N-VA calls for comprehensive reform of health insurance funds

The N-VA wants to fundamentally rethink the role and responsibilities of Belgium’s health insurance funds (mutualities). The call comes after recent reports revealed that several funds are generating significant profits. “These organisations have become highly profitable enterprises, drifting far from their core mission. It’s time to intervene—conflicts of interest are looming,” says MP Frieda Gijbels.

Dual role under fire

Health insurance funds currently manage public money from the compulsory health insurance system, while also selling private products such as hospitalisation and dental insurance. According to the N-VA, this dual role creates serious risks. “It opens the door to conflicts of interest—especially when these funds help decide how RIZIV budgets are distributed,” Gijbels explains.

She is therefore proposing a structural reform: the task of managing payouts under the compulsory health insurance system should eventually fall entirely under the RIZIV (National Institute for Health and Disability Insurance). This would also mean removing the funds from RIZIV’s management bodies. “Why would they advocate for better reimbursement of dental care when they can sell that very coverage themselves as a private package?” she asks.

Health insurance funds could still operate as providers of voluntary insurance and as contact points for advice and referrals. “But these insurance products must meet the same tax and regulatory standards as those of any other insurance company,” Gijbels adds.

She also questions their role in other bodies that help decide how RIZIV funds are used, especially since some funds operate their own hospitals or pharmacies. “Given the risk of conflict of interest, they should not have a seat in RIZIV’s negotiation committees,” she states.

Gijbels also argues that the advisory doctors employed by the funds should be transferred to RIZIV. “Currently, they assess their own members—yet have every incentive to be lenient, knowing that strict rulings could cause customers to switch to a competitor.”

Mandatory supplementary insurance under scrutiny

All funds require their members to pay for compulsory supplementary insurance, which includes an obligatory contribution. This obligation, and the membership fees that come with it, place an unnecessary burden on citizens, Gijbels says—especially since the revenues mainly benefit the funds themselves, which have been profiting from this system year after year.

That’s why N-VA wants to abolish this obligation. At the same time, Gijbels is calling on the government to better promote the Auxiliary Fund for Health and Disability Insurance, which offers the same legal coverage—without charging additional membership fees.

Stricter oversight and heavier penalties

The N-VA also targets the system of financial accountability. The government has already decided that funds must reimburse any undue payments they’ve made. But according to the N-VA, current sanctions are far too lenient. Fines often amount to just €125—completely disproportionate to the losses the Social security Social security is currently managed at the Federal level in Belgium. The most important pillars of Belgian social security are: sickness and invalidity insurance (NIDHI), pensions, unemployment insurance and child allowances. In addition, occupational illness, occupational accidents and annual holidays are dealt with at this level. Some Flemish parties have been campaigning for years for (large parts of) social security to be transferred to the Regions and Communities. social security system suffers when funds fail to carry out their duties properly.

Finally, the party wants to eliminate the exemptions health funds can obtain from RIZIV when they prove that the inability to recover undue payments wasn’t their fault. “This kind of risk is part and parcel of the job for which they’re already well compensated,” Gijbels says. “On top of that, they also receive significant bonuses for the sums they do manage to recover.”