Dirk Devroey and Marleen Finoulst are, respectively, a general practitioner/professor at the Vrije Universiteit Brussel and a physician at Gezondheid en Wetenschap. Both are board members of SKEPP. Their piece was published in De Morgen.
A quarter of a century ago, on 1 January 2001, the Belgian health insurance funds opened the floodgates. In a fierce commercial competition for the favour of citizens, the largest player, the Christian Mutuality (CM), decided to include homeopathy, osteopathy and chiropractic care in its supplementary insurance.
The tone was set. What the compulsory health insurance scheme (RIZIV) quite rightly refused to reimburse due to a complete lack of scientific evidence was, through a back door, nevertheless reimbursed from the budget of supplementary insurance. Politically backed by the now-defunct Colla law, the health insurance funds ran a marketing machine for years in which pseudoscience was cleverly used as a customer draw.
Today, 25 years later, a long-overdue correction is finally on the table. Minister of Public Health Frank Vandenbroucke (Vooruit) has abolished the Colla law and proposes a far-reaching reform pact. In future, health insurance funds would only be allowed to offer supplementary benefits if they can clearly demonstrate a direct, causal link with health or wellbeing.
Authority
The verdict is clear: sugar pills based on extreme dilution (homeopathy) and unproven treatments of energy pathways (acupuncture) are unequivocally excluded. It is a triumph of reason.
When an officially recognised health institution such as a health insurance fund (partially) reimburses a treatment, it inevitably affects the psychology of citizens. Whether one likes it or not, reimbursement conveys authority. It creates the dangerous impression that homeopathy or acupuncture are reliable, scientifically grounded treatments. It legitimises quackery and places placebos on an equal footing with evidence-based medicine. This is not only morally difficult to justify, but—at a time of tight budgets—it is also a misuse of public funds.
Naturally, there is urgency to this reform. Health insurance funds must digitalise, become more transparent and put an end to opaque commercial participations and excessive profits. But the real gain in Vandenbroucke’s vision lies in redefining what a health insurance fund ought to be. It is not a commercial travel agency or a grab bag of alternative wellness trends. It should be a beacon of solidarity and public health.
Let the funds therefore reinvest the millions of euros previously spent on sugar water and unproven claims more wisely. Use that money to promote health literacy among the population. Invest in clear information campaigns based on solid scientific evidence. Teach people how to distinguish reliable medical claims from online nonsense, and how to work preventively on their lifestyle.
The shift has fortunately already begun. CM scrapped its reimbursement for homeopathy back in 2019, but Vandenbroucke’s proposal now definitively extends this approach to the entire sector. Solidarity-based funding belongs in a health system that is solidaristic, effective and, above all, rational. Let us stop financing illusion and start financing science.