Priscilla FIALHO
OECD
OECD Economic Surveys: Belgium 2024
OECD Economic Surveys: Belgium
Abstract
Employment gaps for women, older people, foreign-born, and people with disabilities remain large in Belgium. Improving the integration of these groups in the labour market would reduce socio-economic inequalities, boost economic potential, and improve public finances. Belgium’s system of individual learning accounts for training rightly aims to improve workers' employability and career prospects but should better target underrepresented groups. Barriers to labour market participation, notably for women, call for increasing access to childcare and addressing financial disincentives to work in the tax-benefit system. Prevention, retention, and rehabilitation policies for those with disabilities need strengthening to better support employment. Measures should include focusing disability assessments on remaining work capacity, earlier implementation of return-to-work programmes, and stronger incentives to participate and implement reintegration measures.
The Belgian labour market has been very tight with widespread labour shortages (Chapter 2). It remains characterised by relatively low participation and employment rates by international comparison with large and persistent regional disparities. Employment gaps for low-skilled workers, women, foreign-born, youth, older workers, and people with disabilities are large (Figure 3.1; OECD, 2022a). Greater integration of these groups into the labour market would reduce socio-economic inequalities, benefiting society more widely. Moreover, enhancing their employability could offset population ageing, help improve the sustainability of public finances and sustain higher levels of growth in the long-term (Chapter 2). This chapter starts by taking stock of progress and providing recommendations to expand employment opportunities for groups underrepresented in the labour market. It then looks in more detail at policies to improve the employability of persons with disabilities, a group that has grown rapidly in Belgium in recent years and where the rate of employment is low in international comparison.
Employment rates, 2023
Note: “Low education” is below upper secondary education and “Disability” indicates individuals with some or severe limitation of activity. Data on people with disability refer to 2020 or latest year available.
Source: Eurostat.
Labour market outcomes have improved over time for all groups but persons with disabilities and low-skilled workers. In the last decade, the participation and the employment rates have increased for women, for older workers, and for foreign-born. Improvements were particularly significant for older workers. For young workers, the employment and the participation rates have not increased significantly, but this is mostly explained by improvements in educational attainment and the extended duration of tertiary education (CSE, 2023). Persons with disabilities, however, did not experience any meaningful improvement in labour market outcomes. Low-skilled workers perform even worse than ten years ago (CSE, 2023; Figure 3.2). Additional efforts are needed to improve the employability of groups underrepresented in the labour market and close the remaining employment gaps.
Policy makers should pay particular attention to individuals with disabilities. Belgium is the European country with the highest share of persons that are inactive due to prolonged sickness or disability. Approximately three out of ten inactive persons between 20 and 64 years old are not participating in the labour market due to prolonged sickness or disability (CSE, 2024). While the participation rate for workers without disabilities in 2022 was 75%, this percentage fell to 58% for individuals with a moderate disability, and to 24% for individuals with a severe disability (CSE, 2024).
Employment rates
Source: Eurostat.
Promoting lifelong learning
Low-educated and older workers are less likely to enrol in lifelong learning. The previous Economic Survey of Belgium shows that there is a 45-percentage point gap in lifelong learning participation rates between low-educated and highly educated workers (OECD, 2022a). Similarly, the Survey highlights that the lifelong learning participation gap between young and older workers is among the highest in Europe. Lifelong learning can go a long way to break the cycle of disadvantage that grips low-educated workers. Facilitating participation in adult education and training can also help extending working lives by ensuring that older workers continue having the right skills to stay in employment. However, identifying and communicating skill needs to employers can be challenging, especially for those who lack basic skills. Employers may also find it relatively more costly to train low-skilled workers and prioritise those who are already highly educated. For older workers, proximity to retirement may discourage and limit access to training.
As recommended in previous Economic Surveys of Belgium, the federal government is setting up an individual learning account. To ensure that all employees have access to lifelong training, including the low-skilled and workers close to retirement, since 1 January 2024, every full-time employee in a company with at least 20 workers is granted an individual right to five training days per year and pro rata entitlement is applied for part-time workers. Before the reform, training obligations for employers were not defined at the individual level. Training days are financed by the employer and can be cumulated for up to five years. Training should take place during working hours and employees receive their full wage during that time.
While the introduction of an individual training right is welcome, there is scope to assess the programme effectiveness in the coming years and to potentially improve the programme’s design. Independent workers, individuals on non-regular contracts, and those employed in small firms are excluded from the system (Chapter 5). These groups are already at a disadvantage in the labour market and under-represented in training and are precisely those that would need support. The individual learning account and the training rights should cover all segments of the working population. The individual learning schemes in Switzerland (Geneva Canton) or in Singapore, for example, are almost universal as they cover all individuals above a certain age threshold (OECD, 2019). Funding could come from public sources for those employed in smaller firms who do not necessarily have the means to pay for training, for workers in non-standard forms of work and for the unemployed. The French system is funded out of a dedicated social contribution on medium-size and large firms so that employers are only indirectly involved, and the collected funds can benefit all workers, including small firms’ employees (Chapter 5). This option would reduce the cost of the measure for public finances.
Specifically targeting disadvantaged groups within the existing system should be considered. High and low-skilled workers, or yet workers with and without disabilities, are entitled to the same training days although the cost of training these groups differs markedly. In France, for example, individual allowances are defined in monetary terms instead of days. As the cost of training is generally lower for low-skilled workers, monetary entitlements would get them more training (OECD, 2020). Otherwise, modulating the amount of support according to some criteria might be possible. In France, individuals who have no upper secondary qualification accrue EUR 800 per year, against EUR 500 for more highly skilled individuals. In Austria, women returning from child-related leave, low-income employees above 50 years old, low-educated individuals, and immigrants benefit from higher support (OECD, 2019).
Plans to develop a web platform to inform about the individual training account scheme needs to be pursued. Administrative barriers are likely to affect disadvantaged groups disproportionately, since they tend to be less able to navigate complex systems. The planned web platform needs to centralise information about the federal programme and existing regional programmes. Flanders introduced an individual learning account in 2023 (‘Opleidingstegoed’) which provides an overview of regional training rights and incentives. It is important to ensure the complementarity of the federal and regional schemes as they are being developed. The unified platform could serve as a single point of entry, informing individuals about eligibility to different programmes and potentially allowing for the accumulation of different sources of funding or support. These steps would help improving coordination across the federal and the regional governments as recommended in the previous Survey (OECD, 2022a).
The development of the federal individual training account needs to be accompanied by guidance on the choice of training programme and opportunities for the recognition of skills. Career guidance would help to ensure that workers use their training credit to acquire relevant skills, for which there is labour market demand. Career guidance could even become an allowable expenditure under the available funds. In France, the individual learning account can be used for skill assessments and career guidance services (OECD, 2021a). The unified web platform, discussed above, could provide information on career guidance programmes, such as the recently expanded Coup de boost project, offering professional guidance and advice to young unemployed workers in the Walloon region. In Flanders, an online tool ‘Competentiecheck’ can be used to assess users’ skills, suggest suitable jobs and provide with training suggestions. Developing recognition of prior learning would be particularly helpful for the integration of skilled migrants, namely Ukrainian refugees, who are often highly qualified but struggle to have their qualifications recognised (Table 3.1; OECD, 2022a). Active outreach measures can help to increase the take-up of in-person information and guidance services.
Enhancing women’s opportunities in the labour market
Women in Belgium are less likely to participate in the labour market and be in employment than men (Figure 3.3) and earn less on average. In 2021, the employment gender gap was, on average, eight percentage points, but the gap is larger for low-educated workers, at 19 percentage points, and migrants, at 21 percentage points. In terms of labour force participation, a third of women of working age are inactive, compared to 25% for men. Among inactive women, 25% of them are highly qualified, compared to 20% for men (CSE, 2023). The participation and employment gaps increase, and the wage gap develops, after the birth of a child and women do not catch-up afterwards (CSE, 2023). Closing the gender employment gap by 2060 could potentially increase Belgium’s GDP growth per capita by up to 0.2 percentage points on average over the period 2023-2060, boosting the size of the workforce and contributing to a better allocation of labour (Fluchtmann et al., 2024).
As in many countries, women assume a larger share of unpaid work than men. They are more likely to adjust their professional lives to accommodate parenting responsibilities through reduced hours, part-time work, parental and caregiver leave, or even career interruptions (André et al., 2023; CSE, 2023; Figure 3.3). Four out of five part-time workers in Belgium are women. Among women working part-time, 20% declares that they would like to work more hours. When part-time work is deemed voluntary for women, it is often justified to take care of children or dependent adults. Even when working full-time, women work, on average, less hours than men. On average, in 2021, men working full-time worked 39 hours and 12 minutes per week. Women, on the other hand, worked 36 hours and 48 minutes (CSE, 2023). Evidence suggests that fathers tend to be more involved in unpaid work when they are taking parental leave (Tamm, 2019; Knoester et al., 2019). In Belgium, parental leave remains unevenly split between mothers and fathers (CSE, 2023). Mothers and fathers are entitled to four non-transferable months of leave in line with EU regulation, but low replacement rates provide low incentives for fathers to stay home.
Note: Both full-time and part-time workers were taken into account for the gap in hours worked.
Source: OECD Employment and Labour Market Statistics database.
Increasing the availability of childcare can significantly attenuate gender gaps. It can reduce the opportunity cost of paid employment, boost participation in lifelong learning, and increase enrolment in activation programmes. In Belgium, only 33% of 0–2-year-old from low-income households participate in childcare, compared to more than 70% from high-income households. Uptake of childcare services among migrants is particularly low (OECD, 2023). The provision of early childcare - for children under 2 ½ years - at an affordable price should be expanded. Most childcare facilities charge means-tested fees and childcare costs can be deducted from income taxes, but availability remains an issue with large shortages and long waiting lists. Efforts by the regional governments to create additional childcare places and the reform of the priority rule for the allocation of childcare places are going in the right direction (Table 3.1). In Flanders, childcare costs are reimbursed for jobseekers participating in training. Actiris, the public employment agency of the Brussels region, also provides language training for migrant mothers that could help address issues related to cultural norms and gives recently employed people and jobseekers participating in job interviews and training access to childcare services. These promising initiatives could be extended to other regions.
Addressing gender biases in the tax and benefit system would also contribute to lower gender gaps in employment and income. Effective tax rates for second earners with children and for low-income single parents claiming the Guaranteed Minimum Income, who are more often women, are among the highest in the OECD (Figure 3.4). The partial splitting system for couples, which allows for an amount of income to be transferred between spouses if one earns 30% or less of the total family income, to decrease the overall labour income tax paid under progressive rates, should be abolished, as recommended in the previous Survey (OECD, 2022a). In the same vein, the tax break for paid maintenance allowances to ex-spouses and children should be removed. It provides tax advantages to higher-income taxpayers and contributes to the gender income gap, by allowing the payer of maintenance allowances - mostly fathers - to deduct 80% of the paid amount, while beneficiaries - mostly mothers - are taxed on 80% of the received allowance. Strengthening in-work benefits could support return-to-work and reduce benefit dependency for single parents, as discussed below.
Note: In Panel A, the participation tax rate measures the implied tax on earnings when moving into employment for a single person with two children earning 67% of average wage, claiming guaranteed minimum income. In Panel B, the effective marginal tax rate measures the proportion of an earnings increase resulting from raising working hours from 50% to 100% that is lost due to higher taxes, employee social security contributions and the withdrawal of means-tested benefits for second earners with two children earning the average wage, with a partner working full-time in average wage job.
Source: OECD Taxes, Wages and Benefits database, 2022.
Strengthening work incentives for low-income and unemployed workers
Generous income support for the unemployed weakens work incentives, increasing the risk of long-term unemployment, skill deterioration, and permanent labour market exclusion. Unemployment benefits in Belgium are time unlimited, and although the benefit decreases with duration, it does so more slowly than in other OECD countries, in small steps, and with relatively lenient job search requirements. Moreover, and while a range of factors, such the family situation is considered in the calculation of the benefit, the absence of means-testing for the long-term unemployed implies that long-term unemployed persons in households with potentially very different financial needs receive the same level of income support (Hijzen and Salvatori, 2020). Means-testing benefits for the long-term unemployed would improve adequacy and equity in the unemployment benefit system. Combined with stricter job-search requirements and greater activation support, means-testing could also increase work incentives for people benefitting from relatively high replacement rates. Associated savings could be used to step-up activation measures targeted at long-term unemployed with low employability and who face multiple barriers to employment. Reducing benefits over the unemployment spell in fewer and larger steps without increasing the steepness of the benefit phase out could be considered as evidence suggests it might increase job-search intensity and reduce unemployment (Salvatori, 2022).
High effective labour income taxation can reduce incentives to work for the unemployed and low earners. In 2022, Belgium had the highest labour tax wedge among 38 OECD member countries. The take-home pay of an average single worker, after taxes and benefits, was 60% of the gross wage, compared with the OECD average of 75% (OECD, 2023). The federal “work bonus” programme, which reduce the amount of social contributions paid by low-wage workers, was scaled up to lower the participation tax rate. This programme has proved quite effective in making work pay (Dagsvik et al., 2011) but may create disincentives to increase wages (low-wage traps). Its effects on work incentives are being evaluated. Similarly, the introduction of the Flemish “Jobbonus” in 2022, an annual wage premium for low-wage workers, aims to reduce financial disincentives to work. As part of a revenue-neutral broad tax reform, in-work benefits could also be expanded by extending to low-wage workers the possibility to cumulate unemployment benefits and income from work, building on existing schemes for part-time workers and as recommended in previous Economic Surveys of Belgium (OECD, 2022a; 2020). Withdrawing benefits targeted at low-income earners more gradually would help to address low-wage traps.
The share of individuals who receive disability benefits has been rising fast by international comparison (Figure 3.5). Health conditions and access to medicine have improved and are at odds with such expansion in disability benefits (OECD, 2023; CSE, 2024). This increase is caused, in part, by the improved labour force participation of women and 50–64-year-olds, raising the number of insured individuals. However, changes in workforce age structure and composition cannot fully account for the increase in disability benefits (De Brouwer and Tojerow, 2023). The remaining part could be explained by changes in job characteristics, disability insurance eligibility, assessment, and attractiveness relative to other social protection programmes, or yet, differences in perception, stigma, attitudes, and awareness.
Most disabilities are acquired later in life, as people age, causing functional limitations. Low back, neck, and mental health disorders have become the leading causes explaining the increase in disability benefits (OECD, 2021b; 2022). Women and older workers are more likely to report low back and neck pain than men and younger workers (Gorasso et al., 2022). Women are also overrepresented amongst those with mental health conditions (OECD, 2021c). This trend has been accelerated by the COVID-19 pandemic, as mental health worsened considerably during lockdowns, particularly affecting women and young people (Claes et al., 2023; Bruggeman et al., 2022).
Design features of social protection programmes could have generated spill-over effects on the inflow to disability benefits. Important unemployment insurance reforms in 2012 and 2015 tightened the generosity of the unemployment insurance system. As a result, even though the number of jobseekers remained stable over that period, the number of unemployment beneficiaries declined (Figure 3.6, Panel A; OECD, 2022c). Similarly, tightening access to different pathways into early retirement, namely old-age unemployment programmes and old-age pension schemes, may have led to the progressive substitution of pension, early retirement, and unemployment with disability benefits (Figure 3.6, Panel B and C). Plans to continue increasing the legal pension age are likely to exacerbate that trend.
Note : Panel A shows the share of unemployment and disability beneficiaries over total population. Disability benefits includes income replacement benefits (integration benefit), invalidity benefits to salaried and self-employed and permanent incapacity benefit due to work accidents.
Source : Eurostat SILC, INAMI - Service des indemnités - Direction finances et statistiques.
Note: Panel A shows the share of unemployment and disability beneficiaries over working age population. Panel B and C show the labour market status of each age from 50-64 years old in 2005 (panel B) and 2020 (panel C).
Source: Labour Force Survey and OECD SOCR database; OECD (2022); Minne and Saks (2023).
There are considerable opportunities for public policy to address rising disability benefit claims, promote the reintegration of disability insurance beneficiaries, and improve the employment rate of workers with disabilities.). First, preventive measures at work can help workers with health problems to retain employment and avoid transfers onto sickness and disability benefits. This is particularly important as moving people off prolonged sickness and disability insurance is very difficult. Second, providing good incentives and employment support would keep workers on prolonged sickness away from entering disability benefit, and reduce the likelihood that disability insurance beneficiaries remain inactive for too long and lose contact with the labour market. This is a critical point as work search requirements and employment support in the disability insurance system were relatively weak up until recently. Finally, the design of the disability benefits system could be revised to further reduce substitution effects between unemployment protection, early retirement schemes and disability insurance, although changes to the disability system eligibility and generosity would need to be wary of the increasing disability poverty gap in Belgium (OECD, 2022).
Strengthening prevention and retention at the workplace
Employers’ attitudes and perceptions are critical for ensuring the successful integration of people with disabilities in the labour market. Employers can influence the trajectory of workers by offering safe and healthy workplaces, preventing health deterioration, sickness, and work incapacity. Employers can also accommodate the workplace so that employees with severe health conditions remain at work.
Putting more emphasis on prevention to keep workers healthy
Several policy levers can help supporting employers in promoting health and well-being at work. Workplace regulations setting minimum health and safety standards, for example, should be adapted to new working practices, such as teleworking. In Belgium, teleworkers report working almost two hours per week more than their colleagues in the office (Walrave, 2010). Moreover, only about 30% of firms include the workplace at home in their risk assessments (EU-OSHA, 2021). Excessively long working hours in unsuitable remote work environments raise health risks, such as musculoskeletal strain (OECD, 2022d).
The “right to disconnect” regulation introduced in April 2023 as part of the Labour Deal is welcome. However, it does not apply to firms with less than 20 employees and there are no sanctions for employers failing to comply. The law should clarify what employees can do if an employer does not respect the right to disconnect. In France, where a similar law was introduced in 2017, several companies have already been fined for not respecting the right to disconnect. Information and guidance should also be provided on the implementation of workplace occupational health and safety at home.
Financial incentives can encourage employers to go beyond minimum standards and actively promote well-being at the workplace. Some countries, such as the United States or Australia, have tax credits and subsidies in place to incentivise employers to invest in workplace wellness programmes, with an emphasis on the prevention of mental health and musculoskeletal disorders (OECD, 2022d). Certification and award schemes can help to create reputational incentives for employers. Companies promoting wellbeing at work would attract investment from institutional investors and private funds looking for sustainable and socially responsible investments. Information and guidelines supporting the implementation of good practices by employers could also be considered. Trade unions and business associations could help developing and disseminating such guidelines. The federal datamining project that collects information on working conditions and professional risks could help to identify workers whose health is deteriorating before it is too late.
Tackling the issue of deteriorating health for workers in physically intensive jobs, hazardous or arduous work may require specific measures. Some countries introduced special retirement schemes allowing for early retirement without benefit reduction. Belgium considered an option that would introduce a wage-loss compensation allowance for those seeking reduced working time due to medical reasons. However, these schemes need to be narrowly defined to avoid misuse. Defining the criteria can be controversial and reaching an agreement with social partners difficult, as Belgium has experienced. Moreover, job tasks are constantly evolving, making it hard to design generic rules that will adequately target special regimes.
Alternatively, other countries are questioning the need for pension reforms to deal with hazardous or arduous jobs, and the permanent withdrawal from the labour market sometimes at very early ages. Establishing a professional training framework providing reskilling and upskilling to allow workers in hazardous or arduous jobs to move to another position or a different job could be a more efficient approach (OECD, 2023). The federal individual training account could be adapted for that purpose. If health risks materialise, the disability insurance system, with strong return-to-work policies, would be better suited to address the issue than old-age pension policies.
Promoting the retention of workers with recurrent or prolonged health issues
Many employers perceive the costs of new recruitment and training to be lower than the costs of retention, adjustment and accommodation with existing workers suffering from health problems (OECD, 2010). The challenge for policy makers is to promote job retention, without discouraging the hiring of new workers with chronic health problems or a disability. Legislated employer obligations can help but are difficult to enforce in practice. Mandatory employment quotas of persons with disabilities in the public sector, for example, are not always respected and should be strictly enforced (European Commission, 2022). In fact, the public sector should lead by example. Additional measures to fight discrimination should be considered, such as information disclosure requirements regarding staff diversity, which would facilitate the identification of discrimination patterns. In this vein, social partners (Commissions paritaires) will have to complete sector-specific employment reports on diversity every two years. The obligation to provide reasonable accommodation at the workplace for persons with a disability is also difficult to enforce. Successful enforcement often requires the timely involvement of workers’ representatives and trade unions (OECD, 2010).
Some countries have gone a step further and transferred financial liabilities for sickness and disability to employers, strengthening incentives for employee retention. In the Netherlands, employers pay the costs of sickness benefits for as long as two years during which workers usually cannot be dismissed. The measure was effective in lowering long-term absences (OECD, 2008). In addition, employers with above average sickness and disability claims must pay higher social contributions. Belgium has recently introduced a similar experience-rating system. Since 2022, employers’ social contributions increase by 0.625 percentage points for firms employing more than 50 workers whose average inflow rate into disability benefits over the last year is twice the sector average and three times higher than the private sector average. The return of these additional contributions goes to sectoral funds to finance actions for prevention or re-integration. Belgium could also consider increasing the employer-paid sickness period currently set at one month for private sector white collar employees and less for blue collar employees (Box 3.1). The employer-paid sickness period could increase on a case-by-case basis until all workplace adaptations and accommodations have been exhausted. To mitigate the risk that employers actively seek to avoid hiring persons perceived as being at higher risk of sickness or disability, employers hiring workers with disabilities could be partly or fully exempted from this obligation, along the lines of the Dutch “no-risk policy and premium discount” (OECD, 2010).
Accommodating the workplace for persons with health problems or with a disability can bring additional costs to employers. Therefore, support measures to help firms fulfil their obligations are welcome. Belgium has several programmes scattered across different governments and agencies. Employers can receive a return-to-work premium (EUR 1 725) when hiring or reintegrating people that have been receiving disability benefits for more than a year. The Flemish government has put in place an individualized support, including a wage subsidy and guidance ('Individueel Maatwerk'), which can be awarded for a period of two to five years, renewable, and also applies to self-employed workers and workers affected by psychosocial problems. In Wallonia, AVIQ, an agency dedicated to the elderly and persons with a disability, introduced two wage subsidies, one intended at stimulating new job hires and the other to promote job retention. The first, known as prime à l’intégration, can be awarded for one year for employers hiring a person with a disability previously unemployed or inactive. The second, known as prime de compensation, can be awarded for a period of five years to cover up to 45% of the wage costs associated with an employee with a disability. AVIQ has yet another subsidy available for a maximum period of six months, the prime de tutorat, if another person has been employed to accompany, train, and advise the workers with a disability. In the Brussels region, Actiris provides a range of support measures, including insertion allowances and support for workplace environment adaptation.
Financial compensation for workplace adjustment and adaptation can also be quite effective. One advantage of these schemes, compared to wage subsidies, is that they do not generate deadweight, substitution, or displacement effects. Funds are effectively used to benefit the employee with a disability, helping to reduce work barriers, making them more productive, and increasing the likelihood of long-term employment (OECD, 2021c). The Flemish employment services agency, VDAB, grants an allowance for the costs of adapting the job post because of the disability. AVIQ, in Wallonia, and Actiris in Brussels, have similar schemes in place. However, take-up for this financial compensation schemes is low (European Commission, 2023). Additional efforts to raise awareness of the public support available to employers are needed. Centralising and streamlining information about different existing programmes in one place would help.
Sometimes, workplace adjustment and adaptation might even be costless, but lack of knowledge about possible solutions hinders their implementation. Developing guidelines and training programmes for managers and co-workers, in close consultation with associations representing people with disabilities, to inform and raise awareness about technical solutions, practical ideas, and tools to adjust and adapt could make a significant difference. In the Brussels region and for the French speaking community, PHARE awards employers a one-off bonus of maximum EUR 1 000 to conduct awareness-raising and training campaigns on accommodating disabilities at the workplace for all employees. Similar initiatives could be implemented in other regions.
Working time and workplace flexibility can help providing reasonable work accommodation for persons with a disability at almost no cost. Teleworking, for example, if well-regulated as discussed before, and at an intermediate level of intensity to balance the benefits and costs from a well-being and productivity perspective, can provide an accessible workspace and break down some of the employment barriers (Criscuolo et al., 2023). Working from their own home means that persons with a disability have more control over their environment, can easily access medical or special equipment if needed, and do not need to commute to work. Flexibility to organise the workday or week makes it easier for persons with a disability to organise medical or rehabilitation appointments, or to plan breaks according to their individual needs (OECD, 2022d). Mainstreaming flexibility at the workplace would prevent the need to disclose disability, which could be particularly important for persons with unobservable disabilities, such as mental health disorders. The introduction of the four-day work week in 2022 may also help, although take-up has been low so far.
New technologies also have the potential to create a more accommodating environment and help removing some of the barriers faced by people with disability. Assistive technology enabled by Artificial Intelligence, for example, renders impairment or functional limitation less disabling (OECD, 2023). Vision-to-language tools can describe text and objects aloud for people with vision problems. Speech recognition algorithms can translate speech to text and enable the control of intelligent devices through voice activation. Text simplification tools can help people with cognitive disability to understand content. Chatbots provide an accessible interface for users to access information easily through queries and answers. Technology can also make training more accessible for persons with disability. Virtual reality technology, for instance, can be used to provide customised training, offering realistic scenarios for simulation.
To fully grasp the benefits of new technologies, public reimbursement mechanisms should be introduced, subsidising access to specific digital and assistive technology for low-income individuals with a disability. Often, people with disabilities do not have access to basic digital technology, such as a computer or the internet (Figure 3.7). Such reimbursement mechanisms, or cost-of-disability payments, do not create any disincentive to work and are much more likely to help people out of poverty with a limited net cost. The list of reimbursed solutions would need to be updated regularly to keep-up with the latest technological developments (OECD, 2023). The federal Allocation d’Intégration could be the starting point for such a reimbursement programme (Box 3.1). It could be adapted and expanded to reimburse the costs associated with digital and assistive technology when those can make a meaningful difference.
Note: Data refer to 2019, except for Iceland, Ireland, Italy (2018) and United Kingdom (2016).
Source: EU-SILC.
Rethinking the disability insurance system to encourage returning to work
Greater efforts are needed to transform the disability insurance system into an employment-support instrument alongside its function of providing income support. In fact, many people with a reduced capacity to work can and want to work, but their choice will be influenced by the income provided by disability benefits (MacDonald et al., 2020). Recent reforms to the disability insurance system also need to be enforced, assessed, and continued to limit the inappropriate use of the scheme, such as being an informal pathway to early retirement or an alternative to unemployment (Box 3.1). Disability benefits can be more generous than unemployment protection in some cases, for example, and used to come without any activation requirements (De Brouwer and Tojerow, 2023; Browne, Neumann and Pacifico, 2018).
Strengthening the effectiveness of the Return-to-Work policy
Recent reforms to the sickness and disability benefits system in the private sector are going in the right direction (Box 3.1). The introduction of a formal return-to-work plan and return-to-work coordinators will help identifying individuals who can benefit from accommodations at the workplace, rehabilitation or activation programmes. For a successful reform implementation, the federal government needs to make sure that health insurance funds have appropriate resources to hire enough coordinators. Involving the employer in the reintegration strategy is also a welcome measure as it has proved quite effective in other countries (OECD, 2022c). Yet, there remains ample scope for further reforms to strengthen the return-to-work policy.
Contributory sickness and disability benefits
Health care insurance is mandatory, and individuals are free to choose between one of the five non-governmental and non-profit health insurance funds, who play the role of intermediaries between INAMI, the national institute managing sickness and disability benefits, and the population. INAMI sets the terms for disability assessment and benefits and allocates financial resources across the six health insurance funds (including a public fund) according to precise rules. The health insurance funds execute INAMI’s policy and distribute the sickness and disability allocations.
In the first 30 days (15 days) of sickness, private sector white collar (blue collar) employees receive between 100% of their salary paid by the employer. Certification by a general practitioner is enough. After 30 days, the burden is transferred to the public system. The health insurance fund needs to request “primary” disability benefits to INAMI on behalf of the individual. To be eligible, the individual must have worked at least 180 days full-time, or 800 hours part-time, over the last 12 months and paid social contributions. All professional activities must have ceased at the time of application and medical incapacity be at least 66%. If approved, the individual receives 60% of the last salary or a minimum allowance.
Past those first 30 days, and since October 2022, the employer must inform the occupational doctor about the employee’s absence. All employers are obliged by law to have an occupational medicine service, which most companies outsource externally. The occupational doctor will then establish a first contact with the worker to discuss possible options to eventually return to work. The worker has no obligation to react and there are no requirements following-up that initial contact.
The occupational doctor cannot initiate a formal reintegration procedure. Such procedure can only come at the worker’s initiative or upon request from the employer. To make such formal request, in most cases, the employer needs to wait at least three months. Within 50 days of that request, the occupational doctor will invite the worker to a reintegration assessment. If the worker refuses to attend three times, the reintegration procedure is closed. The occupational doctor will then inform the health insurance fund, but there are no systematic sanctions. After the reintegration assessment, the employer has between two and six months to propose a reintegration plan, based on the occupational doctor’s recommendations, proposing a new occupation within the firm, adaptations to the workplace, or a reduction in hours worked. The worker has then two weeks to accept or refuse that proposal. If the worker refuses, the occupation doctor informs the health insurance fund, but again, there are no systematic sanctions. The worker can request additional appointments with the occupational doctor and the support of labour unions throughout that process at any time.
Before 2022, the employment contract could be systematically terminated due to medical force majeure without any severance payment, although the individual would still preserve disability benefits. This was changed in 2022 as more than half of reintegration plans resulted in dismissals. The dismissal procedure by medical force majeure is now a separate and independent administrative procedure, requiring additional justification from the employer.
Procedures are similar for unemployed and self-employed. Unemployed are insured from the 1st day of medically certified incapacity if they have worked or been actively searching for a job at least 180 days over the last 12 months. The individual receives the lowest value between the unemployment benefit or 60% of the last salary. Self-employed are insured only after 8 days of incapacity if the last social contribution dates no longer than 30 days ago. Self-employed receive a lump-sum disability payment. A formal return-to-work procedure can also be initiated for non-employed individuals, at their own initiative or initiated by the health insurance fund’s advisory doctor after a medical assessment. In this case, the health insurance doctor proposes a rehabilitation plan, including contacts with employment services and participation in vocational training programmes, which remain voluntary.
Since 2016, after four months of “primary” incapacity, if no reintegration or return-to-work procedure has been voluntarily initiated already, it became mandatory to develop a formal Return-to-Work plan. The health insurance fund’s advisory doctor must assess the individual’s remaining work capacity. If deemed apt to return to the previous job, the employer must draw a reintegration plan. If deemed apt to return to the labour market, and if not employed, the doctor proposes a rehabilitation plan.
Additional resources have been allocated to health insurance funds in 2022 to create a new role and hire “Return-to-Work coordinators”, responsible for establishing face-to-face contact with disability benefit recipients, liaising with the advisory doctor, the occupational doctor, and employment services. Meetings with the coordinators are mandatory. Benefits can be cut by 2.5% if individuals fail to attend those meetings. Yet, the Return-to-Work coordinators cannot oblige individuals to execute the plan. In addition, since October 2023, mandatory visits to the health insurance funds’ doctors or members of the multidisciplinary team were introduced after four, seven and eleven months of “primary” disability.
After one year of “primary” disability, the health insurance fund must submit a new application to INAMI to prolong disability benefits, potentially after another medical examination. If approved, the individual receives between 40% and 65% of observed earnings in the last year, depending on the household composition or a minimum allowance. Disability benefits then only cease if the individual is no longer considered disabled by the health insurance fund’s doctor or the medical council of INAMI. Medical re-assessments by the health insurance fund’s doctor or members of the multidisciplinary team are mandatory, and their frequency depends on the capacity to return to work.
Non-contributory benefits at the federal level
Allocation de remplacement de revenue (ARR): Means-tested monthly cash allocation for individuals whose disability reduces their earning capacity by at least two-thirds.
Allocation d’intégration (AI): Means-tested monthly cash payments to compensate for additional costs associated with the disability. These costs include fees for requiring personal assistance, special mobility devices, special household equipment, care, and household maintenance services.
First, early intervention is critical to prevent workers on sickness and disability benefits getting detached from the labour market. Waiting for four months after the start of disability benefits to assess the individual’s work capacity and define a Return-to-Work plan could be too late as this means the worker would have been out of work for five consecutive months already, and the probability to leave the sickness and disability benefits system after six months is low (CSE, 2024). Disability benefit recipients should fill a questionnaire on their work capacity after ten weeks. Nevertheless, the assessment of work capacity and the development of a Return-to-Work plan should come earlier. In Norway the employer is required to follow-up with the employee during the first four weeks of sickness and discuss if an improvement of the working environment could remedy the situation. In the Netherlands, the employer must draw a formal return-to-work plan in the first eight weeks. If employers’ efforts to reintegrate the worker are considered insufficient, they can even be mandated to pay for an additional year of sickness leave (OECD, 2022b).
Reintegration procedures can be strengthened. The employer-paid sickness period could be extended beyond 30 days, on a case-by-case basis, until all the possible adaptations and job modifications have been exhausted by the employer, before applying for “primary” disability benefits, similarly to what is done in Denmark (OECD, 2022b). If the individual is already receiving “primary” disability benefits and is considered apt to return to the previous workplace with some adaptations after a reassessment, employers who do not put in sufficient efforts to reintegrate the worker could be required to contribute to the disability benefit payment.
Efforts from individuals with remaining work capacity to implement their personalised Return-to-Work plan should also be monitored closely. At present, there are no sanctions if an individual receiving disability benefits refuses the employer’s reintegration plan or to participate in a rehabilitation or activation programme proposed in the Return-to-Work plan. In Norway and the Netherlands, sickness and disability benefits can be suspended, reduced, or cut if the employee does not put in effort to actively contribute to the development of a Return-to-Work strategy. In Luxembourg, people with partial work capacity that are not employed are obliged to register with employment services and enrol in training and reintegration measures (OECD, 2022b). The Return-to-Work coordinators should be able to impose sanctions on individuals who, despite showing up to the meetings, do not register with regional employment services and refuse to participate in rehabilitation and activation programmes. The rule stating that participants in activation or rehabilitation programmes can lose their entitlement to disability benefits within six months of programme completion should then be removed, as recommended in the previous Economic Survey of Belgium (OECD, 2022a).
Partial disability benefits are another way of encouraging people with a disability to remain in work or to return to employment. This involves working part-time and receiving a partial sickness or disability benefit on top of a partial salary. Belgium has a partial disability benefits system in place, whose take up has increased over the past five years. Nevertheless, workers need to have stopped all professional activities to apply for “primary” disability benefits and to prolong disability benefits after a year. Workers can then request an authorisation to work part-time from the first day that they receive disability benefits, and they are even allowed to start part-time employment while waiting for such authorisation, but this still means that they are out of work during the application period and until the benefits are granted. Alternatively, Belgium could consider letting people apply for partial disability benefits directly. The partial benefit, though, would have to be significantly reduced to prevent full-time workers that would otherwise continue working from moving into subsidised part-time work. The introduction of a wage premium for workers reducing working hours and at risk of getting detached from the labour market for medical reasons (ArbeidsParticipatieToeslag) has been envisaged.
Moving away from a purely medical assessment
For the above reforms to work, sickness and disability assessments need to move away from a purely medical perspective. Entitlement to prolonged sickness and disability benefits should be determined according to a reliable assessment of a person’s remaining functioning capacity and labour market competitiveness, taking new working practices and new technologies to accommodate the working environment into account. Currently, there is too much focus on a medical diagnosis of loss of physical or mental functioning, as assessed by a medical practitioner with limited expertise in labour market developments and rehabilitation programmes. The recent reform that expands the role of multidisciplinary teams in the evaluation of work incapacity goes in the right direction.
One way forward would be to modify the content of the sickness certificate to include information on the degree of work capacity and the type of tasks a person can do, and to provide training to general practitioners on work and workplace matters. Sickness certificates should then be renewed regularly, and an extended certificate could be required after a prolonged period of sickness, encompassing a deeper assessment of the individual’s functional capacity. In Ireland, sickness certificates are renewed every week, and in Norway and Luxembourg, extended medical certificates are required after six weeks of absence (OECD, 2010).
Disability assessments should be conducted by an independent and interdisciplinary team, which could include the health insurance fund advisory doctor, an occupational doctor, a Return-to-Work coordinator, and public employment services staff, assessing people’s functional capacity (OECD, 2022b). Advisory doctors in health insurance funds should receive training on work and workplace matters. Occupational doctors should ideally be systematically involved in disability assessments, even for individuals who are not employed. For that purpose, the number of occupational doctors, currently in shortage (Cour des Comptes, 2021), needs to increase and they need to become work and workplace specialists. Finally, once admitted on “primary” disability benefits, the frequency of reassessments needs to increase. This is particularly important given the rise in mental health conditions, which can be more volatile and evolve frequently. The introduction of mandatory visits to the health insurance funds’ doctors after four, seven and eleven months of “primary” disability at the end of 2023 is a step in the right direction (see Box 3.1). Reassessments should also be more systematic once admitted on long-term disability after one year.
Better integrating services across agencies
Smooth coordination and active cooperation between relevant agencies are particularly important to avoid workers with health and disability problems moving from the caseload of one institution to the other, without any visible improvement on their well-being and re-employment perspectives (Box 3.2). Better integrating services provided by relevant agencies or having them share front offices, namely employment services, agencies supporting employers to accommodate the workplace and individuals with disabilities purchasing special equipment, Return-to-Work coordinators, and benefits administration, could be a way forward. Sharing front offices would improve disability mainstreaming, i.e., avoiding the use of special systems or services for people with disability, and instead, developing systems and services that are disability inclusive (OECD, 2022b).
Regional employment services are in a good position to identify and support those jobseekers with health barriers to employment, who may end up directly entering disability insurance from unemployment insurance. While targeted measures are in place in all regions, employment services can better support workers with remaining work capacity in their job-search efforts. Spending on active labour market policies targeted at workers with disabilities, one of the hardest-to-place group of workers, and on rehabilitation programmes is low in international comparison (Figure 3.8). Face-to-face counselling should be available for job applicants with health barriers to employment or with a disability. Regional employment services’ resources should be better targeted at people with a disability or at-risk of entering disability benefits. This will be particularly important as employers become increasingly involved in return-to-work plans, to prevent inflows into disability benefits from unemployment insurance to increase in response.
Disability policy is interdisciplinary, involving different institutions. The health system, the social protection system, the employment services, and the education and training systems all play a key role. In Belgium, the institutional fragmentation is complicated by the division of competences across different governments, as follows:
Federal government: Sickness and disability benefits system. Anti-discrimination law.
Regional governments: Accessibility in urban development and mobility. Employer support to accommodate the workplace. Employment services and vocational training.
Communities’ governments: Special and integrated education and training. Support for special needs and special care at home.
Financing arrangements can also influence incentives in dealing with workers with health conditions in an efficient way. Since 2018, health insurance funds receive financial incentives to promote the work reintegration of members on sickness and disability benefits. Before, sickness and disability insurance beneficiaries would count as one-and-a-half in the financing formula to compensate health insurance funds for their costs. As a result, health insurance fund’s doctors had little incentive to initiate return-to-work procedures or to reassess individuals on disability benefits. Now, individuals on disability benefits count as one in the financing formula. Moreover, insurance funds receive financial rewards based on the number of reintegration procedures launched, the number of medical assessments performed, and the number of part-time work authorisations granted. Financial incentives could be strengthened and complemented with data accumulation, sharing and dissemination requirements, to facilitate programme evaluation and generate a healthy competition for performance among insurance funds.
Overall, Belgium’s disability protection system is fragmented between public and private sectors, various governments, different agencies, and administrative procedures, or yet, different types of payment, including contribution-based and means-tested payments. Simplifying the disability protection system and potentially integrating different social insurance programmes could contribute to better income security, while improving system efficiency. Some OECD work has advocated for the introduction of a single working-age benefit for all individuals out of employment, with top-up payments to cover additional costs, such as costs-of-disability, which would be independent on employment status (OECD, 2022c).
Source: OECD Social Expenditure Database.
Adjusting the eligibility, the benefit calculation, and harmonising rules
To limit the inappropriate use of the disability insurance scheme, other changes to the system could be considered. For example, the minimum contributory period could increase with age, as done in Austria (OECD, 2022c). The basis for calculating the disability benefit could also be reconsidered. Currently, the calculation formula uses the last income earned (with ceilings), which favours older claimants as income generally increases with age. Adding to the issue, payments for unemployment benefits become independent of previous earnings after a while, making disability benefits particularly attractive for high wage-earners. Finally, to prevent younger workers from using the disability insurance system as an alternative to unemployment insurance, Belgium could reconsider the minimum age at which disability payments can be claimed. Non-contributory and means-tested programmes, such as the federal Allocation d’Intégration or the Allocation remplacement de revenue, are a more effective tool to keep young workers with limiting conditions out of poverty and in employment (see Box 3.1). In Belgium, individuals are eligible at the age of 16, while in peer countries, such as Austria, the Netherlands, Norway, or Switzerland, eligibility starts at the age of 18 (OECD, 2022c).
However, if such changes to the disability insurance system are considered, Belgium needs to be wary of the increasing disability poverty gap. The share of individuals with a disability living in poverty increased from 14% in 2005 to 26% in 2019, with significant differences across regions (OECD, 2022c). Stricter contribution requirements for eligibility may leave groups with limited work histories, where women are overly represented, out of the main disability programme. Similarly, cutting benefit generosity could exacerbate the disability poverty gap. There are few examples of OECD countries that have reduced the generosity of disability benefits, possibly due to the political difficulty of such reforms. Such reforms can be successful in reducing inflows into disability benefits, but without efforts to equipping persons with disabilities for the labour market, through more effective return-to -work policies, for example, can create spillovers to other social protection programmes (OECD, 2022c).
Belgium’s disability insurance system for public sector employees is characterised by complexity, both in institutions and applicable rules. Depending on the relevant public authority, eligibility, assessment, benefits, and procedures can differ significantly from the “headline” system for private sector employees, making it difficult to track rules applicable to specific workers, creating barriers to job mobility, and contributing to the inequity of the disability insurance system. Harmonising rules for the public sector and progressively aligning the treatment of workers with disabilities in the public and private sectors should be considered. In particular, it is important that recent changes in the return-to-work policy for the private sector also apply to the public sector to preserve system equity and expand the impact of these reforms.
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