Note for the press

Improving the performance of the Belgian health system: increased focus on access, quality of care and sustainability

Brussels, Belgium, 9 September 2010

At the occasion of the Belgian Presidency of the EU Council, the European Observatory on Health Systems and Policies and the Belgian Healthcare Knowledge Centre (KCE) are proudly presenting the newest health system review on Belgium, which has been produced in close collaboration with and supported by the Belgian Ministry of Health. This comprehensive description of the Belgian health system is part of a series of Health Systems in Transition (HiT) country profiles1, covering the entire European region as well as key OECD countries outside Europe. This new Belgian HiT presents the evolution of the health system since 2007, including detailed information on new policies. This update also seals a more permanent collaboration between the European Observatory and the KCE as part of a network of ‘national lead institutions’ (NLI) to report more systematically on health system developments in European countries.

The Belgian population generally enjoys good health and high life expectancy, with good access to health services of high quality. According to a Eurobarometer study of 2007, Belgian citizens value the quality of health services, their availability and accessibility far above the EU average. As a health system based on progressive solidarity-based financed in combination with mainly private health care delivery, based on independent medical practice and predominantly fee-for-service payment, patients in Belgium benefit from a high degree of choice and from relatively unbridled access to health services. Nearly the whole population is covered for a very broad benefit package. Since 2008, also the self-employed are guaranteed the same coverage.

Private and public health spending reached the level of 10.2% of gross domestic product (GDP) in 2007, ranking total health expenditures for the Belgian population among the highest in the European region. In order to keep pace with overall expenditure growth a yearly growth norm for the statutory health insurance budget of 4.5% is being applied since 2004. Despite of this, patients in Belgium continue to pay a high share out of pocket, either through official co-payments or diverse supplements. In order to prevent patients from foregoing essential care due to these high out-of pocket costs, existing protection mechanisms have been further extended to new categories of beneficiaries and co-payments (cf. OMNIO system of preferential reimbursement, threshold system of maximum billing). In addition, special measures were taken for chronically ill patients and supplementary fees charged to hospital patients were forbidden for certain categories of patients and also for two-person rooms. Given the economic downturn and the resulting soaring budget deficit, the 4.5% growth norm may come under pressure.

Next to addressing these financial challenges, reforms also aim to further improve overall quality and efficiency of the health system. Quality of care and patient safety is increasingly monitored through the establishment of information systems and providers stimulated through feed-back and peer review mechanisms. Also financial incentives are used to tackle significant differences in clinical practice (including prescription patterns). Other important aspects are the strengthening of the primary care level as well as a better integration of different levels of care. The use of the general medical file held by the general practitioner is consolidated as a way to strengthen the position of the GP. Also through the creation of patients’ pathways and the establishment of care programmes and networks, a more structured and coordinated health care delivery system is put in place.

The need for a coordinated approach also extends beyond the mere scope of curative care, to also include prevention and population-based interventions as well as long-term care. This inevitably also requires coordination between different levels of policy-making, as health policy in Belgium is a combined responsibility of both the federal state and its federated entities (regions and communities), which are mainly in charge of the latter aspects. To facilitate cooperation between different levels, inter-ministerial conferences are regularly organized, which can result in protocol agreements on specific policy areas (e.g., long-term and elderly care, vaccination programmes, cancer screening, etc.). A good example of this broad integrative approach is the so-called Cancer Plan 2008-2010, which combines actions on prevention and screening, on care, treatment and support given to the patients as well as on research, technological innovation and assessment.

Despite a traditional abundant supply of health care providers, Belgium increasingly suffers from shortage of health care professionals. Due to the uncertainty about an impending GP shortage, in June 2008 the quota for medical graduates accepted for further training was increased for 2015-2018. Also financial incentives were introduced to set up new GP practices. Better remuneration for GP visits beyond regular hours (night hours, on weekends and during holidays) has been introduced as means to increase after hours availability. KCE is currently evaluating the extra-burden that after hours create to propose further adequate recommendations.. In 2008 the government also adopted a plan to increase the attractiveness of the nursing profession using four specific lines of actions: reducing work load; strengthening qualification; improving salaries; and providing better social recognition.

This Belgian health system review will be a valuable tool to assess its performance in comparison to other countries’ health systems. Following the signing of the WHO Tallinn Charter on health systems, Belgium has started a process for regularly reporting on its health system performance. To that effect the KCE published a first pilot study in June 2010 to look at the performance indicators and their feasibility.

The Belgian Health System Review is available in English on the web site of the European Observatory on Health Systems and Policies at and on the KCE web site


European Observatory on Health Systems and Policies

The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health care systems in Europe and beyond. It engages directly with policy-makers and experts and works in partnership with research centres, governments and international organizations to analyse health systems and policy trends.

The Observatory is a partnership that reflects the dynamic nature of policy-making. It includes national governments and decentralised authorities (Belgium, Finland, Ireland, Netherlands, Norway, Slovenia, Spain and Sweden, the Veneto Region, the French Union of health insurance funds); international organizations (the World Health Organization Regional Office for Europe, the European Commission, the World Bank, and the European Investment Bank); and academia (London School of Economics and Political Science and London School of Hygiene and Tropical Medicine).

1 HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in
health systems. They describe the institutional framework, process, content and implementation of health and health care policies
reform as well as policy initiatives in progress or under development.

For more information please contact:

Sherry Merkur
Research Fellow
European Observatory on Health Systems and Policies
London School of Economics and Political Science
Cowdray House, Houghton Street
London, WC2A 2AE United Kingdom
Tel.: +44 (0)207 955 6194

Willy Palm
Dissemination Development Officer
European Observatory on Health Systems and Policies
WHO European Centre for Health Policy
WHO Regional Office for Europe
Zelfbestuursstraat 4 rue de l’Autonomie,
B-1070 Brussels, Belgium
Tel.: +32 (0)2 525 0926

Sophie Gerkens
Expert junior en analyse économique
KCE - Belgian Health Care Knowledge Centre
Centre administratif Botanique
Door Building (10 ème étage)
Boulevard du Jardin Botanique, 55
1000 Bruxelles, Belgium
Tel.: +32 (0)2 287 3388

Liuba Negru
Communications Officer
WHO Regional Office for Europe
Scherfigsvej 8, DK-2100 Copenhagen Ø,
Tel.: +45 39 17 12 19
Fax: +45 3917 1880
E-mail :