Belgium: #9 in the 2021 World Index of Healthcare Innovation

Introduction

Belgium ranks 9th overall in the World Index of Healthcare Innovation with a score of 50.51. Belgium’s strongest dimension is Fiscal Sustainability (61.53, #12), but the country is well behind WIHI leaders Czech Republic 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, Choice, and Science & Technology, where its rankings were near the average of its peers. Belgium’s Quality rankings were 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 originating in 1851 and fully established by 1894. Health insurance was made 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. Prescription drug reimbursements are negotiated by the Commission for the Reimbursement of Pharmaceuticals, with the final decisions made by the Belgian Minister of Social Affairs. 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% discount to net income from intellectual property. The discount means that innovative drug companies enjoy an effective income tax rate of 3.8% 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 81.7 years. Belgium’s #20 ranking in overall quality may seem surprising given the country’s solid performance in preventing hospitalizations and high cancer survival rates. 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. Belgium’s greatest strength in the Quality dimension is its infrastructure (#7), especially in maintaining optimal hospital capacity.

Choice

Belgium’s health care is a system of contradictions, including its #16 ranking overall in the Choice dimension. Belgium’s Bismarckian health insurance system is more affordable than similar countries (only the Czech Republic is a cheaper Bismarckian county), but lacks the same number of plan choices and variation of Germany or the Netherlands. And while the country has world-class provider choice (tied for #1), it lacks effective access to newest pharmaceutical advances like its European neighbors.

Science & Technology

Continuing the same theme, Belgium ranks #11 overall in Science and Technology. Belgium ranks #4 in medical advances, trailing only the United States, Switzerland, and Denmark.

On the flip side, Belgium ranks #22 in health digitization. And while the country does not have Nobel laureates in chemistry or medicine/physiology in the last 20 years, it is competitive in scientific research, as measured by how often its researchers’ papers are cited.

Fiscal Sustainability

Belgium ranks #12 overall for fiscal sustainability. Belgium ranks #3 in public health spending per capita, but its fiscal trajectory in health care is heading in the wrong direction; the country’s growth in public health spending is among the worst in the Index (#26). The accelerated public health spending is especially worrisome given Belgium’s #25 ranking in national solvency, with its debt-to-GDP ratio approaching 100%.