Belgium: #10 in the World Index of Healthcare Innovation

Introduction

Belgium ranks 10th overall in the World Index of Healthcare Innovation with a score of 51.90, just one spot below its usual ranking since 2021. The country’s strength is particularly notable in Science and Technology, where it ranks 8th, boosted by the second-highest R&D spending per capita among the indexed countries.

In terms of Fiscal Sustainability, Belgium is ranked 10th. However, it still trails behind WIHI leaders like the United Arab Emirates and Germany as it faces pressure from rising public healthcare spending.

While Belgium shows adequate performance in Quality and Choice, ranking around the middle of its peers, its Quality score has been impacted by its initial struggles during the COVID-19 pandemic, having among the highest mortality rates among WIHI countries.

Background

Belgium maintains a health insurance system similar to systems found in Germany and Austria, with its roots extending back to 1851 and becoming fully operational in 1894. Health insurance has been mandatory since 1963, requiring Belgians to secure coverage through one of seven main national associations of sickness funds, with six operating as private non-profits.

The majority of healthcare providers in Belgium are privately operated. The pricing for prescription drugs is controlled through negotiations by the Commission for the Reimbursement of Pharmaceuticals, under the final decision making authority of the Belgian Minister of Social Affairs. Moreover, the Belgian government determines an annual global budget for public pharmaceutical expenditures, currently capped at €1.5 billion. Companies exceeding this budget are required to reimburse the excess, ensuring fiscal sustainability within the healthcare sector.

Belgium’s strategic fiscal policies, including an 85 percent tax reduction on net income from intellectual property, have nurtured a dynamic biotechnology sector. This significant tax incentive reduces the effective income tax rate for qualifying innovative drug companies to just 3.8 percent, making Belgium an attractive hub for pharmaceutical research and development. Leading companies in this sector include Janssen (part of Johnson & Johnson), UCB, Galapagos, and Ablynx, which contribute robustly to the national and global pharmaceutical landscape.

Belgium’s health system operates on a hybrid model that combines mandatory health insurance with extensive private sector involvement in healthcare provision. This system ensures comprehensive medical service accessibility to its population of approximately 11.5 million people. The system is characterized by a high degree of accessibility and quality, facilitated by both public and private funding mechanisms. In 2024, Belgium invested approximately €30 billion in healthcare, representing about 10 percent of its GDP. The system’s efficiency and the collaborative approach among government bodies, private insurers, and healthcare providers continue to uphold Belgium’s high healthcare standards and innovation.

Dimension Performance

Quality

Belgium ranks 18th in Quality, which may be unexpected considering its strong outcomes in cancer survival and low treatable mortality rates. The country does well in several areas, placing 15th in patient-centered care, 14th in infrastructure, and 11th in disease prevention. Despite these strengths, Belgium has encountered significant challenges during the COVID-19 pandemic, experiencing one of the highest per capita fatality rates early in the crisis, which reflects its 21st position in pandemic preparedness. Additionally, issues in patient safety further complicate the healthcare landscape. Nonetheless, Belgium boasts a high life expectancy, standing at 82 years, indicative of its robust healthcare system.

Choice

Belgium’s healthcare system features several contradictions, including its Choice ranking (23rd). Belgium’s Bismarckian health insurance system is more affordable than Austria’s and Germany’s, but its cost is rising and lacks the variety of plan choices 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 in Science and Technology. This notable placement is largely due to its robust research and development sector, which contributed to a high rank in medical advances (4th), following closely behind Switzerland, the United States, and Denmark. However, Belgium’s slower development of high-speed mobile and broadband infrastructure hampers its ability to fully utilize electronic health records, contributing to a lower ranking in health digitization (13th). Additionally, despite a competitive scientific research community, evidenced by frequent citations of its researchers’ papers, Belgium ranks 16th in scientific discoveries, with no Nobel laureates in chemistry or medicine and physiology in the past two decades.

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 (26th). The accelerated rate of its public healthcare spending is especially worrisome given Belgium’s low ranking (23rd) in national solvency; its debt-to-GDP ratio, alarmingly, exceeds 105  percent.