Transgender Healthcare Belgium
Overview of General Healthcare1
The first Belgian national law for the provision and funding of healthcare was enacted in 1894. Thereafter, Belgium introduced social health insurance for most citizens in 1945.
The Belgian social security system, is mandatory but nominally available to all citizens. However, non-payment of insurance contributions can cause one to drop from the system; it is also not available to the homeless because social security can only be accessed if a patient has a home address.
The system is financed by contributions extracted from one’s wage by their employer. The employer then pays that plus their own contribution directly to the social security services. In the case of self-employment, a contribution is made as a percentage of their declared earnings. In addition to social security contributions, complementary systems based purely on premiums paid allow extra hospital coverage, travel cover and aftercare.
The provision of healthcare is noted for its accessibility, capacity and high-quality treatment. With four doctors per 1,000 inhabitants, Belgium is far above the OECD 2.9 average and Belgian hospitals are equipped with the advanced equipment and highly qualified staff.2
Belgium healthcare is not free at the point of use despite having already paid social security contributions, but costs to the patient are capped. For a consultation with their general practitioner and any medical acts performed, a patient pays a fee, receives a receipt listing all medical acts performed, and, if necessary, a prescription. The patient sends the receipt to their mutuality who then refunds the patient around 75% of any expenses incurred.
Hospitalised patients pay weekly advances for their care (up to €100 each week), for which they receive an invoice that is sent to their mutuality which refunds a portion of the costs.
The Belgium healthcare system is operated in three parts: One is the social security service mainly funded by the exchequer of the federal government which also organises and regulates healthcare. Another comes from a system which is covered by patients’ private insurance. The last is the service coverage provided by the medical industry itself; this service deals with distribution of healthcare products for research and development undertaken in hospitals and universities.
Both the federal and regional governments for each municipality have their own ministers for health, with administrative support provided by the civil service.
The provision of Belgian health care is at three levels.
- The first level is the primary care that is provided by general practitioners, the emergency services and the emergency departments of the hospitals. Polyclinics are in place either as part of a hospital or as an independent entity within the Ministry of Health’s purview and they provide non-urgent first-line care.
- The second level of care is provided by hospitals for acute and immediate technical interventions and intensive or general in-patient care.
- The third level provides chronic and long-term care by way of rehabilitation clinics, service flats, home care providers and old-age residences.
General practitioners are generally in private practice or as part of a group practice. They are arranged into local organisations to take care of out-of-hours services. For non-general care, a general practitioner would refer a patient to a specialist.
Hospitals are distinguished between two types:
- General hospitals – providing services such as cardiology, endocrinology and maternity.
- Psychiatric hospitals – providing care either in a controlled and restricted environment or in therapeutic day clinics for out-patients.
The majority of both these types of hospitals are publicly funded; the handful of private hospitals are owned and operated outside of and without public service with funding offering luxury services and accommodation at a premium price.
Drugs and medicines, even over-the-counter painkillers, may only be sold by high street pharmacies. Non-medical supplements such as health foods and vitamins are available from supermarkets or specialist health stores.
Transgender Rights in Belgium3
Prior to 2007, when transgender people were free to change their legal gender (with conditions), gender change was only possible through obtaining a favourable court judgement. The 2007 Act removed the legal aspect but maintained a requirement that anyone applying to alter their legal gender must have a “constant and irreversible inner conviction to belong to the sex opposite to that mentioned in the birth certificate” and that “the physical body is adapted to the opposite sex as far as possible and justified from a medical point of view.” This meant sterilisation was required.
On 1 January 2018, a new law amended the 2007 law allowing an adult to file an application with a statement that their gender identity does not match their present legal gender. The requirement for medical, surgical or psychiatric opinion or interaction has been removed. Upon filing an application, the individual will be informed of the legal consequences of their transition and afterwards, the applicant has a three-month waiting period after which they may declare their awareness of these consequences.
Under the Act, minors who are at least 12 years of age may change their name but not their legal gender; at 16, with parental consent and psychological monitoring, minors may apply for a change of their legal gender.
Aspects of the Act, such as the waiting period, have met with criticism. The Executive Director of TGEU, Julia Ehrt declared that
The waiting period prolongs the procedure unnecessarily. It is brought in to ‘prevent abuse.’ This shows a lack of understanding and a mistrust of trans people, who are the ones often suffering from accused identity fraud when documents and gender expression do not match. Respect for gender identity and self-determination are not reflected in gender recognition laws which often, instead, focus on preventing abuse.”
The organisation’s Senior Policy Officer, Richard Köhler, called for the age limit to be dropped commenting, “Gender identity knows no age limits, and many young trans people will suffer with the current limitation.”4
Many Belgian hospitals, like Ghent University Hospital (Universitair Ziekenhuis Gent), are known for their specialisation in gender reassignment surgery (GRS). There have been instances of French nationals heading to Belgium for GRS as an alternative to hospitals in France which remain unwelcoming to transgender patients – even in the more progressive medical facilities. This, of course, places a burden on Belgian hospitals.5
The website transhealthcare.org provides a list of surgeons in Belgium that specialise in gender reassignment surgery.
Based at the above-mentioned Ghent University Hospital are Dr. Stan Monstrey, Dr. Salvatore d’Arpa, Dr. Katrien Bonte and Dr. Piet Hoebeke.
Universitair Ziekenhuis Gent De Pintelaan, 185 9000 Gent
Doctor Monstrey is a professor in Plastic Surgery and is a leading member of UZ Gent’s Centre for Sexology and Gender and has been president of WPATH’s previous incarnation of HBIGDA between 2005 and 2007. He has co-authored many of the most cited articles on the subject of transgender surgery and the book Principles of Transgender Medicine and Surgery (2007), which is regarded as an authoritative text for medical professionals. Dr. Monstrey performs and co-performs the following procedures:
- For trans men: Top surgery, phalloplasty, glansplasty, penile implant, scrotoplasty, vaginectomy, urethroplasty (with Dr. Hoebeke) and hysterectomy (with Dr. de Sutter).
- For trans women: Breast augmentation, facial-feminising surgery (FFS), trachial shave, orchiectomy, penile inversion vaginoplasty and labiaplasty.
Dr. Monstrey has a current waiting list of five years. He follows WPATH standards and requires surgery letters.
Doctor d’Arpa performs glansplasty, phalloplasty and scrotoplasty. Doctor Bonte performs voice feminisation surgery. Doctor Hoebeke performs penile implant surgery, urethroplasty and vaginoplasty.
Ringlaan 51 2600 Berchem Antwerpen
The private 2Pass Clinic offers a suite of treatments for the transgender patient. Primarily aimed at trans women, they provide treatments and therapies around feminisation of the face, body and voice as well as electrolysis and laser depilation treatment
Dr. Bart van de Ven
Dr. van de Ven speicialises in body sculpting, breast augmentation, FFS and voice feminisation surgery. His colleague, Dr. Maarten Doornaert performs body sculpting and breast augmentation also, as well as buttock augmentation and top surgery.
Universitair Ziekenhuis Leuven Avenue G Thérasse, 1-B-5530 Brussel/Bruxelles
Dr. Marc Remacle
Dr. Remacle performs voice feminisation surgery at UZ Leuven.
Wellness Kliniek Grotestraat, 42 3600 Genk
Dr. JL Hoeyberghs
Dr. Hoeyberghs specialises in facial feminisation surgery as part of this private clinic that offers other, more general, plastic surgery procedures.
Cliniques Universitaires Saint-Luc Avenue Hippocrate, 10 1200 Woluwé-Saint-Lambert Bruxelles/Brussel
The largest hospital in Brussels, Saint-Luc, is a not-for-profit hospital offering all specialist treatments for the transgender patient.
CHU Saint-Pierre/UMC Sint-Pieter Rue aux Laines, 105 1000 Bruxelles/Brussel
More info: https://www.qunomedical.com/en/saint-pierre-university-hospital
Located in the centre of Brussels, Saint-Pierre Hospital is associated with the prestigious medical school – Université Libre de Bruxelles/Vrije Universiteit Brussel Faculty of Medicine. The facility on Porte de Hal deals with emergency services and infectious diseases while César de Paepe houses an international patient clinic and a centre for the prevention of breast cancer.
Global Care Clinic
The Plastic, Reconstructive and Aesthetic Surgery Clinic is under the care of Dr. Brigitte Maguin.
Global Care Clinic Zolder Kerkstraat, 105 3550 Zolder
While the procedures for transgender patients are listed on the qunomedical website, there is nothing specific on the clinic’s own website that seems to align with the former’s listing of treatments.
Other international links and information pages