Abstract
In Belgium, the “public” side of health coverage is delegated and organized around non-profit private health insurers, namely mutual benefit societies, and as such, it is excluded from the perimeter of EU insurance law and regulation. Over the last two decades, and as a result of various governmental attempts to reduce health expenditure, mutual benefit societies nevertheless developed and managed on their own a variety of complementary coverage. This situation was challenged during the 2000s by for-profit insurance companies seeking to penetrate the market. In this context, they used both Insurance and Solvency II directives in their search for supranational support to challenge the position of mutual benefit societies. In turn, the latter responded by working politically to secure their position at the domestic level. As a result of these political struggles, a reform adopted in 2010 reinforced several features of the Belgian public-private mix by safeguarding the position of mutual benefit societies for complementary coverage. But this same reform also opened the supplementary side of health coverage to competition and aligned it with EU provisions, thus marketizing a share of the public-private mix in Belgium—with recent figures suggesting that this new pillar is now expanding.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
ASSURALIA. (2018). Les dépenses nationales en soins de santé (13th ed). Bulletin Hebdomadaire Assurinfo, no. 12.
Benoît, C., & Coron, G. (2019a). Expliquer l’échec de la mobilisation d’intérêts économiques à l’échelon européen: l’identité mutualiste aux prises avec la régulation du secteur de l’assurance. Politique européenne, 63(1), 8–35.
Benoît, C., & Coron, G. (2019b). Private Health Insurance in France: Between Europeanization and Collectivization. The Milbank Quarterly, 97(4), 1108–1150.
Bonoli, G. (2001). Political Institutions, Veto Points, and the Process of Welfare State Adaption. In P. Pierson (Ed.), The New Politics of the Welfare State (pp. 238–264). New York: Oxford University Press.
Colle, P. (2014). Quelques réflexions sur la loi du 26 avril 2010. Revue Belge de Sécurité Sociale, 3th trimestre, 321–327.
CURIA. (2010). Judgment of the Court (8th Chamber) of 28 October 2010—European Commission vs. Kingdom of Belgium. Luxembourg, C-41/10.
Ebbinghaus, B. (2005). Can Path Dependence Explain Institutional Change? Two Approaches Applied to Welfare State Reform. MPIfG Discussion Paper, 05/02.
Ebbinghaus, B. (2006). From Path Dependence to Path Departure in Welfare Reform Analysis. Newsletter of the European Politics & Society Section of the APSA, 5(2), 1–4.
Ebbinghaus, B. (2015). The Privatization and Marketization of Pensions in Europe: A Double Transformation Facing the Crisis. European Policy Analysis, 1(1), 56–73.
Ebbinghaus, B., & Gronwald, M. (2011). The Changing Public-Private Pension Mix in Europe: From Path Dependence to Path Departure. In B. Ebbinghaus (Ed.), The Varieties of Pension Governance: Pension Privatization in Europe. Oxford: Oxford University Press.
Engels, J. (1970). Evolution of the sickness and disability insurance 1945–1970. National Institute for Sickness and Disability Insurance: Brussels.
Esping-Andersen, G. (1996). Welfare States Without Work: The Impasse of Labour Shedding and Familialism in Continental European Social Policy. In G. Esping-Andersen (Ed.), Welfare States in Transition (pp. 66–87). London: Sage.
European Commission. (2006). Commission Scrutinises Belgian Law on Supplementary Health Insurance Provided by Private Sickness Funds. Brussels, IP/06/1781.
European Commission (2008). Reasoned Opinion C2008/1458.
Geerkens, E. (2002). Les mutualités professionnelles, un axe majeur de la politique sociale patronale pendant l’entre-deux guerres en Belgique? Revue Belge de Philologie et d’Histoire, 80(4), 1275–1349.
Graziano, P., Jacquot, S., & Palier, B. (Eds.). (2011). The EU and the Domestic Politics of Welfare Reform. Basingstoke: Palgrave.
Hassenteufel, P., & Palier, B. (2007). Towards Neo-Bismarckian Health Care States? Comparing Health Insurance Reforms in Bismarckian Welfare Systems. Social Policy & Administration, 41(6), 574–596.
Itçaina, X., Roger, A., & Smith, A. (2013). Institutionnalizations Compared: Implementing the EU’s 2008 Wine Reform. Comparative European Politics, 11(1), 119–142.
Lewalle, H. (2006). Regard sur l’assurance maladie privée dans l’Union européenne. Revue française des affaires sociales, 2-3, 141–166.
Ministère des Affaires sociales et de la Santé publique. (2009). Notification au Conseil des Ministres. Brussels, CMR Note du 13/07/09 (2009A70750.014).
Ministère des Affaires sociales et de la Santé publique. (2010). Réponse à la procédure de l’article 226-Mise en demeure-dossier 2006-4293. Brussels, Cellule stratégique du ministère, LO/LB/FP/JMC/ch.
Mossialos, E., & Thomson, S. (2004). Voluntary Health Insurance in the European Union. Brussels: World Health Organization and European Observatory on Health Systems and Policies.
Naczyk, M. (2013). Agents of Privatization? Business Groups and the Rise of Pension Funds in Continental Europe. Socio-Economic Review, 11(3), 441–469.
Perelman, J., & Closon, M.-C. (2004). Hospital Response to Prospective Financing of Inpatient Days: The Case of Belgium. Mimeo: UC Louvain.
Pierson, P. (2000). Not Just What, but When: Timing and Sequence in Political Processes. Studies in American Political Development, 14(1), 72–92.
Pierson, P. (2003). Big, Slow-moving and… Invisible: Macrosocial Processes in the Study of Comparative Politics. In J. Mahoney & D. Rueschemeyer (Eds.), Comparative Historical Analysis in the Social Sciences (pp. 177–208). New York: Cambridge University Press.
Rezsohazy, R. (1957). Histoire du mouvement mutualiste chrétien en Belgique. Brussels: Editions Erasme.
Schokkaert, E., Guillaume, J., & Van de Voorde, C. (2018). Risk Adjustment in Belgium: Why and How to Introduce Socioeconomic Variables in Health Plan Payment. In T. McGuire & R. Van Kleef (Eds.), Risk adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets. London: Academic Press.
Schokkaert, E., & Van de Voorde, C. (2000). Risk Adjustment and the Fear of Markets: The Case of Belgium. Healthcare Management Science, 3, 121–130.
Schokkaert, E., & Van de Voorde, C. (2005). Healthcare Reform in Belgium. Health Economics, 14, S25–S39.
Schokkaert, E., Van Ourti, T., De Graeve, D., & al. (2010). Supplemental Health Insurance and Equality of Access in Belgium. Health Economics, 19, 377–395.
Smith, A. (2016). The Politics of Economic Activity. Oxford: Oxford University Press.
Stevens, Y., Van Rompaey, L., Huber, V., & Van Buggenhout, B. (1998). Issues in Complementary Health Insurance in Belgium. International Social Security Review, 51(4), 71–91.
Streeck, W., & Thelen, K. (2005). Introduction: Institutional Change in Advanced Political Economies. In W. Streeck & K. Thelen (Eds.), Beyond Continuity. Institutional Change in Advanced Political Economies (pp. 1–39). Oxford University Press: Oxford.
Thelen, K. (2003). How Institutions Evolve: Insights form Comparative- Historical Analysis. In J. Mahoney & D. Rueschemeyer (Eds.), Comparative- Historical Analysis: Innovations in Theory and Method (pp. 208–240). New York: Cambridge University Press.
Thomson, S., Busse, R., Crivelli, L., van de Ven, W., & Van de Voorde, C. (2013). Statutory Health Insurance Competition in Europe: A Four-country Comparison. Health Policy, 109, 209–225.
Woll, C., & Jacquot, S. (2010). Using Europe: Strategic Action in Multi-Level Politics. Comparative European Politics, 8(1), 110–126.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 The Author(s)
About this chapter
Cite this chapter
Benoît, C., Del Sol, M. (2021). Private Health Insurance in Belgium: Marketization Crowded Out?. In: Benoît, C., Del Sol, M., Martin, P. (eds) Private Health Insurance and the European Union. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-54355-6_6
Download citation
DOI: https://doi.org/10.1007/978-3-030-54355-6_6
Published:
Publisher Name: Palgrave Macmillan, Cham
Print ISBN: 978-3-030-54354-9
Online ISBN: 978-3-030-54355-6
eBook Packages: Political Science and International StudiesPolitical Science and International Studies (R0)