a country · BelgiumBelgium

The classic European cross-border case: a small country with spare hospital capacity, short waits and three land borders, which has been treating its neighbours' patients since long before the EU wrote a directive about it. Belgian fertility centres in particular draw patients from across Western Europe. And Belgium is the country that could not report its own cross-border numbers to the Commission, because its sickness funds do not collect them the same way.

The ESHRE taskforce counted the fertility side in a single month in 2010, across six receiving countries: Belgium took the largest share of the 1,230 patients surveyed, 29.7%. Of the patients in that study overall, 31.8% came from Italy, 14.4% from Germany, 12.1% from the Netherlands and 8.7% from France, and the reason they gave, again and again, was law rather than price.

The Commission's data for 2022 shows what the state can and cannot see. Belgium received 47 requests for prior authorisation and granted six — 12.7%, among the lowest rates in the EU — and reimbursed EUR 11,880 for authorised cross-border care in the whole year. For care not needing authorisation, it reported nothing at all: the national contact point told the Commission that not all health insurance funds had supplied data and it would rather report none than part.

Inference — a country whose hospitals have treated foreign patients for decades and whose central reporting cannot count them is not unusual; it is the normal case, stated plainly for once. The trade that shows up in the Commission's tables is the small, authorised, state-mediated part. The rest is a Dutch family in a Belgian waiting room, paying an insurer that settles the bill without anyone writing the word cross-border on it.

Two routes and a private one. Under the Directive the patient pays the Belgian hospital and reclaims at home at home rates; under the older social-security coordination the home fund authorises first and the treatment is billed between the systems; privately, the patient simply pays. Belgian hospitals are used to all three and quote in euro against the national fee schedule, which is published and applies to residents.

Belgium's most recent reported cross-border figures remain those for 2022: 47 authorisation requests, six granted, EUR 11,880 reimbursed, and a blank where the larger column should be.