Belgium’s Healthcare System: The Way Forward to Address the Challenges of the 21st Century; Comment on “Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study”

Document Type : Commentary


WHO Collaborating Centre on Family medicine and PHC, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium


In this paper we have tried, starting from the results of an analysis of the functioning of integrated care in the Belgian Health System by Martens et al, to design a strategy that could contribute to better addressing the challenges of the 21st century in Belgium. We proposed health system changes at the macro-, meso- and micro-level. We focused on health policy development and organization of care, emphasizing the importance of a shift from a hospital-centric towards a primary care based approach. Special attention was paid to the need for institutional reforms, in order to facilitate the further development of interprofessional integrated care, that focuses on the achievement of the life-goals of a person.


  • epublished Author Accepted Version: March 13, 2022
  • epublished Final Version: March 15, 2022
  1. Martens M, Danhieux K, Van Belle S, et al. Integration or fragmentation of health care? examining policies and politics in a Belgian case study. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.58
  2. OECD, European Observatory on Health Systems and Policies. Belgium: Country Health Profile 2021, State of Health in the EU. Paris: OECD Publishing; 2021. doi:1787/57e3abb5-en
  3. Country Cooperation Strategy (CCS) WHO - Belgium 2016-2022. Published November 28, 2018. Accessed March 9, 2022.
  4. De Maeseneer J. Healthcare in Belgium in 2030: towards a decentralised health system in a solidarity society. Available in Dutch and French on   Published 2019.
  5. Veronese N, Demurtas J. COVID-19: impact of pandemic on older people health and well-being. In: Demurtas J, Veronese N, eds. The Role of Family Physicians in Older People Care. Cham: Springer International Publishing; 2022:471-476. doi:1007/978-3-030-78923-7_29
  6. Yazbeck AS, Savedoff WD, Hsiao WC, et al. The case against labor-tax-financed social health insurance for low- and low-middle-income countries. Health Aff (Millwood). 2020;39(5):892-897. doi:1377/hlthaff.2019.00874
  7. Pascolo L, Vermassen D, Reuchamps M, Caluwaerts D. The changing dynamics of Belgian federalism: is there a reversal of the paradox of federalism? In: Belgian Exceptionalism. Routledge; 2021:138-152. doi:4324/9781003104643-12
  8. Schellevis FG, Groenewegen PP. Together we change: an ambitious blueprint for primary healthcare in Flanders. Eur J Gen Pract. 2015;21(4):215-216. doi:3109/13814788.2015.1092517
  9. World Health Organization. Creating 21st century primary care in Flanders and beyond. WHO Regional Office for Europe. Accessed March 9, 2022. Published 2019.
  10. European Commission, Directorate-General for Health and Food Safety. European Solidarity in Public Health Emergencies: Fact Sheet Accompanying the Opinion by the Expert Panel on Effective Ways of Investing in Health (EXPH). Publications Office; 2021. doi:2875/556855
  11. Boeykens D, Boeckxstaens P, De Sutter A, et al. Goal-oriented care for patients with chronic conditions or multimorbidity in primary care: a scoping review and concept analysis. PLoS One. 2022;17(2):e0262843. doi:1371/journal.pone.0262843
  12. De Maeseneer J, Boeckxstaens P. James Mackenzie Lecture 2011: multimorbidity, goal-oriented care, and equity. Br J Gen Pract. 2012;62(600):e522-524. doi:3399/bjgp12X652553
  13. Tange H, Nagykaldi Z, De Maeseneer J. Towards an overarching model for electronic medical-record systems, including problem-oriented, goal-oriented, and other approaches. Eur J Gen Pract. 2017;23(1):257-260. doi:1080/13814788.2017.1374367
  14. De Maeseneer J. COVID-19: using the crisis as an opportunity to strengthen primary health care. Prim Health Care Res Dev. 2021;22:e73. doi:1017/s1463423621000748