Belgium: Enhancing the Cost Efficiency and Flexibility of the Health Sector to Adjust to Population Ageing

Belgium has a good record in delivering accessible care, but adaptation to population ageing will becomplicated by the fragmentation of responsibilities in the healthcare system and a strong reliance ongovernment regulations. The organisation of the system could be rationalised by giving sickness funds a moreactive role as promoters of cost-efficiency, better aligning the incentives of the different levels of governmentand focussing on medium-term budgeting. At the level of care providers, better information flows andincentive structures could facilitate addressing practice and efficiency variations and supplier-induceddemand. This notably involves completing the shift to pathology-based budgets in hospitals, more capitationin the remuneration of doctors and measures to tackle the high spending on drugs. Once incentives forcost-efficiency are in place, a shift towards a more demand-driven system could be encouraged by phasingout over-prescriptive hospital regulations. In addition, relative remunerations of doctors should be revisedregularly to ensure an adequate supply per specialty. In long-term care, home care, which is generallycost-efficient, could be further encouraged by giving more autonomy to patients to organise their care. ThisWorking Paper relates to the 2013 OECD Economic Survey of Belgium (www.oecd.org/eco/surveys/belgium).