Abstract
Observers who attempt to situate Belgium in typologies of European healthcare systems inevitably conclude that Belgium is a hybrid, possessing characteristics of different types in a unique “ecosystem” of health care. The Belgian system in part resembles NHS-style systems with their reliance on tax revenues to finance health care; but Belgium also relies, perhaps to a surprising extent in Western Europe, on private expenditure. Belgium has strong elements of so-called mutual aid systems in which government’s role largely entails subsidizing and regulating the private organizations that serve as insurers (Immergut 1992). However, the Belgian system goes beyond the limited intervention understood by this model: government spending in Belgium is considerable and insurance coverage is extensive and compulsory. As in the Dutch and German systems, insurers in Belgium act as intermediaries between patients and providers, with extensive market freedom for doctors, hospitals, and patients. Yet compared with its neighbors, Belgium exhibits distinctive traits, for example, being less enthusiastic than the Netherlands about embracing market-based reforms to achieve efficiencies (Schokkaert and Van de Voorde 2010;van Doorslaer and Schut 2000). Overall, Belgium belongs on the spectrum of national insurance healthcare systems, in which the state plays the role of the administrator or “steward” of the health system, not the owner, with a focus on enabling the system to achieve social goals such as redistributive or equity-promoting outcomes (Saltman 2004: 5–6).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Banting, Keith G. and Stan Corbett. 2002. “Health Policy and Federalism: An Introduction.” In Health Policy and Federalism: A Comparative Perspective on Multi-Level Governance. Ed. Keith G. Banting and Stan Corbett. Kingston, ON: Queen’s University Institute of Intergovernmental Relations. 1–38.
Béland, Daniel and André Lecours. 2005a. “Nationalism, Public Policy, and Institutional Development: Social Security in Belgium.” Journal of Public Policy 25 (2): 265–85.
Béland, Daniel and André Lecours. 2005b. “The Politics of Territorial Solidarity: Nationalism and Social Policy Reform in Canada, the United Kingdom, and Belgium.” Comparative Political Studies 38 (6): 676–703.
Busse, Reinhard. 2001. “Expenditure on Health Care in the EU: Making Projections for the Future Based on the Past.” Health Economics in Prevention and Care 2 (4): 158–61.
Corens, Dick. 2007. “Belgium: Health System Review.” Health Systems in Transition 9(2): 1–172.
de Cock, Johan. 2002. “Federalism and the Belgian Health Care System.” In Health Policy and Federalism: A Comparative Perspective on Multi-Level Governance. Ed. Keith G. Banting and Stan Corbett. Kingston, ON: Queen’s University Institute of Intergovernmental Relations. 39–68.
De Rynck, Stefan and Rudolf Maes. 1995/1996. “Belgium: Regions, Communities and Subregional Authorities in the European Integration Process.” In Regions in Europe, I. Ed. Joachim Jens Hesse. Baden-Baden: Nomos Verlaggesselschaft. 101–127.
Deschouwer, Kris. 1991. “Small Parties in a Small Country: The Belgian Case.” In Small Parties inWestern Europe: Comparative and National Perspectives. Ed. FerdinandMüller-Rommel and Geoffrey Pridham. London: Sage, 135–51.
European Observatory on Health Care Systems. 2000. “Belgium.” Health Care Systems in Transition Report 1–93.
Falter, Rolf. 1998. “Belgium’s Peculiar Way to Federalism.” In Nationalism and Belgium: Shifting Identities 1780–1995. Ed. Kas Deprez and Louis Vos. New York: St. Martin’s Press, 177–97.
Federal Public Service Social Security. 2008. Everything You Have AlwaysWanted to Know about Social Security. Brussels: SPF Sécurité sociale.
Gerkens, Sophie and Sherry Merkur. 2010. “Belgium: Health System Review.” Health Systems in Transition 12 (5): 1–266.
Gijsels, Hugo and Jos Vander Velpen. 1992. Le Chagrin des Flamands: Le Vlaams Blok de 1938 à nos jours. Brussels: Editions EPO.
Hooghe, Liesbet. 1991. “A Leap in the Dark: Nationalist Conflict and Federal Reform in Belgium.” Occasional Paper 27, Ithaca: Cornell University Western Societies Program.
Immergut, Ellen M. 1992. Health Politics: Interests and Institutions in Western Europe.Cambridge: Cambridge University Press.
Ishiyama, John T. and Marijke Breuning. 1998. Ethnopolitics in the New Europe. Boulder, CO: Lynne Rienner.
Laible, Janet. 2008. Separatism and Sovereignty in the New Europe: Party Politics and the Meanings of Statehood in a Supranational Context. New York: Palgrave Macmillan.
Mudde, Cas. 2000. The Ideology of the Extreme Right. Manchester: Manchester University Press.
Parlament der Deutschsprachigen Gemeinschaft, DG in Belgium, Brussels. http:// www.dg.be/en/desktopdefault.aspx/tabid-2837/5390_read-35163/ Accessed on22 December 2010.
Portail Belgium.be, Informations et services officiels. http://www.belgium.be/fr/la_belgique/pouvoirs_publics/regions/competences/ and http://www.belgium.be/fr/la_belgique/pouvoirs_publics/communautes/competences/ Accessed on 22 December2010.
Portal Wallonia, Action social et santé, Santé http://www.wallonie.be/en/themes/action-sociale-et-sante/sante/index.html Accessed on 24 December 2010.
Saltman, Richard. 2004. “Social health insurance in perspective: the challenge of sustaining stability.” In Social health insurance systems in Western Europe. Ed. Richard B. Saltman, Reinhard Busse and Josep Figueras. Berkshire, UK: Open UniversityPress, 3–20.
Schokkaert, Erik and Carine Van de Voorde. 2003. “Belgium: Risk Adjustment and Financial Responsibility in a Decentralized System.” Health Policy 65: 5–19.
Schokkaert, Erik and Carine Van de Voorde. 2005. “Health Care Reform in Belgium.”Health Economics 14: S25–S39.
Schokkaert, Erik and Carine Van de Voorde. 2010. “Belgium’s Health Care System: Should the Communities/Regions take it Over? Or the Sickness Funds?” Paper presented at the Fourth Public Event of the Re-Bel Initiative. 16 December, Brussels.
Schokkaert, Erik, Tom Van Ourti, Diana De Graeve, Ann Lecluyse and Carine Van de Voorde. 2010. “Supplemental Health Insurance and Equality of Access in Belgium.” Health Economics 19: 377–95.
van Doorslaer, Eddy K.A. and Frederik T. Schut. 2000. “Belgium and the Netherlands Revisited.” Journal of Health Politics, Policy and Law 25 (5): 875–87.
Van Oyen, Herman, Jean Tafforeau and Marc Roelands. 1996. “Regional Inequities in Health Expectancy in Belgium.” Social Science & Medicine 43 (11): 1673–78.
Velaers, Jan. 1996. “La Réforme de l’Etat.” In Un parti dans l’histoire 1945–1995: 50 ans d’action du Parti Social Chrétien. Ed. Charles-Ferdinand Northomb and Frank Swaelen. Louvain-la-Neuve: Duculot. 107–54.
Editor information
Editors and Affiliations
Copyright information
© 2013 Janet Laible
About this chapter
Cite this chapter
Laible, J. (2013). Devolution, Nationalism, and the Limits of Social Solidarity: The Federalization of Health Policy in Belgium. In: Costa-Font, J., Greer, S.L. (eds) Federalism and Decentralization in European Health and Social Care. Palgrave Macmillan, London. https://doi.org/10.1057/9781137291875_11
Download citation
DOI: https://doi.org/10.1057/9781137291875_11
Publisher Name: Palgrave Macmillan, London
Print ISBN: 978-1-349-33040-9
Online ISBN: 978-1-137-29187-5
eBook Packages: Palgrave Political & Intern. Studies CollectionPolitical Science and International Studies (R0)