Belgium is facing growing political pressure after a new review raised concerns about sickness benefit payments. The findings suggest that a significant number of long-term health claims may have been extended without proper medical justification.
The review was carried out by Belgium’s national health insurance institute, known as RIZIV/INAMI. A sample of 2,000 cases from 2025 was examined, focusing mainly on younger workers and people with mental health conditions.
According to the findings, around one in four people who had been on sick leave for more than a year were receiving benefits for longer than necessary. In many cases, officials concluded that the individuals could have returned to work earlier.
The study showed that about 25% of claims should have been reduced or ended sooner. Among younger claimants, inspectors believed that 70% could return to a similar job. For younger patients with mental health conditions, the figure was even higher at 84%.
These results have placed Belgium’s health insurance system under intense scrutiny. The country’s mutual health funds, known as mutualities, are responsible for managing sickness benefits and supporting long-term patients.
Some of these mutualities, particularly socialist-linked funds, were criticized for higher rates of incorrect payments compared to others. The report has raised questions about consistency in medical assessments and oversight.
Belgian Health Minister Frank Vandenbroucke responded strongly to the findings. He said the system needs major reform and stated that mutualities “must completely reinvent themselves.”
He also warned that their long-term future could be at risk if improvements are not made. His comments have added political pressure on the organizations responsible for managing public health insurance.
The issue has become a wider political debate in Belgium. Several political parties, including the Flemish nationalist N-VA and the liberal MR, have raised concerns about the power and independence of mutualities.
Lawmakers are questioning whether doctors working for these organizations are fully independent when deciding on sick leave approvals. Some argue that stronger oversight is needed to ensure fairness and accuracy in benefit decisions.
At the same time, the health minister has proposed linking public funding more closely to performance. This could include evaluating how well mutualities help patients access vaccines, treatments, and general healthcare services.
Supporters of reform say the system needs greater transparency. They believe better checks could reduce misuse and ensure that support goes to those who truly need it.
However, others warn against overly strict changes. They argue that many people on long-term sick leave genuinely need support, especially those with mental health conditions. They caution that reforms should not harm vulnerable groups.
The debate also highlights growing concerns about mental health in the workforce. Many of the cases reviewed involved psychological conditions, which can be difficult to assess and manage over time.
Despite the criticism, the minister said abolishing mutualities entirely is not a solution. He emphasized that reform, not removal, is the goal of current discussions.
A parliamentary hearing on the issue is expected to take place in Brussels this week. Lawmakers are expected to question officials and review possible policy changes.
The findings from the review have opened a wider conversation about how Belgium manages long-term sickness benefits. As pressure builds, the country is now facing decisions that could reshape its health insurance system in the coming years.
