Introduction

Belgium ranks 9th overall in the World Index of Healthcare Innovation with a score of 51.99. Belgium also ranked 9th in 2021 and in 2020. Relative to other countries Belgium’s strength lies in its performance in Science and Technology (8th overall, with the second highest R&D spending per capita among Index countries).

Belgium scores well on Fiscal Sustainability (10th), but the country lags behind WIHI leaders United Arab Emirates and Germany, and its low costs are under threat from accelerated public health care spending growth.

Belgium performed relatively less well, but still adequately, in Quality and Choice, where its ranked near the average of its peers. Belgium’s Quality rankings were negatively affected by the country’s poor performance early in the COVID-19 pandemic, where until recently it had the highest mortality rate among WIHI countries.

Background

Belgium, like Germany, Austria, and other central European countries, has a mostly private health insurance system, launched in 1851 and fully operational by 1894. Health insurance became compulsory in 1963. Today, Belgians are required to obtain health insurance from one of seven main national associations of sickness funds, six of which are private non-profits.

The health care provider system is mostly private. That said, prescription drug reimbursements are negotiated by the Commission for the Reimbursement of Pharmaceuticals, with Belgian Minister of Social Affairs making all the final decisions. The Belgian government also sets an annual global budget for public pharmaceutical expenditures, and requires drug companies to reimburse the government for spending in excess of that budget.

Belgium is host to a diverse and growing innovative biotechnology sector, thanks to a tax system that applies an 85 percent discount to net income from intellectual property. The discount means that innovative drug companies enjoy an effective income tax rate of 3.8 percent if they reside in Belgium. The best-known Belgian pharmaceutical company is Janssen, a unit of Johnson & Johnson; other prominent companies include UCB, Galapagos, and Ablynx.

Quality

Belgium’s life expectancy is among the highest in the world at 82 years. Belgium’s Quality ranking (20th) may seem surprising given the country’s solid performance in cancer survival and relatively low rate of treatable mortality. However, Belgium has struggled to meet the challenge of COVID-19, having suffered one of the highest fatality rates per capita in the modern world earlier in the pandemic. Belgium also struggles with patient safety (27th).

Choice

Belgium’s healthcare system features several contradictions, including its Choice ranking (23rd). Belgium’s Bismarckian health insurance system is more affordable than similar countries (only the Czech Republic is a cheaper Bismarckian county), but lacks the variety of plan choices and overall variation of Germany or the Netherlands. And while the country boasts a world-class choice of providers (tied for 1st), it lacks effective access to new drug treatments and generic drugs alike.

Science & Technology

Belgium ranks 8th overall in Science and Technology. Due to its productive research and development sector, Belgium is particularly strong in medical advances (4th), trailing only the United States, Switzerland, and Denmark. That said, Belgium’s low ranking for health digitization (12th) reflects the country’s late development of high-speed mobile and broadband infrastructure compared to its neighbors.

Belgium also ranks 15th in scientific discoveries. The country does not have a Nobel laureate in chemistry or medicine/physiology in the last 20 years, though it has a competitive scientific research community, as measured by how often its researchers’ papers are cited.

Fiscal Sustainability

Belgium ranks 10th for Fiscal Sustainability. Belgium’s public healthcare spending is among the lowest in the Index (3rd), but its fiscal trajectory is heading in the wrong direction; the country’s growth in public healthcare spending places it in the bottom third of the Index (22nd). The accelerated rate of its public healthcare spending is especially worrisome given Belgium’s even lower (23rd) ranking in national solvency; its debt-to-GDP ratio, alarmingly, exceeds 114 percent.