Belgium’s fragmented healthcare system facing reorganisation

Belgium’s political landscape is undergoing a reshuffle, raising critical questions about how the new Belgian government will address the fragmented state of healthcare. Re-federalisation of the healthcare system is an idea gaining traction.

Disparities between Flanders and Wallonia extend beyond language and culture; they also manifest in their respective healthcare systems. The winning party, N-VA, advocates for regional responsibility in healthcare, aiming to tailor policies to each population’s unique needs and habits.

But does Belgium’s language border also serve as a health border?

“The differences in healthcare between Flanders and Wallonia are significant. For example, Flanders focuses more on primary care, while in Wallonia, people tend to go to the emergency department and hospitals more quickly, with 14% more hospital consultations and 82% more emergency consultations per 100,000 beneficiaries,” Kathleen Depoorter, Belgian MP, N-VA, told Euractiv.

“But doesn’t Flanders also contribute to that bill? By empowering the regions, they can better tailor their policies to the specific needs and habits of their population,” she added.

Disparities and fragmentation

Depoorter highlights data from 2020 to illustrate the disparities. “Flanders uses fewer medicines. Wallonia uses 10% more antibiotics and 30% more antidepressants than Flanders. In addition, Flanders uses fewer scans with radiation and bets on MRI, while Wallonia uses more CT and RX scans,” she points out.

Belgium’s healthcare system is at a crossroads. Amidst rising operational costs, personnel shortages, and a fragmented structure, it is uncertain if the next Belgian government will re-federalise healthcare as some parties believe or delegate responsibilities to the regions.

During the COVID-19 pandemic, Belgium’s decentralised healthcare governance was put to the test. Nine different ministers were responsible for the pandemic response, each with their own jurisdiction, which led to coordination complexities.

The pandemic underscored the challenges of a healthcare system divided across various administrative levels, highlighting the urgent need for streamlined decision-making.

Margot Cloet, Managing Director of Zorgnet Icuro, the umbrella organisation of Flemish general hospitals, mental health initiatives and social profit facilities from residential care, emphasised before the elections that there is a necessity for intense cooperation among the different governments.

“We ask the various governments in this country to work together intensively on the fragmented patchwork of healthcare. Maintaining sustainable care will require voluntary efforts to constructively work on solutions that make care more efficient and better. If everyone only sweeps in front of their own door, we will not be able to realise the necessary changes. There is no time to lose. Let’s get started.”

Frank Vandenbroucke, Deputy Prime Minister and Minister of Social Affairs and Public Health said in a pre-election interview with Zorgnet Icuro: “In this country, there is only one short-term solution: intense cooperation within healthcare and among all governments responsible for care. I advocate that in the coming legislative period, at all levels—Flanders as well as federal—we start from mutually agreed health objectives.”

He remarked: “I did not negotiate intensely for more than a year for an inter-federal plan for integrated care for nothing. It is now agreed in principle that we can make agreements, and it has already been agreed that we will work together in an integrated manner for a number of priority areas.”

The fragmented structure of Belgium’s healthcare system, with competencies divided among different administrative levels, has led to significant inefficiencies.

Jeremie Vaneeckhout of the Groen party (Greens) highlighted the need for more collaboration around prevention, saying “There has often been a discussion in Flanders: we are not going to invest in prevention because the benefits go to the federal level. I find that a very cynical view of health because ultimately it is about the same people.”

Advocacy for re-federalisation

The French-speaking MR political party (Renew) wants to re-federalise prevention. Laura Hildago, president of Young MR, told Euractiv that several heavyweights also wanted this discussion to be put back on the table.

The party believes that Belgium, even though recognised as one of the best in Europe for its healthcare system, can still do better.

“But it’s time to rationalise and strengthen the north and south of our country even more. It’s absolutely essential to rationalise and strengthen collaboration pending possible re-federalisation of prevention,” they state.

Les Engagés (EPP) also supports re-federalising prevention. A spokesperson told Euractiv, “The fragmentation of responsibilities for health between the different levels of government is detrimental to the effectiveness of policies. It requires heavy coordination between ministers with no hierarchy.”

“Currently, when federated entities invest in prevention and health promotion, the savings benefit the federal government. This is not an incentive to invest in prevention, even though one euro invested in prevention generates four euros in healthcare savings. The COVID-19 crisis demonstrated that in an emergency, unity of command is essential,” they added.

As Belgium debates the future of its healthcare system, the tension between regional autonomy and the need for unified governance remains a critical issue. The outcome will significantly impact the efficiency and effectiveness of healthcare delivery across the country.

[By Nicole Verbeeck, Edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy Lab]

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