Compulsory social health insurance covers most Belgian residents (99%), who are affiliated to a sickness fund of their choice or to the public auxiliary fund. The provision of care is based on the principles of independent medical practice, direct access (no gatekeeping), free choice of physician and of health care facility, and predominantly fee-for-service payment. The organization of the health care system is divided between the federal authorities and the federated entities. Current health expenditure per capita in Belgium (EUR PPP 4 168) in 2021 was among the top 10 in the EU, representing 11.0% of GDP. Public expenditure on health was 77.6%, while out-of-pocket payments and voluntary health insurance represented shares of 17.9% and 4.5%, respectively.
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