Subsidyland Belgium: mutuality’s, transparency and taxpayer money
Subsidyland, mutuality’s, transparency and taxpayer money are four words that go to the heart of Belgium’s subsidy problem. Belgium has become a subsidyland in which mutuality’s (healthcare insurance organisations), NGOs and countless civil-society organisations no longer stand at the edge of government, but have become almost financially fused with it. The problem is not that solidarity costs money. The problem is that taxpayer money flows through a forest of structures, while transparency often comes only afterwards, hidden in tables, registers and annual reports that ordinary citizens can barely understand.
Belgium’s health insurance system is, of course, not a minor detail in the budget. The National Institute for Health and Disability Insurance, RIZIV, reported that the global budget for health care insurance in 2024 amounted to more than 42 billion euros. More than 37 billion euros of that went to the budget objective for reimbursing medical services. This is the large social machine on which millions of people rightly rely. But precisely because of that, the machine should not be treated as a sacred cow about which no critical questions may be asked.
Take the mutuality’s. They carry out public tasks, but at the same time they are organisations with their own brands, campaigns, structures, research departments, member services and political histories. For 2024, the administrative costs for the insurance institutions were set at almost 1.3 billion euros for the five national federations, plus more than 22 million euros for HR Rail. Together, that amounts to more than 1.3 billion euros in administrative costs. That figure alone deserves a public debate that goes further than: “That is simply how the system works.”
And that is exactly where the problem lies in subsidyland. Every euro is defended as necessary, social, historically developed or technically unavoidable. But when everything is necessary, nothing is truly weighed anymore. How many counters, umbrella organisations, national federations, non-profits, advisory councils and partner organisations are needed to achieve the same social goal? How much money goes to care, guidance and protection for citizens, and how much remains stuck in structures that mainly keep themselves alive?
The defenders of the system have a point: without mutuality’s, the organisation of health insurance would look different and possibly more chaotic. They reach citizens, help with files, identify problems and play a role in consultation. But a useful role is not a blank cheque. Anyone who receives public money must be able to publicly demonstrate what added value they provide, at what cost, with which alternatives and with which measurable results. Mutuality’s should be compared annually on the total costs they incur per insured person.
The same applies to NGOs and other organisations. Nobody disputes that associations, poverty organisations, care initiatives, cultural institutions and international NGOs can have social value. But value is not a free pass for funding. In Flanders alone, the subsidy register recorded more than 18.8 billion euros in awarded subsidies in 2024. The Flemish government itself describes subsidies as a “structural and significant part” of the expenditure budget. That is not pocket change. That is a parallel financial ecosystem.
Moreover, many of these subsidies largely end up with the same type of activist organisations, often located on the left side of the political spectrum. If these 18.8 billion euros in subsidies were abolished and the organisations had to raise money from their members or visitors, that would be much fairer. If citizens do not need an organisation, then that organisation should cease to exist. Maintaining organisations simply for the sake of maintaining them costs society an enormous amount of money. Reducing the lowest income-tax bracket with this subsidy money would give the purchasing power of almost all citizens in our country a boost.
And yes, Flanders now has a subsidy register. That is better than nothing. The register has mapped subsidies since 1 January 2022 and shows amounts for companies, organisations, informal associations and local authorities. But transparency is more than putting data online. Real transparency means that citizens can quickly see why an organisation receives money, which objectives were agreed, whether those objectives were achieved, and what happens if they are not.
Today, things often work differently. The citizen pays, the government distributes, the organisation reports, the administration checks, and somewhere deep inside that process trust is supposed to arise. But trust is not a policy instrument. Trust must be the result of control, simplicity and clear choices. This is especially true when it concerns taxpayer money that is circulated through mutuality’s and civil-society structures.
That is why the word “circulation” is so fitting. The government collects money, passes it on to organisations, which then provide services, run campaigns, write reports, organise consultations and apply for subsidies again. Sometimes that is efficient. Often it is simply the circulation of money. And the more layers there are in between, the harder it becomes to see where each euro ultimately lands.
Those who criticise this model are quickly accused of being antisocial. That is too easy. Criticism of subsidy politics is not criticism of care, poverty reduction or solidarity. On the contrary: anyone who takes solidarity seriously should want resources to reach those who need them, not those who know the subsidy procedure best. A government that spends billions has a duty to justify every intermediate layer. Every euro that remains with citizens can be spent by those citizens themselves. And if a ticket to a classical concert becomes more expensive, that is not a problem. After all, expensive tickets for Tomorrowland are not subsidised either.
A mature debate about mutuality’s should ask three questions. First: which tasks must they perform because they can demonstrably do them better than the government, private service providers or digital systems? Second: which costs are unavoidable, and which are historically grown luxuries? Third: why does the system remain so fragmented in a country that simultaneously complains about budget deficits, staff shortages and administrative overload?
NGOs and civil-society organisations also deserve that test. Not because they are suspicious, but because subsidyland can remain healthy only if subsidies are one-off or temporary, targeted and verifiable. A subsidy must not become a long-term lease on taxpayer money. It should be a contract: this problem, this objective, these resources, this deadline, this evaluation. Those who achieve results can continue. Those who mainly reproduce themselves should stop. The best system would, in principle, be to provide no subsidies at all. Citizens can organise themselves perfectly well without financial help from the government, because in the end they pay for it through taxes anyway.
The real reform of the mutuality’s is therefore not a blunt across-the-board cut. That mainly produces outrage and rarely better policy. The real reform is radical transparency: one public overview per organisation, including all government funding streams, management costs, objectives, evaluations and overlaps with other subsidies. Not hidden in PDFs, but understandable for the taxpayer.
Belgium can remain solidarity without being naïve. Flanders can support associations without becoming a subsidy machine. And the mutuality’s can continue to play a role without their historical position suffocating every discussion. But then the government must dare to say that even good intentions can become too expensive, and that organisations should provide their own income.
In a country with waiting lists, high taxes and tight budgets, the question is not whether solidarity may cost money. Of course it may. The question is whether, and how much, tax money we continue to channel through structures whose added value is too often assumed instead of proven. As long as that question is not central, Belgium will remain too much what it is today: a comfortable subsidyland for organisations, and an expensive country for the citizen who pays the bill.
Image credits: Mohamed Hamdi via Unsplash
