Belgian Eye Doctors Under Fire Over Rising Fee Supplements

Belgian ophthalmologists are increasingly charging patients supplementary fees on top of official medical tariffs, reigniting a fierce debate about healthcare affordability and transparency. The controversy escalated after Dr. Johan Blanckaert, an ophthalmologist and vice-chairman of the BVAS doctors’ association, defended the practice by stating that €140,000 in annual profit from supplements is “not disproportionate.”

According to De Morgen, which broke the story on June 8, 2026, Blanckaert argued that doctors begin their careers late and retire early. “You also have to consider that we only really start around our 32nd year, and for most it stops at 65,” he said.

The Deconventioning Trend

The controversy is rooted in a long-term shift away from Belgium’s convention system, where doctors agree to charge official government-set tariffs. Data from the Belgian health insurance agency RIZIV, reported by Knack, shows that only 20% of Belgian eye surgeons were still fully conventioned in 2021, down from 35% in 2012. For gynecologists, the rate fell from 38% to 23% over the same period. Across all hospital specialists, the proportion of fully conventioned doctors dropped from 75% to 68%.

This trend means more patients face unpredictable out-of-pocket costs. Fee supplements can only be charged for patients in single rooms, creating a strong financial incentive for both hospitals and doctors to favor single-room occupancy. A patient in a single room pays an average of €2,778 for a hospital stay, nearly nine times the €323 average for a multi-bed room, according to a Test-Aankoop report published in May 2026.

Soaring Costs

The financial burden on patients has reached record levels. In 2024, Belgian patients paid €1.60 billion out of pocket for hospital stays, including co-payments, supplements, and non-reimbursed costs. Approximately €760 million consisted of doctors’ fee supplements, up from €697 million in 2023 — an increase of 13.1%. For more than one in ten hospital admissions, the bill exceeded €1,000, with outliers surpassing €10,000.

Government Reform Push

Health Minister Frank Vandenbroucke (Vooruit) is pushing a framework law to cap fee supplements at 125% for hospital stays in single rooms and 25% for consultations, with full implementation targeted by 2028. As VRT NWS reported, Vandenbroucke has defended the reform vigorously. “Today, hospitals charge an average fee supplement of 106%. That’s lower than the 125% I’m proposing as a maximum. But there are hospitals that dare to charge 300%. Those excesses have to go,” he said.

Vandenbroucke has also pointed to stark disparities: a birth costs €700 in fee supplements in one hospital, while patients pay €2,200 for the same procedure in another. He argues that hospitals charging few supplements are not going bankrupt, countering claims that the reform would cripple hospital finances.

Doctors Push Back

Medical associations have strongly opposed the reforms. BVAS and other groups called for a strike on July 7, 2025, closing practices and providing only urgent care. Blanckaert has been a prominent voice in the opposition, arguing that official tariffs are outdated and insufficient to sustain modern practices.

Speaking at the Medische Wereld congress in April 2023, reported by Healthcare Executive, Blanckaert rejected the framing of doctors as “people with supplements.” He noted that supplement income covers investments in equipment, personnel, and innovative treatments not yet reimbursed by the state. In a 2023 interview with Medi-Sfeer, he argued: “The convention rate was created in 1964 as a social rate, alongside the normal rate. But now we are gradually moving toward that social rate for everyone. That won’t work.”

Analysis: A System at a Crossroads

The conflict represents a fundamental tension in Belgian healthcare. Doctors argue that supplements enable innovation and compensate for the real value of specialist care, while the government and patient advocates contend that the system is opaque, unfair, and creates a two-tier healthcare structure.

Vandenbroucke’s reform is the most significant attempt to cap supplements in decades, but it faces formidable opposition from medical associations who view it as an attack on professional autonomy and a step toward state medicine. The political battle is far from over, with the framework law still under debate and doctors threatening further industrial action.

What’s Next

As of June 2026, the fate of Vandenbroucke’s framework law remains uncertain. The reform has divided the medical profession and sparked heated political debate. For patients, the immediate concern is clear: without reform, out-of-pocket costs will continue to rise, making healthcare increasingly unaffordable for many Belgians. The coming months will determine whether the government can push through its caps or whether the supplement system will continue to expand unchecked.