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