Since 1 January, six centres specialising in transgender identity support have been officially recognised in Belgium, ensuring that patients at these facilities can receive health insurance reimbursement.
Four of these centres are located in Flanders, raising concerns from the Walloon LGBTQ+ federation Prisme. These centres cater to individuals whose gender identity does not align with the sex they were assigned at birth. They offer psychosocial support and, if necessary, medical consultations to anyone who seeks their services.
Prior to January, only the UZ Gent and CHU de Liège centres were recognised by the National Institute for Health and Disability Insurance (Inami). In 2023, these centres saw 1,456 patients.
To address the increasing demand, authorities decided to expand the number of recognised centres. An application process was initiated, and centres were selected based on "important, precise, and objective criteria," according to Inami. The criteria included existing experience with transgender patients, having a qualified team, and offering both adult and non-surgical child support. Four additional centres were chosen, three in Flanders (Sint-Niklaas, Antwerp, and Genk) and one in Brussels (Erasme Hospital).
'Not accessible to everyone'
Prisme is concerned about the geographic distribution of these centres, advocating for a territorial network that would provide accessible support for transgender individuals closer to their homes.
Erynn Robert, coordinator of the federation, notes that before the centre expansion, many Walloons travelled to Flanders for support, attracted by the renowned expertise of UZ Gent, Belgium's historic specialist. They suggest the CHU de Liège has received fewer requests: "It's a vicious cycle. UZ Gent has performed these surgeries for many years with high satisfaction rates. Historically, Liège's setup took longer to establish, and there's a 'rumour' of poorer quality care, which deters patients."
Prisme is also critical of concentrating medical expertise in a few centres. "This means it's not necessarily accessible to everyone. In Belgium, there's a noticeable divide between major urban centres and rural areas. For some disadvantaged individuals, it poses an additional barrier, especially if they lack independent transport," Erynn Robert explains.
Conversely, Inami defends its approach of concentrating expertise to ensure the highest quality follow-up. It argues that with more patients per centre, the standard of care improves. Inami also cautions against expanding the number of recognised centres beyond the affected population, noting that it could be counterproductive.
