Our commune

I lost our first weekend in Belgium to an ear infection, but things are getting better now. After paying through the nose for health care in America I was worried at how much the doctors visit would cost us - because while I registered in our commune on Friday, until the registration is formalised I have to pay the full cost for health care.

 

The commune registration is very quaint. You have to line up at the town hall with your residence contract to prove that you live in the commune. Some time over the next week the police will make a visit to your house to ensure that you do indeed live there, then they will send you your registration card, which allows you access to health care, unemployment benefits and so forth.

 

Registration registers you in both a Community and a Region. Regions are basically States, with Flanders, Walloon and Brussels being the three Regions, with responsibility over most physical infrastructure. Communities are a parallel division of power, being responsible for intangibles such as language and culture, but also (oddly enough) health care. The three Communities are the Flemish, French and German. So someone living in Flanders will be registered in the Region of Flanders and the Flemish Community, someone living in the French part of Walloon will be registered in the Region of Walloon and the French Community, someone living in the German part of Walloon will be registered in the Region of Walloon and the German Community, while someone living in Brussels will be registered in the Region of Brussels and either the French or Flemish Community, depending on their choice (since Brussels is the only officially Bilingual city). The Communities and Regions are quite important, as the Federal Government has been stripped of power by the Flemish-French dispute.

 

The Belgian health care system works as a multi-sector universal health-insurance system with third-party health providers financed through public taxation on the “solidarity principle”.

The system was developed in 1894, and essentially means that every person has to register with a private “sick fund” of their choice, which are dominated by the Catholic, Socialist and Liberal funds. People do not pay anything to their health insurance directly, instead insurance funds only get money when people use health care services. When someone does use a health care service they pay a small percentage (depending on how vital it is - for life-saving services they pay nothing) and the health insurance fund pays the rest and claims reimbursement (plus an administrative cost) from the government. Since the government is obliged to pay without medical review, in Belgium the health insurance funds try to get everyone to access as much health care as possible, unlike America where they tend to do everything possible to keep people from using health care. As a result there is actually an oversupply of health care, no waiting lists, a hospital within 20km of every person and a doctor for every 300 people.

 

Luckily this meant I could just walk into a doctors surgery to get a prescription for my ear infection, and even paying full price due to a lack of a registration card the appointment was reasonable - just €30. Our worries about language issues were also unfounded, the doctor seamlessly switched from Flemish to English and seemed oddly embarrassed when he found the only flaw in his English ability - not knowing the English name for the skin lining the ear canal (do we even have a word for that?).