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Chapter 1 | The impact of the crisis on the health system and health in Belgium
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by 2012 had reached a GDP level of barely 0.1% above the level of mid-2008
(Eurostat, 2013a). Total government revenues increased between 2008 and
2012, from 48.7% of GDP to 51.0% of GDP. At the same time, the level
of expenditure increased markedly from 45.9% in 2008 to 51.6% in 2012,
leading to an increasing government deficit.
The average increase in government expenditure was 2.6% from 2002 to 2014:
1.3 percentage points higher than GDP growth. Social security expenditure
started to increase at a more rapid rate from 2009 onwards. Almost one-third
of social security expenditure consists of pensions. The real increase in pensions
accounted for 3.4% in 2012. Sickness and disability insurance benefits also
increased because of the broadening of welfare measures. 1 This growth in social
security expenditure was tempered by the moderate or even decreasing trend in
other types of social security expenditure. For example, annual average health
care expenditure per capita (which represents almost one-third of the total
social security budget) grew by only 0.6% in real terms between 2009 and
2011, much less than in previous years (the annual average growth rate between
2000 and 2009 was 3.7%) (Eurostat, 2013a; OECD, 2013c). Measures that
contributed to this tempering of health care expenditure included savings on
physician fees and drug reimbursement measures (see section 3.3).
While the government's deficit as a percentage of GDP or gross debt had
been decreasing since 2000, it started to increase again in 2007 (when it was
84% of GDP) and in 2012 stood at approximately 100% of GDP (Eurostat,
2013c) (Table 1.1). The increase of the debt ratio was the result of the
country's worsening economic prospects, the capital injections the government
administered to ailing financial institutions and also from exogenous factors
such as the European Union's (EU) financial measures to support Greece,
Ireland and Portugal. In terms of the Belgian Government's sovereign credit
worthiness and borrowing capacity, the average 10-year government bond rate
generally remained solid, despite some fluctuations, throughout the previous
decade, even with the impact of the economic crisis. The average 10-year
government bond rate decreased between 2000 and 2005 to reach its lowest
level before the crisis in 2005, at 3.4%. The situation worsened afterwards and
interest rates started to increase until 2008, reaching 4.5%. However, between
2008 and 2010 trust was regained, particularly after the formation of the new
federal government and its budgetary agreements, and this was reflected in a
decline in the interest rate. In 2012, Belgian bond rates approximated those of
the strongest European countries, at 3% (Eurostat, 2013b).
1 For example, the eligibility period for receiving the invalidity pension after the pensionable age was equalized between
men and women, and greater numbers of people with psychiatric disorders and locomotor or connective tissue diseases
became eligible for invalidity benefits.