at the pharmacy you visit. You pay the pharmacist directly but in this case you only pay the difference between what the drug costs and the reimbursement. Once again, if you are a coop member you will need to affix a sticker to the slip. If you want generic drugs you should tell your doctor although in some cases the pharmacist will make a courtesy call to the doctor if you ask.

You are free to go to any doctor, dentist, pharmacy or hospital you choose, anywhere. You are also free to go to any specialist directly without using a GP referral. As long as the doctor works within the healthcare system you are fine in terms of reimbursement. Nearly all doctors do and those few that don't will advertise the fact. In some big cities like Brussels, Antwerp or Liege you may find doctors or dentists that only use private insurance. Anywhere else this rarely happens.

The government health insurance does not fully reimburse your bill. Expect to pay anywhere from half to a quarter of the bill yourself. While that may sound like a lot, the low cost of healthcare means it remains affordable for nearly everyone. Low income people also have other means of financial aid. Hospital bill are reimbursed more generously.

If you need to go to the hospital an ambulance will be called. Your doctor can treat you at the hospital and he or she will visit you there even if you are referred to a specialist there. Your attending physician is obliged to stick with you until the matter is resolved, unless you decide to switch doctors.

Once again, you are free to choose any hospital. If you are injured during a race or if you need emergency care, someone will choose a hospital for you. In an emergency the ambulance will take you to the nearest hospital. In a race, the organizers advertise the hospital they intend to use. If you are unhappy with these choices you can request a transfer later.

When you do go to a hospital remember to bring everything or have someone bring everything for you, including soap and towels. As a rule hospitals do not provide anything. Also remember that you will be put in a shared room or ward unless you request -and agree to pay for- a private room. Accommodations vary from hospital to hospital with some providing TV's and phones while others have neither.

Hospital stays in Belgium are very generous compared to the US. Nobody will try to usher you out and a weeklong stay is not unheard of for most indications so be prepared to bring or have someone bring personal items. The general consensus is that hospital food is pretty poor quality, but that too is no different from the US.

It is customary to give presents at the end of a longer stay and you should bring something for the staff and the doctors if possible. Flowers and chocolates are common but fancy wine and liquor are the rule.

Remember that anything and everything you say to a doctor or medical staff is covered by doctor-patient privilege. It can never be revealed to anyone, not even in a court of law. You cannot even release your doctor from this duty. Nothing you tell your doctor, or nothing your doctor discovers while treating you can be revealed to an outsider or be used against you or anyone else. If you go into a doctors office with a gunshot wound, they cannot tell the police about it. Minors are covered too and doctors cannot reveal issues to their parents without consent. This too is very different from US law.


Jenna Schrock said...

Belgium has an excellent health care system, as with most of Europe. Their health and dental services are always a priority. In fact, a British doctor remarked that removing socialized health care can result in a revolution.

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