The Belgian government withheld nearly €15 million from the country’s health insurance funds last year because they failed to meet performance targets, according to figures obtained by De Tijd from the National Institute for Health and Disability Insurance (Riziv).
Since 2022, the government has been allowed to withhold up to 20% of the mutualities’ annual administrative funding based on their performance the previous year against seven criteria.
Those checks include whether they process reimbursements and benefits on time, carry out sufficient internal controls to prevent abuse, and launch enough return-to-work pathways for people on long-term sick leave.
The weaker the score, the less operating funding a health insurance fund receives.
The system of financial accountability has become increasingly significant. In 2023, the total amount withheld stood at €8.5 million. That rose to €11.7 million the following year and reached €14.8 million in 2025. Over two years, that amounts to an increase of almost three-quarters.
Even so, the withheld amount still represents only a small share of the total administrative budget of more than €1.4 billion that the government allocates to the mutualities.
The National Union of Liberal Mutualities recorded worsening results in recent years and lost €2.6 million last year alone.
The neutral health insurance funds, the smallest of the five umbrella groups by membership, were among the stronger performers.
The National Alliance of Christian Mutualities, which includes CM in Flanders, and the independent health insurance funds, known in Flanders as Helan, also performed better than average.
