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Last Updated: Friday, 2 June 2006, 16:36 GMT 17:36 UK
Europe diary: Belgian health
1 June 2006

In his diary this week, BBC Europe editor Mark Mardell praises Belgian health care, after his son was rushed to hospital, and reflects on the mass of data US Homeland Security officials want on passengers flying from Europe.

The diary is published every Thursday.

SMOOTH OPERATION

renal ward
British wards are rarely super clean, quiet and calm
I've had a weird and fractured week. Travelling back from Montenegro, expecting a day off and a quick turnaround for a meeting in Vienna, I get an alarming call in a transit lounge. My son has been rushed to hospital with appendicitis. I spend an uncomfortable, panicky flight back, unable to read, write or listen to music, just staring out of the window. I had been reading Phillip Roth's "Everyman" which features two near-deaths and one actual death due to, yes you guessed it, appendicitis. My son's pain was dismissed by a British consultant as "wind" or "all in the mind". It was spotted for what it was instantly by a Belgian GP. After a 2am operation, all's well that ends well.

MUTUAL HEALTH

The hospital is super clean, quiet and calm, in a way that British wards rarely are.

I was rather a fan of the Belgian medical system even before this. I've been lucky in having had very good GPs in England and they are equally good here. But it's easier to get an appointment, even though your phone call goes straight through to the doctor who gives you an appointment herself (or himself). No dragonish receptionists.

The system is based on insurance: the doctor or hospital charges you and you claim the money back off your "mutual". It's rather odd that such a system, which frightens the living daylights out of those keenest on preserving free health care in the UK, is used in Belgium and France, which are rather less keen on the glories of free enterprise.

I stress that I write as a consumer, rather witless about my own financial affairs, rather than as a journalist who has studied the system, but the disadvantages are not plain to me, nor do they seem to point to a particular political outcome. What I don't know is how the mutual system works for someone who hasn't got enough money to pay the rather large bills in the first place.

PASSENGER INFORMATION

Zaventem airport
Zaventem airport, usually crowded, was inconveniently empty this week
After these few traumatic days off, I am back at work, visiting Zaventem airport. Not, for once to travel, but to do some filming. Why is it that when ever I come here to catch a flight there are queues and queues, and that now, when I want people around, it's all but empty? I'm here to do a piece on the European Court ruling that the European Commission shouldn't have agreed to hand the US passenger information collected by the airlines. If they don't find a way round this, the US could stop any European flights landing from 30 September, when the ruling comes into effect.

DATA BINGO

Do you know what your OSI information is? No, thought not. Ask a Homeland Security officer, I'm sure they do. Its just one of the 34 pieces of information the Americans want off the airlines. Originally they even wanted to know the choice of meal on the flight but they dropped that. A lot remains. Credit card details, e-mail address, travel plans have been widely reported. But I'd love to hear from any airline people who can tell me what the rest actually means.

fish and chips
Suspicious? And will they know if a passenger chooses fish?
What is "divided PNR information", "SSI information", "Collected APIS information" or "Received From information", for instance? Most intriguing of all is the category "General Information". What could this include, I ask one specialist? "Things like dietary information" is the reply. So they do know whether you had the chicken or the fish, after all.

The other thing that intrigues me about this, is how intelligence services use what must be literally millions of pieces of information they receive every day. I can see it would be useful tracing someone's movement after a crime has been committed, and I can also understand how they could use it to keep an eye on a particular suspect. But how does this mass of data prevent crimes? Do they have programme searching for particular patterns?

Perhaps the CIA uses it for a recondite form of bingo to while away the long hours. When a man from Nantes with 10,400 air miles and three credit cards sitting in seat 27 chooses the fish an agent completes his line and shouts "bingo!"

VETO POLITICS

The spectre is of course that no agreement will be reached and millions of passengers won't be able to fly. That seems unlikely to me. The Court of Justice ruling was that the European Commission didn't have the power to make the agreement under the law it used. The commission had argued its case under a directive to do with "supply of services" rather than "criminal justice", which is outside its reach.

Even if it can't find a new law to base an agreement on there is nothing to stop individual countries, or even individual airlines, making the agreement. That's where things really get interesting and data commissioners and national privacy laws start being invoked.

The Commission could be the losers on this, having to hand back powers to the nation state. But they've got an eye on the main chance. Their response is: "This ruling may confirm the Commission's intention to apply the passerelle and shift policies in the area of police and criminal /justice cooperation from the third to the first pillar." Which means: "Oy! Drop your veto!"

Here are some of your comments:


I lived in Belgium for four years, and have been very impressed with the Belgium health care system. My wife, a Belgie, is impressed as well. Never had to wait to see any doctor. I have found the Chilean health system, which employs a model similar to the US, but the mutual payment is directly between them and the hospital for those who can afford it. hey still have some way to go, as the poor get sent straight to the public hospital, which wouldn't be such a good thing. Regardless, I feel on firmer medical ground in Belgium and Chile, than I did in the UK where I felt like a second class citizen in the eyes of the NHS.
Simon L, Santiago, Chile

Most Americans feel that the requests for personal information from Homeland Security is totally absurd. We know that they couldn't possibly make any sense of all that data anyway. Having said that, would I object if European governments asked for the same info on me? Absolutley not. When I am a guest in someone's country I fully expect to abide by their rules. Each nation has the right to decide what information they want on the visitors who enter their country.

So if France wants to know my choice of entre on my flight to Lyon, they are welcome to that info, do you think they'll deny me entry when they find out I don't drink wine.
Tris, Nashua, USA

The National Health Service isn't free Mr Mardell. Everybody pays National Insurance to pay for health care!
Lesley, Rijswijk, Holland

Really, if these data systems were fundamentally unsafe, or if the information was largely misued by our government, our free media would be all over this, and we would be witnessing a significant decline in foreign travel to the US. There will be mistakes, unfortunately. I challenge anyone to give me the name of a country that has perfect security and protection policies and systems. This sacrifice in privacy, to me, is a small price to pay compared with the security potential afforded to passengers, airlines, our infrastructure, our way of life. Give us a break, will you?
Dave, Las Vegas, Nevada, USA

It seems that it is ok to undermine human rights when a country's security is at risk. How is this consistent with the claims of those same states that human rights are universal? What is worrying is that those same states which urge countries whose security is much more at risk and thus they do not respect human rights, to respect them, they themselves are proponents of security over human rights. Maybe with the level of surveillance already present in most developed countries, the notion of the Panopticon is not that far fetched. If the EU wants to be a different power from the already existing powers in the world, it needs to stick more to principles and be consistent with its external policy. I really want to believe that the EU will be different from the rest.
Mile, Kikinda, Serbia

My wife's mother is a nurse in Belgium, and the reality is a little different from that presented by Mr Mardell's ill informed rapture. Just to cover a point he conveniently misses, those without cover in Belgium are quietly, but ruthlessly, refused treatment and (as in Belgium you pay for you stay) are simply dumped on the streets. I know of one case where, after a long illness, a man's wife died and he was presented with the bill for her care. He committed suicide a few days latted because he couldn't pay. When you know the truth, and are not cushined by a nice Brithis salary, it is a brutish, uncivilised system that lets down the most vulnerable. Reporters for the BBC should try digging beyond flimsey pre-conceptions and the 'media spin' that other countries pump out - they might start writing stuff worth reading then!
G. Fincham, Norwich

Whilst waxing lyrical about the supposed merits of the Belgian health system, Mr Mardell might like to think about what pays for all those nice operations and efficient doctors - Yes well no prizes there, it's our exhorbitant taxes that are rather high (40%) for what is, in effect, a shell of a country. But don't tell that to the Belgians because it might dent their self-satisfied sense of pride in their system. By the way, if he knows a good GP in this city who does not talk on his mobile whilst treating you or go on endlessly about acupuncture then could he tell me.
Frank Faraday, Brussels, Belgium

I have recently moved to Sydney after living eight years in Antwerp, Belgium. Judge by the following example whether you would rather have the Belgian system or the NHS have: It's Saturday evening - 8:00pm I am in the kitchen preparing fritjes (chips). Whilst chipping the potatoes I cut my finger quite badly. After 30mins of trying to stem the flow of blood I realise i need to pay a visit to the hospital. But it's Saturday night and I will have to go to the emergency department... It will be hell and having a relatively minor cut I will be stuck there for hours whilst other more needy injuries are treated ahead of me, right?

Wrong! I walk into the local hospital. I lived in a village outside Antwerp - but it still had it's own hospital - the emergency department was fully staffed and dealing with 2 other patients. I was stitched up immediately and was back home within half an hour.
Lindsay Parker, Sydney, Australia

Maybe we should call the American goverment's bluff and refuse to provide them with all this information they want. Would the American economy be able to deal with the enormous losses their refusal to let European airlines land would entail? No more landing fees, employment of bagage handlers, catering firms, purchase of aviation fuel etc etc. Not to speak of losing the money tourism provides. Touring companies, hotels etc their losses would be phenomenal. Could places like Disneyland survive without foreign visitors?.. As for passengers' dietary requirements, do they expect the airlines to keep a note if the passenger ordering a kosher meal actually ate it? What is there to stop a muslim terorrist to order a kosher meal, but consume food they themselves brought onto the flight? All this sounds like a "we must seem to be being really strong and pro-active", without any thought of the consequences of what will happen if the other party refuses to play ball.
Maya, wokingham, berkshire

Good for the USA, it is a great shame that our government does not put as much effort into protecting our borders
Richard White, Westcliff-on-Sea England

I wonder when Mark will be tried for high treason in the UK - he is destroying one myth about British superiority after another. Next thing he might discover is the ease of using the metric system or the Euro. Gordon Brown must be fuming. Obviously, "American intelligence" is an oxymoron. Does it ever cross their mind that some jihadist willing to blow himself up may also swallow his pride and order .... kosher?
Ronald Vopel, Brussels, Belgium

A Kosher meal is perfectly "halal" (religiously allowed) for Muslims, as it meets many more requirements than those required by Islam. So a person requesting a Kosher meal on a flight could be a Muslim. So are U.S. authorities going to take note of everyone requesting a kosher meal!
Zahid, Nottingham

I dont understand what the big fuss is. The information they request (minus the inflight meal) is already available to those who wish to know. All our data is stored in places where governments can gain access - I dont care if they know I am flying to see my aunt in Chicago and staying 5 days. The sooner people stop being so stupid about irrelevant information the better.
Susan Du Becker, Breda, Holland

The meals! The meals! Once I travelled (BA) next to an English Muslim working as a banker in Egypt. He had requested a special breakfast in order, he hoped, to avoid the bacon and sausages, and when it was brought to him with great pride, it proved to be a pork chop. My standard brekker was pig-free. So the CIA would be better advised to check the lists of passenger requests rather than the kitchen lists of what is actually provided ... if they're playing Spot the Porkophobes, that is.
Deborah Hubbard, Pretoria, South Africa

Apart from the mandatory manifest information supplied in advance by ships and aircraft, I think that any other info would be mis-handled, lost or otherwise messed up by US incompetence, witness their credit rating fiasco, or US Army pay catastrophes. They are just not capable.
Dave Ward, Burstadt Germany

I am interested in the dietry information the US has requested. Could it be because if you order a special meal for religious reasons then you must be a terrorist?? Typical shortsightedness from the Americans.
Alison C, Derry

The point about the airline data is that the U.S. were already using it for purposes other than that agreed with the EU. According to the American Civil Liberties Union they were passing this data to the Centres for Disease Control in Atlanta. The agreement between the Department of Homeland Security and the CDC is published on the ACLU website.
Derek Lambert, Reading, UK

You know, it's getting far too much what the US is demanding for their security. This as you nicely put it, is a clear sign that "Big Brother" needs to know everything about everyone. Even with the most advance security system in the world, with satellites floating in space watching they need to know what your choice is on a flight??? What is this now? Let's face the real fact they are slowly working there way at people control and the main reasons why I left America in the first place. This will never prevent any crimes!
George de la Torre, Lebbeke, Belgium

The issue of sending data of airline passengers to USA from Europe is very appalling. One could not expect a country like US to be asking for that kind of information. One could also not understand why EU Commission agreed with it. Fine that US madness is now being checked by the EU court. It means, we still have our dignity and privacy in Europe. US needs to be checked. US is behaving like an empire in decline.
Adigun Olosun, Ostbevern, Germany(Nigerian)

Our average Health system is good u Belgium, as you insist on. Further, the Court of Justice ruling that the European Commission didn't have the power to make the agreement under the law it used The EU Court was right... ! Going as far as Fish or chicken is absolutely ridiculous ! The image of US & CIA is weakened.
Luke, Kortrijk - Belgium

I would think that the authorities would be very interested in anyone who successfully smuggled a plate of cod and chips onto a plane like that shown in your photo. That certainly doesn't resemble the airline food that I'm familiar with!
Graybo, East Sussex, UK

The abbreviations stand for: PNR - Passenger Name Record SSI - Special Service Information (e.g. unaccompanied minors, wheelchair user, etc.) APIS - Advanced Passenger Information System (containing what?) Received From information specifies the name of the third party providing the information, e.g. travel agent or someone booking on another's behalf. It may seem odd that the US even wants to know what someone eats on a flight, but I imagine the fact that someone orders a halal meal may fit into a particular profile they are looking for. If all this nosing doesn't worry you, it should.
Rod Parkes, Taipo, Hong Kong

Of course we all know that dietary information is needed to ascertain the religion of the traveller, which would be otherwise more difficult to establish. I, for one, will not be going to the US any time soon.
Alessandra Asteriti, Edinburgh Scotlant

The issue with meal choice on the plane is that it provides information about the religion of the passenger: kosher, halal etc.
Pietro Crovetto, Stockholm, Sweden

Borrowing 'Piano Tuning, Servicing and Rebuilding' from my local library the computer flashed up a warning that I had borrowed this book four times this year. The librarian looked at me suspiciously. I suppose I must just hope that the next terrorist attack does not involve an exploding Grand Piano otherwise the Department of Homeland Security may wish to talk to me.
eric, harrogate

Mark Mardell would be doing us all a considerable public service if he were to publish all 34 questions required about our lives by the US Authorities in order for us to enter the USA as visitors, what they mean and how they contribute to the US's war against international terrorism.
Andrew Turquet, Raunds, England

So, let me get this straight: "Screw the US and "yes" to everything European!" That about sum it up? I agree that power is therefore, de facto, devolved back to the ("EU") state to either comply or not, but this is where it should have been all along. I'm not necessarily agreeing with the US security requirements (paranoia run amok, quite frankly), but to have the "EU" dictate anything to the UK is anathema.
Mark M. Newdick, US (UK expat)

Requiring this kind of information from European passangers is intrusive, time consuming, and pointless. If Homeland Security really gave a damn about security then something would be done about protecting the ports or chemical/nuclear facilities.
Brian Temple, Gray, Maine, USA

I'm sure a lot of the information is to find links -like they want all the phone records in the US. Consequently if you find yourself sitting next to a suspect and have 'vegetarian' dietary requirements you might find yourself under suspicion. (strict Muslims can have specific requirements regarding meat). For those of the 'if you have nothing to hide, don't worry' camp remember the tourist jailed for three weeks in South Africa because of a mistaken identity. If you have enough data suspicious patterns will emerge through coincidence.
Andrew, Bromsgrove

Two quetions arise from the US' paranoia: 1. Does the US reciprocate, and give all passenger information to countries with inbound flights from the State? And if so, what the hell do we do with it? 2. Is our participation in joining this discussion going to get us in trouble with 'Uncle Sam'?
Trefor Griffith, Bakewell, IK

I can clear up the dietary information: it's an indication of culture. For example, requesting a halaal meal while travelling under the name of Smith, John, would trigger a signal. A Mr Bin Laden ordering the pork fillet and a bottle of vodka has probably saved themselves from a 'probing' investigation by customs.
Mike, London, UK

Why don't the US spooks just use the internet like the rest of us? I had an overseas visitor the other day who wanted to get in touch with a friend working at a nearby GMO research lab. His phone is unlisted and we didn't have an address. Within an hour we had all the information (and more) that we needed about him.
Malcolm Blackie, Norwich, UK

Once the US, as the country of justice and freedom, has signed up on the International Criminal Court and given assurances, that sufficiently educated and competent people are handling the information - let go with all info needed for the Global War on Terror.
Bent Jensen, Horsens, DK

Anyone who trusts their government is an idiot. All the evidence shows that they are incapable of handling personal data properly or securely, or indeed that it is used correctly. There's not one major govt. database in the UK that works properly - and just wait and see the chaos when they try to introduce ID cards
Jeremy Poynton, Frome, England

I think that the US authorities need all this personal data so that they can check you weigh the same coming into the country as you do when you are leaving (a la Douglas Adams). Otherwise by definition, you are stealing part of Uncle Sam's territory.
David Sumner, London, UK

I see no problem with the US potentially banning flights from Europe. Let their businessmen fly to Europe to conduct business, rather than the other way round. This will prove to be yet another economy damaging initiative by US administrators
Nev Rowbottom, Hong Kong

Does the US Government actually consider it possible that if some terrorists plan to hijack a plane for instance, they would pre order a nice Halal meal (giving their identities up!) to give themselves a decent last meal and the strength of will?

As for Public Services, the UK it seems to me, is not far off the US model: either pay up for private care and get a very decent service or don't pay and (eventually) receive substandard treatment in an aging hospital. This is even more the case in the education sector which is saddening. Are there no egalitarian tendencies left in the UK when the European example is so close by and clearly superior?
David Smales, Konstanz, Germany

It's not just flights to the US that require the Passenger Name Records - any travel booking (train, bus, or hire car) or accomodation booking requires its own form of PNR as well. Just try and buy a bus ticket in the US with cash - I did and I had to give them my passport details. But at least they're even-handed about it. US citizens provide the same data when they travel anywhere in the US too. Also, the EU Commission's assertion that the data is securely stored in the US is an outright lie - there are at least 3 commercial websites that will allow PNR information to be retrieved without any authentication other than the flight booking reference printed on your ticket. Guard those tickets!
Gary O'Keefe, Watford, UK

Mark Mardell is right - this information 'request' is over-the-top and bureaucratic - just like current US entry requirements. How many gun crimes are committed by US nationals v terrorist attempts by 'foreigners' in any one year in the US? To Mark the UK expat living in the US.... Why do you have a problem with the EU "dictating" anything to the UK but no problem with US dictating this to the UK for more information than they can ever use? If you are happy to live in the US fine - leave us to remain Europeans - role on full free movement and the Euro!
Ian Wainwright, London, UK

My solution is simple, don't travel to the US, it's gradually becoming an inhospitable place, Homeland security in trenchcoats, cavity searches, creationism, datamania, corruption, ecological denial, don't encourage it by spending time or money there. I'm sure I'll go on some 'list' simply for saying this.
Hugh Barnard, London,UK

If the Americans require all this data (for whatever reason)then we, the European Commission, can demand the same from any American coming to Europe. Perhaps this would be a "quid pro Quo". It will certainly piss them off.
Vince.mcBrearty, Glasgow

Duh! All they need is to see my name on my passport - it does not need AAPS, CCYU, KKK. Some systems company is laughing all the way to Fort Knox.
Sohail Hussain, UK

I will never travel to the USA again.
Daniel Gallagher, London, UK

I have no objection to the information being passed to US government officials, if it meant I could clear immigration quicker. That would be the most useful. In addition to my standard income tax I am taxed on my private medical insurance provided from work. In order to cut waiting lists the NHS are sending patients private. Where is my beneift, while these people receive it for free.
Stuart, Sunderland, UK

1 US anti terrorism seems information and technology led rather then intelligence led. All the answers will swim around in a computer system and then some hapless tourists will be put into chains on arrival because their answers inadvertently led the IT system to flag them up as terrorists. 2 I like to think that US planes will be barred from landing in Europe if European ones are banned from the US. I somehow think this is unlikely to happen - but it would be nice and thought concentrating for the US if it did - there does seem to be the command jump and we start without even asking how how high. 3 In posting this I'll probably end up on some sort of list and destined to holiday in the UK for ever!
chris pryor, Chorley England

In response to Susan Du Becker, the concern is that the US government has outsourced large parts of the collection and analysis work to private companies. The parat from the US has weaker data protection laws than the EU there have also been a number of well-publicised cases where huge amounts of data held by private companies (including credit card details) have been accidentally published or even in a few cases deliberately stolen and sold to criminals. The fewer people who have access to my data and the more controls there are over who can see it the happier I will be.
Jonathan Evans, London, UK

The juxtaposition of topics in Mr Mardell's report coaxes me to mention that in Belgium there is a national database of inhabitants - containing, names, addresses, date of major events, bank accounts, criminal records and so on. This is available to bailiffs and the security services. It has one great advantage, which is that all the official services have access to your standard data and don't require so much justification of your existence. Try living in France and being asked fifty times to produce identity cards, electricity bills and bank references for each official organism that you come across. Referring to the health services, having myself lived in Germany, France, the UK and now Belgium, I do not find the NHS any worse than in any other country in terms of care, though the doctors are a little less willing to precribe treatments.
JN Williams, La Louvičre, Belgium

Like many I'm unhappy and suspicious at the insistance by US authorities of so much personal information being supplied for people entering their country. My solution is a simple one - don't visit. If I'm contributing to a foreign economy by spending my hard-earned money there I don't appreciate being treated like a criminal for doing so. Security is one thing but it's being used as an excuse to accumulate data that I feel is unjustified. I don't trust my own government must less a foreign one. It's a shame as I'm not anti-American. I have American friends, I like the country, there's much of it I'd still like to see but I'm morally opposed to supporting it financially. Mind you, the UK is walking the same slippery path, then what am I going to do?
Roy Lathwell, Hemel Hempstead, UK

hmm, how about a barcode style tattoo for everyone with all that in, granted food might be a little tricky but hey you never know. solve all the passport issues, just check whether everyone is registered, when you scan them in. I mean who needs names, and freedom!
alex, york, uk

so a terrorist would only have to have a meal that does not fit in with their religion to sneek through? or do they suspect everyone with a "foreign" name
David Hiscox, Mountain Ash

I have been a vegetarian since childhood, in WW2. Many airlines know this. UK born, I am a US citizen. Do I have to register as a potential "sleeper" ? Is is safe for me, as a grandfather, to continue to travel four to six times a year ? Are there any known cases of non muslim vegetarians threatening national security ?
Paul Spencer, Miami, USA

A muslim man can eat non-halal meat, so this does not alwys indicate your religion by choice of food!
laura-beth , leeds, uk

America is concidered a safe haveb for information under the Data Protection Act.....A country that thinks that phone taps email collection without warrant should be legal. So much for safe haven. Security services come to the wrong conclusion with the right information what conclusions will they draw from this airline information. More inportantly why are the Europeans and the British frightened of America they seem to give in on all front trade airline info etc.
Tom McKinlay, Florida USA

So all an Al Quaeda terrorist has to do is order the pork chop and take along a cheese sandwich? Besides, there are something like 270 million muslims who aren't terrorists, and quite a few terrorists who aren't Mulims.
Sheila Crosby, La Palma, Canary Islands

The Americans have over reacted. As Mark Mardell implies, they are unlikely to be able to process so much information before aircraft arrive in their country. I recall that the USA immigration and naturalisation service issued visas to more than half the 9/11 hijackers many months AFTER the terrorists had died in the WTC/Pentagon attacks, so their systems are trifle slow. Hence, what are the chances of the FBI/CIA analysing, in any useful way, the daily flood of data from so many EU airlines? Frankly, the way in which US immigration officials greet visitors (why can't they at least smile?!) the insistence on biometric passports; the convoluted, time consuming and expensive visa system, and now the demand for so much personal information about travellers, has put me off visiting my American relatives ever again. And I'm sure I am not the only one who feels that way. In any case, if there is going to be another 'attack on America', the potential perpetrators are probably already there - waiting.
P J W , Lincoln

Isn't the whole meal-airline story just playing into the hands of the terrorists? If you want to make your way safely into the US, just make sure to order some pork on your way there and you'll be cleared instantly... (of course you don't need to eat it, unless that information is also part of the package!?)
Marco, London, UK

It sounds like politicians have decreed [very reasonably] that we must have good airline security after Sept 11th. Those responsible for doing this have opted for something that makes it like real action, but which in reality is not very meaningful. I recently passed through a UK airport and was searched, shoes checked, baggage x-ray for sharp metal objects etc. Then I went to the toilet. The loo-roll dispenser was made of sharp serrated metal!
Martin, N. Ireland

Is this the same US Intelligence Service that had a Bournemouth pensioner locked up in South Africa because they said he was a wanted Mafia Boss? And what about the green form you have to fill in when flying to America that asks if you are a terrorist, tick the Yes/No box!!! If US Intelligence didn't think they really were 'intelligent' the situation would be laughable.
Susan Buddle, Barnham, West Sussex, England

Someone said the NHS is rubbish, which simply isn't true. It has a superb acute treatment system, but the non-acute system does, unfortunately, involve waiting lists. But no patient has to put their hand in their pocket to pay for surgery and claim it back later. As with all things, you get what you pay for and if we spent more of our GDP on healthcare it would be better.

With respect to airline meals. I usually get offered a choice of meal about 2 or so hours into the flight to the US. Surely the plane doesn't then e-mail the US that passenger 47 just had the vegetarian option? It must be a special pre-booked meal that is commented on.
Dr Nick Ashley, Huntingdon Cambs UK

The patient here really needs to be his own ambulating medical record. It's nice being able to go straight to a specialist and have more or less any treatment on demand, but the onus is on the patient to notify the specialist of previous treatment, drug allergies, medical history etc. The one advantage of the UK's otherwise crappy system, where GPs essentially just maximise through-put, is that you have one set of patient records that gets updated for everything that happens to you. This probably also makes the NHS easier to sue... at least record-keeping makes them accountable.
Tom, Brussels, Belgium

My wife and I have been living in Belgium for about 4 years. We are South Africans, used to excellent healthcare - only if you pay dearly for it privately. Our daughter was born in Leuven's university (public) hospital last year. It was an extremely complicated pregnancy and we are forever grateful for the cutting-edge, high-quality and caring service we received from the whole Belgian medical system. This involved countless visits to specialists, MRI's and in-utero surgery. Our only "extra" contribution was 1500 euro because we splashed out on a private hospital room instead of the usual two-patient room. Had we been in SA we would have been financially crippled by the whole pregnancy. Belgian tax and social contributions are high, but they're worth it.
Nils Herloff-Petersen, Ottenburg, Belgium

I've been living in Brussels for 4 yrs now after marrying a Belgian. I had some knee problems after a sports injury back home in the UK and after a couple of ops in the UK, things were still not correct. My father in-law who is a GP in Belgium gave me a recommendation, I called, saw the surgeon the following week, had scans two days after that and was then asked, when do you want it done, this week or next!!! Marvellous. The wards are clean, staff are friendly and the after-care 1st class. Yes only around 85% was paid by the mutual-insurance company, but even when I got a bill direct, I sent it to the mutual, waited till they paid me, then paid the hospital. All in all, it cost me about 300 euro for a 4 day stay in hospital and a major knee op. When I explain to my wife about the NHS and she sees things on the BBC, she is horrified. I'd go for the Belgium system every time. It gives you choice and there are good hospitals and doctors!... My wife gives birth next week to our 2nd baby. She will not be going home 6 hrs after the birth as seems to be the case with friends in the UK. She will be in for 4-6 days, always a private room for maternity wards, with a bathroom and baby facilities. The nurses are there to help mother and baby get prepared for life at home. High taxes yes, excellent health systems, without question. 60 years of the NHS black hole and still dirty hospitals, long waiting lists and a shortage of staff. Time to look at changing it?
Michael Dixon, Brussels, Belgium

Emma of Gent: It is not funding that is the problem with the NHS it is management and political interference. There are now more managers than beds, politicians interfere by setting ridiculous targets, which the hospitals and gp's then work around. 20 billion pounds has been wasted on a ridiculous IT system which will probably never work. Just think of how many doctors and nurses this money could have been used to train and pay, never mind the medical equipment you could have invested it in. You could almost have rebuilt every hospital in Belgium for that money.
garry, glasgow

So in Belgium they pay 60% income tax which doesn't even pay for a free health service? Shangri-La indeed. Not. The NHS ain't perfect, no, but in general it does a remarkably good job. The grass is not always greener. In the UK we should remember how lucky we are to have such a low tax burden compared to the rest of Europe, and if we had to pay 60% income tax here I'd sharpish be off to somewhere where I could keep at least half of my hard-earned money.
Steven Burns, Reading, UK

My father happens to be a doctor in the UK and claims on a daily basis that the health system in the UK is appalling and becoming more&more degraded each year. There is always a could'nt care-less attitude by ancillary staff but even to my father's from doctors themselves. Mind you here in Greece the health system is completely decrepid if it wasn't for good doctors people would be dying right left and centre.
Victor, Athens, Greece

I lived in Brussels from 1975 to 1983. As an asthmatic I used to get my inhalers from the UK, but whenever I wanted medical advice I found Belgian GP's to be excellent. The Mutuelle was an administrative grind, but the system worked. If you really want medical excellence move to Switzerland as I did 1987 to 1993. Again insurance based, but fantastic for the consumer. I didn't go to a GP, I went to a chest doctor - he had X-ray equipment in his surgery. The wife had a Gynie who kept his instruments in heated drawers. The children (born in beautiful local hospitals) only ever saw a paediatrician. It was a real shock to come back to the NHS.
David Cartwright, Coventry UK

I was most interested in the comments concerning Health care in Belgium. I live in Luxembourg where we have a similar system which works extremely well for all concerned. Normally, if it is necessary to be hospitalised, the bill is sent straight to the health insurance so there is no great problem there. All other cost such as visits to G.P. have to be paid first and then claimed back. This can be a problem for some people but banks are usually very accommodating as the Insurance Company normally reimburses straight into the patients bank account. The other subject I found of interest was the information required at U.S. immigration. I have two points. First details such as Credit card information is private and should remain so. To insist on this is an invasion of human rights. Secondly, why do no we in Europe demand the same information from U.S. visitors? I have just returned from a visit to U.S.A. and had to queue behind a mass of Americans who could just wander through just by showing their passports. If we applied the same rstrictions you can be sure that there would be a mass of complaints to the U.S. Embassies. Pat Patterson, Ernster, Luxembourg
Pat Patterson, Ernster

It has always puzzled me why the english with their much more free market economy adhere to a stalinist health care and school system. In short, we have a kind of voucher system, that is state funded and gives (almost) free care or schooling to the individual. It is the competition at the level of the provider (minimum standards set by the state), that gives you the better service. Franz Heijlen Belgium
Franz Heijlen, De Haan

The problem with the NHS is chronic underfunding and lack of political will to do anything about it, because that would involve raising taxes. Of course, the government can find money when it wants to invade other countries, upgrade nuclear weapons or build nuclear power stations (and we all know it's going to happen...). What we need is for the government to stop messing around with false "choice" and actually put enough money into the NHS to run it properly. What the UK should be ashamed of is the fact that NHS trusts are having to cancel or put off operations because of budgetary constraints. What's more important, health or money? Incidentally, I'm delighted by the ECJ ruling. And doubly so that it came at the instigation of the European Parliament. Finally, an example of democratic power within the EU...
Neal Wilson, London

I had a similar experience in London. I went to GP in London (NHS) for knee accident. Being a medic myself , I told the GP I had a serious knee injury which I could not examine on my own knee. He would not even look at my knee if I had not insisted him to do a clinical examination. He sent me away with some pills for "bruises" . I traveled to belgium to have a propoer examination, where a knee ligament injury was diagnosed, needing surgical treatment to avoid further damage. On the other han I now live in Kent, and am very happy with the service provided by the local NHS GP.
mia, Belgium (Living in UK)

Please, can everyone stop calling the NHS a "free" service. Tony Blair is very fond of expressing the merits of our "free" medical care whenever he is asked to comment on the filthy wards and endless expense incurred by the ever suffering tax payer. It is not a free service, we the British tax payers pump billions in to this money pit every year!
John , UK

The problem is that although the British love to criticise the NHS, with very good reason, they still have trouble thinking that other countries can have a good health system. The British obsession with GPs is hilarious. They think that because the UK uses the GP system everyone else must In fact, the GP system only predominates in the UK, elsewhere, you see a specialist without going through a GP (foreigners in the UK are shocked to see GPs, and increasintly nurse, doing what abroad would be done by specialists.) When will the UK lose its poltiical dogma about "free at the point of use." Also, the UK and Ireland have the lowest number of doctors per head in the EU. What does that say?
Richard, Edinburgh, UK

Mark's experience in Belgium is exactly the same as mine in Luxembourg, where I have lived for 32 years. The health insurance,from my husband's employer, functions in the same way. We are free to visit any specialist of our choice, without first having to go through a GP and are able to get scans, blood tests etc. within a week. In fact I was taken aback recently when I was offered a facial scan the day following my phone call! With reference to paying all medical bills - people on low incomes are not obliged to pay the full amount up front.They need only to pay the percentage difference,the bill being sent directly to their health insurance firm.
Heal Patricia, Bridel, Luxembourg

If more Brtish staff worked outside the English-speaking world for a time, they would see how other systems work. More should work elsewhere in Europe for a time. Staff who do work abroad go to North America or Africa/Asia (often for development, charity work). Therefore, few British have experience of the European insurance base systems. The problem is that few doctors in the UK can work in French, German etc, whereas educated Europeans, esp Doctors, now speak English.
Richard, Edinburgh, UK

I can't speak to the Belgian system, but was in the Netherlands about 7 years ago and got very ill. The doctor came to my hotel and, wonder of wonders, he had the necessary medication with him, so I didn't have to try and stagger into a pharmacy. I was stunned. No doctor here in the US would consider making a house call, at least not in a major metropolitan area. Re supplying all the airline passenger data to the US for review, it seems to me just a case of throwing our weight around. Same thing with the Patriot Act which permits wiretapping or recording calls made in the US without any justifiable reason for doing so. I don't know what the rules are in Europe, but visitors to the US should be aware that their calls may be recorded and reviewed. Even if there was useful information in such huge volumes of data, how on earth could it ever be found in a timely fashion?
Grace Ackerman, Arlington, MA, USA

Although I am not denying that people do have negative experiences in UK hospitals, I would likt to put a positive point of view. I had two children in two hospitals in the UK. My youngest child spent 3 months in the paediatric ward of one of the hospitals when she was less than 12 months old. As her parents we spent every day and many of the nights with her. The hospital was clean (as was the other hospital where I had my first child) and we witnessed the cleaning rituals that took place day in and day out between patients leaving and arriving. My daughter was seen by a consultant every day and sometimes twice a day and the medical and nursing care was of a very high standard. Not all hospitals are bad and/or dirty and not everyone has bad experiences!
Adrienne, Aylesbury, UK

I've just left Belgium after 5 years, and I broadly agree with Mark and what others have said about the Belgian healthcare "system". Doctors are for sure much more customer focused; my 1st health check I was in with my GP for 1 hour! I actually felt guilty for taking up so much of his time. It's not all as rosy as some make it sound though. I can say as a self-employed person - I was heavily penalised. I had to pay more than 2x what an employee did (social security + mutuelle), thanks to not having any bargaining power plus Belgium's apparent disdain for the self employed. As a proportion of income, my health care\social security was costing me a fortune (think 20%+ of takehome for *basic* cover) - and when I *did* have to claim for a large number of doctors visits, the mutuelle managed to wiggle out of paying, leaving me with a bill for thousands. Other "independents" I know have had exactly the same. You have to be willing + able to spend hours or days taking time off work to sit in their offices if you do have a problem with the mutuelle. End of the day, they're a business like insurance companies, and will happily wash their hands of you if they can avoid a big payout. The last thing you need when your ill is that kind of bureaucratic hassle, trust me.
Clark, Lausanne

Now that even the Conservative Party seems to have given up trying persuade the UK to adopt a much efficient insurance based system I shouldn't hold you breath for reform in the UK.
John Brewer, London, UK

I fail to see how the belgian healthcare system can be compared to the british system based upon one example. Mr Mardell knows full well the effect his comments make upon those who read them whether he is reflecting as a private individual or as a journalist, and he should be ashamed of himself for the way he has conveyed a political idea whilst masquerading as a private individual. For the record I note that Mr Mardell admits that the British system caters for everybody, when it is needed, free at the point of need, without regard for race, creed, colour, or, money.
philip heath, Claverdon. Warwickshire, UK

I think the people in the UK have the wrong attitude towards everything. The people don't care and don't take pride in what they do. Making the wrong judgement regarding the illness is either a lack of knowlegde or a don't care mentallity. The same applies to the healthcare system, no-one in the government seems to care that the healthcare is rubbish, or the policing. All the ministers seem to care about is who they can sleep with and how long they can keep it quiet for.
Mark Gerben, London (NL expat)

I find it strange that in all of the discussion comparing the Belgian health system to the NHS there is no mention of the COST - not the top-up insurance or 'excess', but the total cost of the systems in Belgium and the UK. I seem to remember hearing that the UK was one of the lowest cost health systems in the world, but you get what you pay for (or, more to the point, you don't get what you didn't pay for during all those years of Tory under-funding). When will people learn to stop whinging and accept that to get first class systems (health, public transport, pension etc.) they will have to pay more tax?
David, Harrogate, UK

A pity the world revolves around money, in this day and age we still literally have to beg for help, surely this is the middle ages?. No medical service is any good if it dosent help those who really need it the worse off. As for Americas insistance on useless information from airlines, Their time would be well spent getting their boys home from a war which is in the end going to achieve nothing as did the vietnam war and get the english lads home too, let the muslims who want to live under muslim law live and fight each other.
Keith, Liege Belgium (ex brit)

I am fortunate to have worked as a nurse in the Belgium healthcare system and for the NHS , so I have seen both systems from the inside. I have often wondered where I would prefer to work and where I would prefer to be a patient, and my conclusion is that there are benefits and disadvantages to both systems, and on balance neither is superior.
Hilary, Leuven Belgium

Mark Mardell seems happy that there are no "dragonish receptionists" in Belgium, but the downside is that your consultation with your doctor can be interrupted repeatedly when other patients phone for appointments or medical advice. This also happens at the dentists, where I have often been left with a mouthful of dental equipment while the dentist sorts out his appointments etc. The quality of treatment is good though.
Kevin Halliwell, Brussels, Belgium

Arguments over insurance based or UK style healthcare are irrelevent unless relative spending levels are included. As a sufferer from chronic heart disease I've been a regular customer of the NHS for the last 20 years. Over that time the quality of my treatment has varied in direct proportion to the percentage of Gross Domestic Product allocated to the NHS by the government. Now spending is higher than ever and this is reflected in the much improved hospital facilities and reduction in waiting time, especially at Addenbrooke's hospital in Cambridge, which is my main treatment centre. But the UK is still nowhere near the top of the European or international league tables in terms of spending on health care. And while Belgium or Germany or wherever may currently have better health care facilities than the UK, many of these countries are struggling to maintain spending at the current levels. The problem with many of the previous correspondents is that they want Belgian levels of healthcare without being prepared to pay Belgian tax rates.
Dave Parker, Bishop's Stortford. UK

I am impressed by learing the massage about the Belgium medical system. I just compare the system with my country and fell sorry being Nepali. Because i fell pain of from system because i am also medical professional. Is there any body in the world who just offer just training for we technically poor people !
Krishna Prasad Adhikari, Nepal,Pokhara

Belgium spends considerably more on health care than the UK - 9% of GDP in Belgium compared to 7.6% in the UK (2001 data). It also has a much higher level of private spending on health care (about 30% of total spending on health care vs about 18% in the UK). And it must be easier to run a health system for 10 million people than for 60 million people. Those who want a 'Belgian' health system must be prepared, at the very least, to pay for it.
Sarah Thomson, London, UK

I have lived in Belgium for about a year and a half now and I wholeheartedly agree that the quality of medical care here is far superior to that in the UK. When I was 19 I was diagnosed with epilepsy in the UK. This basically involved them doing the tests then leaving me sitting in an empty ward waiting for someone, anyone to come and tell me what was happening. Eventually someone came and said 'You have primary juvenile epilepsy. You might grow out of it, you might not. Take these tablets everyday.' That was it. No discussion of cause or further implications. No advice, no offer of counselling, nothing. I never heard from them again. When I came to Belgium 4 years later, having had some epileptic attacks in the meantime, I was about to run out of tablets so went to the doctor to get some prescribed. When she questioned me about my history and found out about my epilepsy, she was immediately concerned that my dosage was too low. She send me off to have another scan and blood tests and lo and behold, it turned out that the dosage prescribed to me by the NHS was about 1/4 of what I needed! I am now living a reasonably fit-free life since my dosage was increased, which would never have happened in the UK. Speaking to people about this issue, some have professed the opinion that doctors and specialists might overprescribe here or suggest treatments that aren't necessary as a way of getting more money out of the 'mutuelles' (health insurance providers)...personally I don't believe that, because the extra things I was given/prescribed did prove entirely necessary, but what do other people think?
Jenni, Brussels, Belgium

I lived in Germany for 10 years and returned almost 5 years ago. The health system in Belgium, as in Germany, France, and most of western Europe, is generally light years ahead of the UK. There is still a long way to go for the UK. As for USA data 'requests': it's about time that Europe should tell the Americans to wind their necks back in and reflect upon their impingement of our liberties.
Jeremy Whitehurst, London, United Kingdom

First of all i would like to say that as a Belgium citizen i'm proud of our medical system Gp's have a perfectly equiped cabinet and performe housecalls on all possible hours day anfd night these people do a great job ! What concerns the U.S.A i see it this way under the umbrellar of "security" the country of the 'free" is becoming the quickly the country of the not so free at all ,run by an president who broke 750 congressional laws more then all his predessors together ! Nearly all men can stand adversity, but if you want to test a man's character, give him power. Abraham Lincoln (1809 - 1865)
Willy vanbiervliet, Ostend Belgium

Here in Holland we also have a great insurance based system whereby those who can't afford the premiums get assistance from the government, most bills are sent directly to the insurance company by the doctor or pharmacy. There is a basic level of care which everyone is entitled to and you can buy extra insurance as you wish. I pay 20 euros a month extra for the best insurance in the market and get back the 30 euros a month I pay for my contact lenses. The result is that I always see my GP the same day, I have always managed to get consultants appointments within 24 hours and I get full and prompt treatment every time.
Jennifer, Netherlands, ex-UK

Our National Health is a noxious malfunctioning money-eating disgrace. Why are we so proud of it? I look with envy to Belgium (a fine country where I have now spent five(?!) holdays, much to my English friends' amazement). One indicative statistic for you: compared to the UK, Belgium has TWENTY times the number of MRI scanners per head of population! Regards, James.
James, Stockport, England

The problem with the Belguim system is overconsumation. The health system is a very good one but very expensive. The cost grows every year with 3%, with an aging population (who needs more medical care) its a very heavy burden on the state budget. People with paying problems for medical bills can get assistance of a local social agency called "OCMW".
Coopman Lorenzo , oostende Belgium

The belgian health care system as described above is open to all, those on or below the poverty line as well as those not experiencing financial difficulty. The workforce pay a large amount of income tax and social security to ensure that the healthcare system is (almost) free. I wish people in the UK would stop moaning about the NHS and just agree to pay more tax to fund it properly. Take a leaf out of the Belgians book
Emma, Gent, Belgium

Dear Marc, thank you for writing a positive story on Belgian's health care system. We get enough bad publicity due to our perceived bad weather and because of ugly Brussels. In response to your remark on how to pay rather large health care bills before you can claim them back from your "ziekenfonds" (or mutuel, as you write, no thanks for representing Belgium as a unilingually French-speaking country), I can say that Belgium has a payment system known as the "maximum invoice" (maximumfactuur). In practice, this means that once your net contribution towards health care costs within a given year reach a certain amount, you are no longer required to pay the whole bill yourself and reclaim a refund from your "ziekenfonds" afterwards. Instead, you only pay your GP or hospital the net contribution that you would have paid anyway, i.e. the difference between the full amount and what you can reclaim from your "ziekenfonds". The exact amount that triggers the system of the "maximum invoice" depends on your "social category" or your income. Widowers, orphans, the disabled, and pensioners are eligible for what is called the "social maximum invoice", with a relatively low trigger. For people not belonging to any of these categories, the amount that triggers their "income maximum invoice" depends on their family income.
Michel Soudan, Ghent, Belgium

I share your experience on the UK system for appendicitis. I was dismissed by the British GP with, unbelievably, period pains. It was eventually diagnosed correctly, and immediately, by a (Croatian) emergency doctor. The hospital was filthy under superficial cleanliness. The staff had no interest in anything but getting you out of the ward, and the hospital, as fast as possible. I had to be re-treated following further complications. A truly disgusting experience. If it happens to you in the UK, be afraid, be very afraid.
Maria , London

I had a different experience with the Belgian health system. I lived with my family in Brussels from 2003 to 2005. My 4 year old son had abdominal pains that suggested gastroenteritus (sorry spell check does not work in this box.) The scan and later xray were so unclear presumably because they were so old that even the doctors admitted that they could not clearly make out if there was an obstruction or not. I have not the slightest medical training but even I thought why not place a tube into his rectum to remove the gas. Instead a bored surgeon decided to operate and opened up his stomach. There was no obstruction only gas. He now has a 4 inch scar on his stomach for no reason. I know the hospitals and transportation systwems appear efficient but I think it has to be remembered the differences in population between the two countries. On a related point, I saw on Sky news a comment from a viewer saying how in Spain their water bill is so much lower than in the UK despite the country having less rainful. Have they not heard of the expressioon 'don't drink the water'. I think we tend to overdo it in praising our neighbours.
Howard Petre, London UK

We have a similar medical system here in Germany and when I had to go to A & E one day I was seen within ten minutes, there where only 5 people in the queue.What amazed me most was that the hospital was super clean and everything seem to calm and quiet, nobody was russhing about or getting irate.I did have to pay for the meidicne I was given because I had forgotten to bring my E111 and didnīt have insurance.The bill didnīt arrive at my house until 2 months later and it wasnīt that much anyway.But of course the people in the UK would rather have a free system that obviously does not work and is getting to costly to finance.
steve, Lindenberg, Germany

Mark Mandell can relax: some Belgian GPs also make mistakes. The one to whom we'd been going to when coming back on visits from the USA (where costs are so high that it was cheaper for me to fly back to Belgium for a root canal dentistry than to have it done in New York) told my wife last september that the abdominal pain she felt was due to "stress from the flight". We went to a hospital emergency ward ("urgences") and the cause was diagnosed after X-rays and operated on. Contrary to what Mark Mandell says, the hospital only charged us what wasn't covered by the "mutuelle" (it may be that different hospitals have different policies in that respect)
john somerhausen, brussels belgium

"millions of pieces of information..." I trust the personal profile data distilled must be valuable commodity for selling/flushing to marketing agencies... there's nothing new at linking "security" politics with business "...someone who hasn't got enough money to pay the rather large bills in the first place"... well, trust me from first hand experience: it'slike having not enough money in any country: (administrative) hell to start with... every single citizen is bound to have some "mutual" health insurance, even without income or activity, you (must) subscribe to some mutual service and pay contributions as "not protected" (by one of the more classic status of employee, self-employed, etc.) it is true that "bottom line" hospital quality that someone "not in order" with his mutual contributions will get in belgium must be much much, much better than in most places. there is after all some debate going on on limiting the number of "foreigners" (mainly dutch) coming to our hospitals for treatment.
marc debacker, brussels

I am a Brit and have lived in Luxembourg and Belgium for more than five years now. I cannot for the life of me understand the fuss made about the sacred NHS in the UK. The private insurance / mutuelle system here means that the provision of health care is highly accessible, sufficient and effective. I also have a son complaining this morning of pain in the appendix area (!)and with a fever. I phoned the doctor who will do a house visit before 11am. When I needed a CT scan I was told I could come in at 8am the next day, MRI scans take about a week, I have access to any specialist I feel I need to see, and the hospitals are maintained at a very high standard. What's not to like? I read in the UK papers about waiting lists and months-long delays in treatment and wonder why?
Nicola Bolton, Arlon, Belgium




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