Context
On 4 June 2025, a preliminary draft law concerning several healthcare reforms was distributed to all organizations active in the healthcare sector in Belgium. This draft is part of the government’s commitment to establish a legal framework for healthcare reforms by the end of the year to ensure the sustainability, accessibility and quality of care.
Impetus for the reform
The government emphasizes the critical need for these reforms to tackle both current and future challenges within the healthcare system. They highlight that without substantial changes, it will be impossible to sustain high-quality and accessible healthcare for all.
Main purpose of the reform
According to the authorities, the primary purpose of the reform is to create a clear and unified legal framework that addresses various aspects of the healthcare system. These include better budget control, reduced administrative burdens and a stronger fight against fraud and abuse. The reform also aims to clarify responsibilities and prevent excesses while maintaining the freedom of healthcare providers. One of the most important, and controversial, goals of the reforms is to reduce the supplements charged above official tariffs by non-conventioned or partially conventioned healthcare professionals.
Content and characteristics
The reform is divided into six main areas:
- Budgetary process: Establishing clear guidelines and responsibilities for budget creation and control, including new mechanisms to address budget overruns.
- Convention mechanism and tariffs: Simplifying and unifying the convention process for all healthcare providers who agree to respect tariffs, and making it more attractive (e.g., some premiums will only be available for conventioned providers). For non-conventioned providers, caps on supplements are under discussion. The current proposal sets the maximum supplement at 25% of agreed tariffs for ambulatory care and 125% for inpatient care. At present, supplements can reach up to 300% of tariffs, which undermines accessibility.
- Consultation model: Streamlining the consultation process within the National Institute for Health and Disability Insurance.
- Digitalization: Reducing administrative burdens through increased digitalization.
- Control: Enhancing measures to combat fraud and abuse in the healthcare system.
- Anti-tobacco measures: Introducing stricter regulations against tobacco and vaping products.
Implementation steps
The government has begun discussions with all relevant stakeholders. A preliminary draft has been presented, and feedback is being gathered. The final law is expected to be approved by the end of the year, with certain measures, such as changes to the convention mechanism and tariffs scheduled to take effect in 2028.
Outcomes to date
The preliminary draft has sparked considerable attention and debate. On 7 July 2025, a first strike was organized, widely supported by various healthcare professionals. The reforms were perceived as a threat to their professional autonomy, remuneration and the quality of care. The government plans to address these concerns through further consultations and clarifications.