Belgium’s healthcare system was ranked fourth in Europe in 2019, outperforming its peers across a number of metrics including a relatively high number of hospital beds per capita (six per thousand citizens, compared to the EU average of five per thousand citizens) and the second-highest number of doctor consultations per capita. With a compulsory health insurance system covering over 99 percent of the 11.5 million Belgian citizens (delivered by various ‘sickness funds’), the country nevertheless strikes an interesting balance between public and private characteristics: most healthcare providers are private with physicians generally paid on a fee-for-service basis but healthcare costs are reimbursed by the state. Roughly three-quarters of all healthcare expenditures in the country come from public funds while patient co-payments account for approximately 17 percent. Patients are able to select the sickness fund through which they prefer to be insured.
However, in terms of cost-effectiveness of healthcare, the country missed placing in the top ten, coming in 12th. As part of far-reaching health sector reforms to address the increasing financial strain of healthcare expenditures, in April 2015, Belgian Federal Minister for Social Affairs and Public Health Maggie De Block launched an Action Plan to overhaul the existing Belgian hospital infrastructure. Prior to this, Belgium had nearly 200 hospitals, mainly public or private not-for-profit hospitals usually run by charities or religious orders. These were typically standalone hospitals with their own independent governance structure offering the widest possible range of medical services in order to compete with other hospitals in the region.
Care in close vicinity does not always equate to quality. Good care means care in the right place, at the right time, and by the right care provider
Under the Action Plan, hospitals will band together to form new “local-regional clinical hospital networks”, with a maximum of 25 hospital networks allowed in the entire country. With the initiative for developing these networks having been left to the hospital sector, the government is looking to encourage bottom-up efforts and collaborations.
Minister De Block elucidates the reasoning behind this dramatic reform, “care in close vicinity does not always equate to quality. Good care means care in the right place, at the right time, and by the right care providers. How can we guarantee that to the patient? Not by offering every possible treatment in every hospital. On the contrary, this could even be detrimental to quality.”
Through these hospital networks, the hope is that basic care services could be rationalized across geographies with highly specialized and complex services centralized in centres of excellence. As Minister De Block highlights, “we concentrated certain uncommon and complex medical procedures like oesophageal and pancreatic surgery. These are life-saving measures, yet patients were twice as likely to die from complications in a centre with little expertise than in a centre that performs 20 or more operations per year. Similarly, we have concentrated interventional stroke care in 15 hospitals that act as centres of excellence.”
A draft Act was approved by the Belgian Parliament in February 2018 stating that hospital networks should be implemented by 1 January 2020. Minister De Block has also indicated that the existing hospital funding model – with all its complexities – should be reformed, and little steps have been made on that front. For instance, since the beginning of 2019, 54 standard hospital interventions are now being reimbursed in the same way across the country, making hospital financing more predictable and manageable as well as increasing transparency for patients.
Despite having introduced one of the most significant healthcare system reforms of the past three decades, Minister De Block is not done. She proclaims, “we have taken crucial steps but it cannot stop here. Everyone is realizing that the traditional competitive model is no longer tenable. We must continue to think about how we can better use the resources deployed. That is the ultimate goal: to give every Belgian patient the guarantee of even better care.”